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Vol. 43. Issue 4.
Pages 539-540 (October - December 2021)
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Vol. 43. Issue 4.
Pages 539-540 (October - December 2021)
Images in Clinical Hematology
Open Access
Hungry megakaryocytes on the hunt? An unusual case of extensive megakaryocyte emperipolesis
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S. Vijaya Devia, Richa Guptab,
Corresponding author
richagupta0209@gmail.com

Corresponding author at: Room 427, Department of Pathology, University college of Medical Sciences, Dilshad Garden, Delhi 110095, India.
a Maulana Azad Medical College, New Delhi, India
b University College of Medical Sciences, Delhi, India
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An 11-year-old female presented with fever and thrombocytopenia (Platelet count - 25 × 109/L). Bone marrow smears revealed hyperplasia and emperipolesis in all megakaryocytes containing intact lymphocytes and neutrophils. (Figs. 1 and 2) No etiology was found. The patient was given intravenous immunoglobulin and steroids on presumption of Immune thrombocytopenia, to which she responded well (Platelet count after 4 months -108 × 109/L).

Figure 1.

Bone marrow aspirate showing megakaryocytic hyperplasia with extensive emperipolesis; Geimsa stain, 400×.

(0.21MB).
Figure 2.

Bone marrow aspirate showing a megakaryocyte with engulfed neutrophils and lymphocytes; Geimsa stain, 1000×.

(0.13MB).

Some emperipolesis may be seen in various disorders, including Immune thrombocytopenia.1,2 Aslan D postulated that, in ITP, emperipolesis contributes to megakaryocyte dysfunction and poor response to therapy.3 This is an unusual case where all megakaryocytes show extreme degree of emperipolesis, yet the patient responded well.

Conflicts of interest

The author declares no conflicts of interest.

References
[1]
A.W. Cashell, D.H. Buss.
Frequency and significance of megakaryocytic emperipolesis in myeloproliferative and reactive states.
Ann Hematol, 64 (1992), pp. 273-276
[2]
S. Rai, M. Sharma, M. Muhary, R. Naik, R. Sinha.
Increased emperipolesis in megakaryocytes in a case of idiopathic thrombocytopenic purpura.
Indian J Pathol Microbiol, 52 (2015), pp. 4523
[3]
D. Aslan.
Emperipolesis in immune thrombocytopenic purpura.
Indian J Pathol Microbiol, 52 (2009), pp. 289-290
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Hematology, Transfusion and Cell Therapy

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