tag:blogger.com,1999:blog-19490962.post114682006735703839..comments2023-12-10T10:06:41.979+00:00Comments on mutations of mortality: Diagnosing ITPTerry Hamblinhttp://www.blogger.com/profile/06346629921055055879noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-19490962.post-1146854956844182552006-05-05T19:49:00.000+01:002006-05-05T19:49:00.000+01:00Vanceyou are absolutely right. ITP is usually easy...Vance<BR/><BR/>you are absolutely right. ITP is usually easy to diagnose clinically, but in the context of thrombicytopenia associated with CLL, a bone marrow is often the only way of knowing whether this is ITP, CLL, MDS or even hypoplastic anemia.<BR/><BR/>I always read my own bone marrows, but many young doctors aren't interested in learning this part of our trade.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1146843295366961062006-05-05T16:34:00.000+01:002006-05-05T16:34:00.000+01:00I appreciate your comment about having a pathologi...I appreciate your comment about having a pathologist who knows how to read bone marrows (hematopathologist). It can be frustrating when you have one who primarily views solid tissue samples.<BR/><BR/>In the setting of CLL, both anemia and thrombocytopenia can be difficult to sort out, and a bone marrow exam is often the most direct approach. However, I do not routinely do bone marrow exams to diagnose ITP outside the setting of CLL. As you know, the diagnosis can often be made clinically. If the patient does not respond to simple measures, such as prednisone, then a further exam can be done.<BR/><BR/>So I was annoyed when I saw a young man, an ex-professional hockey player, who started bruising easily. He had a classic case of ITP. However, the primary doctor had ordered a peripheral smear to be reviewed by a pathologist. The pathologist, who is good with solid tumors, but not with blood, said in his report that he thought there might be lymphoblasts.<BR/><BR/>Well, there weren't, but once that label is on the chart, we have to prove it wrong. So the poor chap had to suffer through a bone marrow examination to prove that he only had what we already knew he had.<BR/><BR/>Picking the right pathologist is just as important a choice as finding the right clinicians. In the U.S., patients do not get to make this choice. The clinicians do not either, as the sample usually goes to whomever is next in rotation. Fortunately, most hematologists are adept at reviewing bone marrow samples themselves and are not completely dependent upon a pathologist.Vancehttps://www.blogger.com/profile/00420873277607900142noreply@blogger.com