Astha Srivastava/LinkedIn
Sep 20, 2026, 16:19
Astha Srivastava: The Missing Megakaryocytes in Amegakaryocytic Thrombocytopenia
Astha Srivastava, Senior Resident at Fortis Healthcare, shared a post on LinkedIn:
”’Missing megakaryocytes’
Amegakaryocytic thrombocytopenia (AMT) is rare, and acquired AMT is often mistaken for ITP. That delays the diagnosis
Presented a poster at the 35th annual conference DSH , ‘The Missing Megakaryocyte,’ on three cases with the same empty megakaryocyte compartment underlying 2 etiologies:
- Case 1: A 48-year-old woman with severe thrombocytopenia, normocellular bmb, near-absent megakaryocytes, a positive ANA (1:320) and a negative myeloid NGS panel. This points to immune-mediated suppression.
- Case 2: An 18-year-old man diagnosed as ITP with 2 years of steroid-, TPO agonist- and cyclosporine-refractory thrombocytopenia. Marrow showed 15-17% blasts and no megakaryocytes with significant bilineage dysplasia in aspirate diagnostic of MDS-IB2.
- Case 3: A 51-year-old man labelled AMT elsewhere , on treatment with steroids and tpo agonist . On progression, the marrow showed hypoplastic MDS with ASXL1, BCOR and IKZF1 variants.
What we took away:
- Refractory thrombocytopenia deserves a careful look at the marrow, not just another round of ITP therapy.
- Work up autoimmunity and clonality together.
- A negative NGS panel doesn’t exclude a clone. Small subclones can sit below detection limits, and mutations can appear months before overt MDS.
- Repeat molecular testing when the clinical picture doesn’t fit.”
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