What is the role of bone marrow aspiration and biopsy in the diagnosis of immune thrombocytopenia (ITP)?

Updated: Jan 11, 2020
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Aspects of bone marrow aspiration and biopsy are as follows:

  • The value of bone marrow evaluation for a diagnosis of ITP is unresolved [4]

  • Biopsy in patients with ITP shows a normal-to-increased number of megakaryocytes in the absence of other significant abnormalities

  • In children, bone marrow examination is not required except in patients with atypical hematologic findings, such as immature cells on the peripheral smear or persistent neutropenia. [5]

  • In adults older than 60 years, biopsy is used to exclude myelodysplastic syndrome or leukemia

  • In adults whose treatment includes corticosteroids, a baseline pretreatment biopsy may prove useful for future reference, as corticosteroids can change marrow morphology

  • Biopsy is performed before splenectomy to evaluate for possible hypoplasia or fibrosis

  • Unresponsiveness to standard treatment after 6 months is an indication for bone marrow aspiration

See Workup for more detail.

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