Thrombopoietin level in young patients is related to megakaryocyte frequency and platelet-count

Purpose: To examine the relationships among platelet counts, bone marrow megakaryocyte frequency. and circulating throm bopoietin (TPO) levels. Patients and Methods: TPO levels in 17 children and one young adult with chronic or recurrent thrombocytopenia were measured by ELISA and megakaryocyte frequency was analyzed by light microscopy. Three groups of patients were studied: Group I patients had aplastic anemia and absent or decreased magakaryocytes; Group II patients had intermittent periods of chemotherapy-induced thrombocytopenia: and Group III patients had normal or increased megakaryocytes. Controls consisted of 77 healthy adults. Results: Patients in Group I had markedly increased TPO levels compared to normal controls. Their levels were significantly different (p = 0.03) from those of patients in Group III. The latter had normal or only mildly increased TPO levels except for one patient with myelodysplastic syndrome. Patients in Group II had markedly elevated TPO levels. After their bone marrow and platelet counts recovered from chemotherapy, their TPO levels decreased. In all three groups, a transient increase in platelet count (e.g., after platelet transfusion or anti-D immune globulin therapy) was associated with a moderate decrease in TPO. Conclusions: From this study, three conclusions can be made: 1) TPO levels are inversely related to megakaryocyte frequency; 2) platelet counts have a modest influence on TPO level: and 3) TPO levels may have clinical utility in diagnosis and management and further our understanding of the pathobiology of the disorders that cause thrombocytopenia.