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High-Dose Intravenous Methylprednisolone for Childhood Idiopathic Thrombocytopenic Purpura-Reply

Am J Dis Child. 1988;142(12):1273-1274. doi:10.1001/archpedi.1988.02150120027023.
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In Reply.—Thrombocytopenia may, as suggested by Dr Özsoylu, accompany megaloblastic anemia; rarely, it can precede the onset of overt anemia. To our knowledge, however, thrombocytopenia does not precede those early and more specific blood smear changes such as granulocytic hypersegmentation or erythrocytic macro-ovalocytosis, which characterize megaloblastic anemia.1 Likewise, the mean erythrocyte corpuscular volume is increased early in the course of megaloblastic anemia, as well as in various forms of marrow failure. Hence, our recommendation to include the peripheral blood smear examination and the mean corpuscular volume among those parameters on which the decision to perform a bone marrow aspiration in a suspected case of ITP is taken.

The usefulness of platelet serology in the diagnosis of ITP has recently been addressed in an editorial, the title of which leaves little doubt as to its conclusions: "Are Platelet-Antibody Tests Worthwhile?"2 We agree with Dr Özsoylu that some tests detecting platelet-associated


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