Acquired Platelet Dysfunction with Eosinophilia: A Report of 3 Cases with Review of Literature

Patients who were in good health, with no history of any drug ingestion or recent travel, presented with spontaneous widespread bruising and ecchymosismainly on the extremities. No history of severe bleeding was noted. These patients on laboratory evaluation did not show any abnormalities in basic hemostatic screen with BT (Bleeding Time), CT (Clotting time), PT (Prothrombin Time), APTT (Activated partial thromboplastin time) and platelet count. None of these patients were having parasitic infestation. Only on direct smear (without anti-coagulant) it was noticed that they have increased eosinophil count and showing abnormal platelet morphology. On Aggregation study they show reduced aggregation with all the agonist (ADP, Epinephrine, Archidonic acid, and Collagen). Normal aggregation pattern was observed with Ristocetin. These changes in platelet function and morphology may be due to acquired storage pool disorder of the platelets termed as APDE (Acquired platelet dysfunction with eosinophilia). Key word: APDE (Acquired Platelet dysfunction with eosinophilia), Eosinophil, Platelets INTRODUCTION Bleeding in the form of ecchymosis and purpura are taken into serious consideration when it occurs spontaneously, that is without any trauma. Most of the time these bleeding episodes are related in to somekind of coagulation defect in the body. But many a time, these bleeding tendencies occur in the absence of the deadly coagulation disorder. They are attributed sometimes to a functional disorder of the platelets, despite normal number of platelets in the blood. Among the many known causes of acquired form of bleeding in the skin and mucous membrane, anincreased eosinophil count is one of the established factor which causes petechiae, purpura and ecchymosis; resulting in the functional disability of the platelet in the formation of primary platelet plug. This is a transient state of platelet dysfunction which is accompanied by a marked eosinophilia known as APDE (Acquired platelet dysfunction with eosinophilia). Almost all cases have been reported from South East Asian countries because of the fertile grounds for the eosinophil count to go up in the blood.