Acquired Platelet Dysfunction with Eosinophilia or Idiopathic Purpura with Grey Platelets?

Dear Editor, An acquired, transient bleeding disorder characterised by a thrombocytopathic bleeding with a platelet storage pool disorder has been reported from the Southeast Asian region and elsewhere since the 1960s.1,2 The condition has been coined acquired platelet dysfunction with eosinophilia (APDE) as cases reported earlier were also found to have eosinophilia. However, a large series of cases published in the 21st century shows that 14% of the affected children do not have eosinophilia.3 The following cases also illustrate that significant eosinophilia is not a constant feature (Table 1). Idiopathic purpura with grey platelets is proposed as a better terminology to describe the condition, so long as the aetiology remains obscure. Case 1 is a Eurasian 5-year-old male who presented with abrupt onset of generalised ecchymosis and scattered petechiae. Non-accidental injury was initially suspected and hence, he was brought to medical attention. Multiple bruises and petechiae were found in the extremities and a couple of ecchymosis were seen on the trunk. The child was otherwise well and no other abnormal signs were seen. The complete blood count was normal with mild eosinophilia (0.75 × 109/L). The peripheral blood film revealed plenty of grey platelets and the results of platelet aggregation were