Clinical utility of the CD10+/HLA-DR+ population in bone marrow mononuclear cells from adults with immune thrombocytopenia

Several patients with immune thrombocytopenia show good clinical courses without any major complications. However, severe bleeding complications, such as hemoptysis, gastrointestinal bleeding, and intracranial hemorrhages, are occasionally observed in some patients associated with marked thrombocytopenia; this results in 1.5-fold higher mortality for such patients compared with the general population. We report here the cases of two patients with immune thrombocytopenia whose bone marrow included a prominent cluster of differentiation (CD)10+/ human leukocyte antigen (HLA)-DR+ population and showed good response to steroid therapy. Conversely, two other patients without a CD10+/HLA-DR+ population were refractory to steroids, and one of them had a serious course. Retrospective examination of 30 patients with severe immune thrombocytopenia revealed that they had a higher percentage of CD10+/HLA-DR+ cells compared with patients with other benign hematological diseases. As differential diagnosis of immune thrombocytopenia and aplastic anemia with severe thrombocytopenia is often difficult, it may be helpful to understand whether CD10+/HLA-DR+ cells are increased. We also show the possible correlation of resistance to steroid therapy and lower percentages of CD10+/HLA-DR+ cells. It has been reported that nonresponsiveness to steroid treatment was a high risk factor for intracranial hemorrhage. Lower percentages of CD10+/HLA-DR+ cells may be a useful tool to identify patients with immune thrombocytopenia at a high risk of serious bleeding complications.