Amegakaryocytic Thrombocytopenia and Triple Vessel Disease: A Case of Critical Diagnostic and Therapeutic Integration

Abstract

Amegakaryocytic thrombocytopenia is a rare hematologic disorder characterized by a profound reduction in platelet production due to the near absence of megakaryocytes, leading to severe thrombocytopenia. This case report elucidates the diagnostic and therapeutic challenges encountered in managing such rare hematological conditions alongside significant cardiovascular disease. We detail the case of a patient who presented with chest pain and was diagnosed with non-ST elevation myocardial infarction (NSTEMI). Subsequent investigations revealed severe thrombocytopenia and underlying triple vessel disease, complicating immediate surgical intervention. Initial management strategies aimed at treating presumed immune thrombocytopenia proved ineffective. A definitive diagnosis of amegakaryocytic thrombocytopenia was established following a bone marrow biopsy. Despite treatment adjustments, including the administration of thrombopoietin agonists and immunosuppression, platelet counts improved but did not reach levels safe for coronary artery bypass grafting (CABG). This case underscores the critical importance of achieving adequate hematologic stability prior to surgical procedures in patients with complex cardio-hematologic profiles to minimize perioperative risks and optimize patient outcomes, illustrating the ongoing challenges in managing severe thrombocytopenia in cardiac patients.