In vitro megakaryocyte colony formation was studied in 25 patients with chronic idiopathic thrombocytopenic purpura (ITP), and compared to 16 controls. A significantly lower number of megakaryocyte progenitors (CFU-MK) was observed in patients (10.8 +/- 12.0 CFU-MK per 10(5) bone-marrow non-adherent mononuclear cells (NAMC), compared to controls (22.5 +/- 15.4 CFU-MK); P < 0.002. Only six patients had a normal number of CFU-MK. The number of CFU-MK was not correlated to initial platelet count (P = 0.35). These findings indicate that in vitro CFU-MK could be of interest in the diagnosis of chronic ITP, and also could be predictive for chronicity in patients with acute ITP.