Cyclic Thrombocytopenia: A Rare Cause of Recurrent Thrombocytopenia

Mosunmoluwa Oyenuga,Rushin Patel,Sara Sartaj,Jyotsana Sinha,Afoma Onyechi

doi:10.7759/cureus.22525

Abstract

Cyclic thrombocytopenia (CTP) is a very rare hematological disorder that is characterized by periodic fluctuations in platelet counts. Diagnosis is generally delayed due to its similarity with immune thrombocytopenia (ITP). The pathophysiology is unknown and there are currently no guidelines for management. Many patients are usually treated for ITP initially prior to diagnosis. We describe a 67-year-old female with a history of multiple episodes of transient thrombocytopenia who presented to the hospital with another episode of thrombocytopenia. Her workup including HIV, hepatitis screening, vitamin B12, and folate was negative. She received a unit of platelet transfusion and was later observed in the hospital. Further review of her chart showed similar episodes in the past with spontaneous improvement. She was diagnosed with CTP. Her platelet count improved remarkably prior to discharge. In patients with recurrent fluctuation in their platelet count, CTP should be one of the differentials as this might prevent further unnecessary therapies.

Highlights

Cyclic thrombocytopenia (CTP) is a very rare hematological disorder in which patients have low and normal platelet counts at varying times [1]
We present a case of long-term recurrent fluctuations in platelet count and negative workup who was later diagnosed with CTP
CTP is often missed in patients who present with thrombocytopenia and have mild to no symptoms

Summary

Introduction

Cyclic thrombocytopenia (CTP) is a very rare hematological disorder in which patients have low and normal platelet counts at varying times [1]. She has a past surgical history significant for thyroid lobectomy She presented to the hospital for further management after she was found to have a low platelet count of 5 x 10^9/L (range: 153-416 x10^9/L) on her blood work during her primary care physician clinic visit. Laboratory workup at that time included hepatitis viral panel, antinuclear antibody (ANA) screening, lupus anticoagulant panel, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS 13) activity, and quantitative rheumatoid factor, which were all negative Based on her recurrent pattern of fluctuations in her platelet count with improvements sometimes without intervention, she was diagnosed with CTP. Repeat platelet check one week after showed a spontaneous increase in her platelet count to 422 x 10^9/L

Discussion

Conclusions

Disclosures