Cyclic thrombocytopenia associated with menorrhagia

Abstract

We studied a 17-year-old female P0 + 0 who presented with menorrhagia and cyclic thrombocytopenia (CTP). Cyclic changes were observed in platelet count in phase with menstruation with a nadir of 4–30 × 109/L and a rise of above 600 × 109/L noted over the 4 months period of the observation. Thrombocytopenia was associated with menorrhagia, gum bleeding and epistaxis, followed about 14 days later by normal or elevated platelet counts. Presenting packed cell volume (PCV), platelet count, and white blood cell (WBC) count were, 0.25 L/L, 4 × 109/L, and 6.8 × 109/L respectively, WBC and PCV all remain stable all through the period of study; antinuclear antibody, direct and indirect antiglobulin test was negative while flow cytometry for Gp IIb/IIIa and Ib were not done. Bone marrow examinations performed at the time of reduced platelet counts showed increased megakaryopoiesis. The patient was monitored and observed with only hematinics prescribed over the follow-up period, and menstrual suppression with combined oral contraceptives. CTP should always be suspected when a diagnosis of idiopathic thrombocytopenic purpura is entertained especially when there is a history of menorrhagia, thrombocytopenia, and rebound thrombocytosis.