(A: bone marrow aspiration

(A: bone marrow aspiration. if the patient was not on any therapy designed to increase the platelet count, her platelet level was back to normal. Follow up to December, 2012; her platelet count continued to fluctuation, 20109/L-40109/L in the middle of menstrual cycle while 105109/L-197109/L at the menses. strong class=”kwd-title” Keywords: Cyclic thrombocytopenia, menstrual cycle, antinuclear antibody Introduction Cyclic thrombocytopenia (CTP) is a rare disease characterized by periodic fluctuations in platelet counts [1]. In women, this phenomenon often occurs in synchrony with menstrual cycle [2-6]. With similar clinical (-)-p-Bromotetramisole Oxalate features to idiopathic thrombocytopenia (ITP), CTP is usually first diagnosed and treated as ITP with lack of response [2,7,8]. We recently encountered a CTP patient related to menstruation with multiple autoantibodies. We indicated that the platelet fluctuation, which correlated with her menstrual cycles and mediated by autoantibodies, might be vital to the pathogenesis of such condition. Case report A 40-year-old married female patient, delivered a boy eight years (-)-p-Bromotetramisole Oxalate ago by normal labor, first presented with a 40-day history of appearance Rabbit polyclonal to PDE3A of purpuric skin rash and bruising, on June 30, 2012. She was readmitted to our hospital on Aug 14, 2012, when she noted bruise on her lips. The platelet count was 24109/L on June 30, 32109/L on Aug 14, while it was 161109/L on July 1, 110109/L on Aug 16. Her physical examination showed skin purpuric spots and bruise over the limbs and truck, but there was no evidence of blood loss from any other site. Liver, spleen, lymph nodes were not enlarged. Antinuclear antibody test and rheumatoid factor (RF) were positive. Quantitative immunoglobin determinations showed elevated IgG levels (17 g/L). Results of repeated examinations of immune complex levels, serum complements C3, C4, Hp antibody and thrombopoietin (TPO) test were all within normal ranges. Bone marrow aspiration and biopsy shown there was no change observed in megakaryocyte number and fluorescence-activated cell sorter (FACS) performed normal (Figure 1). JAK2-V617F gene mutational testing was negative and platelet-associated antibodies were not detected. We initially observed the patient over two complete cycles, and then continued measuring her blood counts for six months (Figure 2). During the entire process, her menstrual was regular without heavy blood loss and prolonged period. The patient was not on any therapy designed to increase the platelet count, however, her platelet level was back to normal line on the next two days, and her hemoglobin and white cell counts remained normal without cyclic change. Reports of follow-up till December 2012 showed that her platelet count continued to fluctuate, and it was 20109/L-40109/L in the middle of two menstrual cycles, while it was 105109/L-197109/L in menses. Open in a separate window Figure 1 Bone marrow aspiration and biopsy shown there was no change observed in megakaryocyte number. (A: bone marrow aspiration. B: bone marrow biopsy. A1, B1: 100x. B2: 400x. A2: 1000x). Open in a separate window Figure 2 The relationship (-)-p-Bromotetramisole Oxalate between platelet, white blood cell counts and hemoglobin levels over a 120-day period. Platelet counts periodic fluctuated in synchrony with menstrual cycle, but the hemoglobin levels and white blood cell counts remain normal without cyclic changes. Discussion CTP is rarely seen, most cases of CTP seem to be idiopathic, while some (-)-p-Bromotetramisole Oxalate are secondary to myelodysplastic, lymphoproliferative diseases and rheumatology. Although the cause of CTP remains unclear, there are several mechanisms documented for the pathogenesis of CTP [2-4,8-12], including autoimmune platelet destruction, megakaryocytic hypoplasia, and hormonal factors. Typically, the highest platelet levels occur between two menstrual cycles, rather than at the time of menstruation [11,13], although in some females the pattern is opposite [5,11]. In our case, the platelet counts fell at the middle cycle of menses and peaked at the menses. Serum TPO test was normal. There was no change of megakaryocyte numbers in bone marrow specimen. JAK2-V617F mutation and platelet-associated antibodies were not detectable. There was no significant.