Juvenile cyclic amegakaryocytic thrombocytopenia: a novel entity

Cyclic thrombocytopenia is a rare disorder described in adults, characterized by periodic platelet count fluctuations of unknown etiology. The authors describe a boy with cyclic changes in platelet counts ranging from 2 x 10(9)/L to 224 x 10(9)/L with a periodicity of 25 days. Since birth, the patient had periods of bruising. Platelet counts were periodically low during these periods. Thrombopoietin plasma levels oscillated inversely with the platelet count, whereas glycocalicin levels oscillated in phase with the platelets. No oscillation was seen in neutrophil and reticulocyte numbers. The bone marrow showed periodic reduction in megakaryocyte counts. In an in vitro megakaryocytopoiesis assay, the patient's CD34+ cells showed megakaryocyte formation, although to a lower level than controls. Addition of patient plasma, collected during the rise in platelet numbers, to cultures with normal bone marrow-derived CD34+ cells caused an increase in the development of CD41+ megakaryoblasts. Because the periods with bruising had existed since birth, apparently this is a form of congenital cyclic thrombocytopenia. The underlying mechanism of the cyclic thrombocytopenia in this patient is not yet clear, and until now, no therapy has been found for this patient. However, platelet transfusions have resulted in cessation of bleeding during thrombocytopenic periods.