Cyclic thrombocytopenia related to menstrual cycle: a case report and literature review

Cyclic thrombocytopenia (CTP) is rarely seen and characterized by periodic fluctuations in platelet counts. In some cases, it occurs in phase with menstrual cycle. A 40-year-old female, presented firstly on June 30, 2012, with a 40-day history of appearance of purpuric skin rash and bruising, was readmitted on Aug 14, when she noted bruise on her lips. The platelet count was 24×10(9)/L on June 30, 32×10(9)/L on Aug 14, while it was 161×10(9)/L on July 1, 110×10(9)/L on Aug 16. Physical examination show skin purpuric spots and bruise over the limbs and truck. Liver, spleen, lymph nodes were not enlarged. Antinuclear antibody and rheumatoid factor (RF) were positive. Results of immune complex levels, serum complements, Hp antibody and Thrombopoietin (TPO) were all within normal ranges. Bone marrow aspiration and biopsy shown there was no change in megakaryocyte number. Fluorescence-activated cell sorter (FACS) performed normal. JAK2-V617F gene mutational and platelet-associated antibodies were not detected. We observed the patient over two complete cycles, and continued investigating her blood counts for six months follow up. During the entire process, her menstrual was regular without heavy blood loss and prolonged period. Her hemoglobin and white cell counts remained normal without cyclic change. Even 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, 20×10(9)/L-40×10(9)/L in the middle of menstrual cycle while 105×10(9)/L-197×10(9)/L at the menses.