Cyclic Thrombocytopenia Treated With Platelet Transfusion and Oral Preparation Containing Hyaluronic Acid (Oralvisc)

Cyclic thrombocytopenia (CTP) is a rare disorder characterized by periodic platelet fluctuation with substantial amplitude from low to high. Currently, there are no standardized guidelines on treatment, and patients with CTP generally do not respond to standard ITP treatments, including corticosteroids, splenectomy, and intravenous immunoglobulin. We present a case of chronic CTP who failed multiple therapies used for immune thrombocytopenia but had resolution of muco-cutaneous bleeding with supportive platelet transfusion at platelet nadir. Eventually, the patient had normalization of the platelet count after she applied an oral preparation containing hyaluronic acid (Oralvisc) for concomitant osteoarthritis. The effect of Oralvisc on the platelet count retained after discontinuation of the drug. We suggest that supportive platelet transfusion at the nadir of thrombocytopenia is an effective management option in symptomatic patients. Anti-inflammatory medications, suppressing bradykinin and leptin, may be applied to alleviate platelet fluctuation and improve symptoms.