Benjamin M, Kotchetkov R
Faculty of Science University of Ottawa Ottawa Ontario Canada.
Royal Victoria Regional Health Centre Barrie Ontario Canada.
Clin Case Rep. 2025 Aug 4;13(8):e70746. doi: 10.1002/ccr3.70746. eCollection 2025 Aug.
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.
周期性血小板减少症（CTP）是一种罕见的疾病，其特征是血小板周期性波动，幅度从低到高。目前，尚无标准化的治疗指南，CTP患者通常对包括皮质类固醇、脾切除术和静脉注射免疫球蛋白在内的标准免疫性血小板减少症（ITP）治疗无反应。我们报告一例慢性CTP患者，该患者对用于免疫性血小板减少症的多种疗法均无效，但在血小板计数最低点时通过支持性血小板输注使黏膜皮肤出血得到缓解。最终，该患者在应用含透明质酸的口服制剂（Oralvisc）治疗伴发的骨关节炎后血小板计数恢复正常。停用该药物后，Oralvisc对血小板计数的影响依然存在。我们建议，在血小板减少最低点时进行支持性血小板输注是有症状患者的一种有效管理选择。可应用抑制缓激肽和瘦素的抗炎药物来减轻血小板波动并改善症状。
