Periodic Thrombocytopenia or Tidal Platelet Dysgenesis in a Man

Abstract

The authors describe the haematologic findings in a man aged 61, who for two years has been under observation with a syndrome of thrombocytopenia, regularly alternating with thrombocytosis of a very regular interval of 39 days. This tidal fluctuation of the platelet counts was within the range 10,000–900,000/μl. There was a synchronous fluctuation of the megakaryocyte numbers in the bone marrow, megakaryocytes being virtually absent in periods of thrombocytopenia. The present condition is by this fact distinct from cyclic thrombotytopenia synchronous with the menstrual cycle in women, in which megakaryocytes are usually plentiful. This case it to all appearences the third one described in the literature of a condition which we would like to label ad interim tidal platelet dysgenesis.

Oscillating platelet counts in healthy individuals: Experimental investigation and quantitative evaluation of thrombocytopoietic feedback control

“…The autocovariance analysis yielded periods of approx. 28 d which compare well with earlier results obtained in healthy cases (1) and in patients with cyclic thrombocytopenia (9)(10)(11)(12)(13)(14)(15)(16). In our cases, the association between platelet fluctuation and menstrual cycle in women was at best tentative.…”

“…25 d (assuming that T , and T, stay in the ranges quoted). This is corroborated by what is known about patients with cyclic thrombocytopenia who were reported to show oscillations with periods of 21-39 d (9)(10)(11)(12)(13)(14)(15)(16).…”

“…Oscillatory fluctuations have also been observed in cyclic neutropenia ( 5 , 6), chronic myelogenous leukaemia (7,8), and cyclic thrombocytopenia Many mathematical models of feedback systems have been proposed to clarify haematopoietic control and/or to explain the oscillations observed (4, [17][18][19]. Most of these theoretic models are so complex that anlysis, presentation (9)(10)(11)(12)(13)(14)(15)(16).…”

Understanding cyclical thrombocytopenia: A mathematical modeling approach

“…Since the general features of cyclical thrombocytopenia and immune thrombocytopenia purpura are very similar, many of the CT patients were misdiagnosed as ITP. Consequently, they received the typical ITP treatment like corticosteroids ( (14), (15), (17), (29), (88), (95), (96)), in-travenous globulin ((4), (47), (56), (70), (93), (100)), plasma infusions (15), colchicine ((70), (81), (86)), and were subjected to splenectomy unnecessarily ((3), (4), (21), (46), (56), (58), (70), (81), (82), (86), (88), (93), (94), (96)). Despite their limitations, the case reports published in the literature suggest that traditional treatment appropriate for ITP does not have a benefic effect in CT cases (39).…”

Cyclic Thrombocytopenia of Acute Type

“…Cyclic thrombocytopenia with a regular period seems to be very rare. A case of periodic thrombocytopenia was recently described in this journal by Engstrom et al (1966), who found that literature contained reports on only two similar cases in males (Demmer 1920, Bernhard & Caen 1962. A short report on the present case might accordingly be of some interest.…”