title: Clonal T cell-mediated cyclic thrombocytopenia.
abstract: Cyclic thrombocytopenia is a rare disorder characterized by periodic platelet count fluctuations of unknown aetiology. We report on a female patient with cyclic changes of platelet counts ranging from 6 x 10(9)/l to 753 x 10(9)/l in 4-week intervals. Platelet counts were inversely correlated to thrombopoietin levels suggesting production failure. Reticulocyte counts and neutrophil counts showed similar, but less prominent, fluctuations. Clonal T-cell receptor rearrangement was detected in bone marrow samples as well as in peripheral blood. Cell typing of blood lymphocytes revealed a relative increase in CD3+ T cells. Treatment with cyclosporine A resulted in a substantial improvement of platelet counts. Taken together, we provide evidence for clonal T-cell mediated bone marrow failure with cyclic impairment of thrombopoiesis responsive to cyclosporine therapy.
authors.affiliation: Department of Internal Medicine I, Division of Haematology & Haemostaseology, The University of Vienna, Austria. vofuer@netway.at
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Füreder
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Mitterbauer
authors.forename: Renate
authors.initials: R
authors.lastname: Thalhammer
authors.forename: Klaus
authors.initials: K
authors.lastname: Geissler
authors.forename: Simon
authors.initials: S
authors.lastname: Panzer
authors.forename: Michael
authors.initials: M
authors.lastname: Krebs
authors.forename: Ingrig
authors.initials: I
authors.lastname: Simonitsch-Klupp
authors.forename: Wolfgang R
authors.initials: WR
authors.lastname: Sperr
authors.forename: Klaus
authors.initials: K
authors.lastname: Lechner
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kyrle
mesh_terms: D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D015329:Gene Rearrangement, T-Lymphocyte; D006801:Humans; D016130:Immunophenotyping; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007958:Leukocyte Count; D008875:Middle Aged; D010507:Periodicity; D010976:Platelet Count; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D013921:Thrombocytopenia / Q000097:blood / Q000188:drug therapy / Q000276:immunology*; D013926:Thrombopoietin / Q000097:blood
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D013926:Thrombopoietin