RESUMEN
Cyclic thrombocytopenia (CTP) is a rare hemorrhagic disorder characterized by cutaneous and mucosal bleeding and periodic fluctuations platelet count. The clinical characteristics and treatment response of a patient with CTP were analyzed. The patient is a 30-year-old male with recurrent cutaneous and mucosal bleeding for 5 years. Skin petechiae, oral blood blister, conjunctival hemorrhage, by tracing the history, monitoring changes in blood routine diagnosis of CTP, further testing of reticulocyte platelets and platelet hormone, and periodically promoting bone marrow megakaryocyte with changes of platelet, confirmed that the patient's periodic reduction in bone marrow hematopoiesis, was causing more damage. Periodic changes of reticulocyte, erythropoietin and erythroid hematopoiesis in bone marrow were also observed. The patient had normal Treg levels, no significant telomere length shortening in peripheral blood nucleated cells, and no clear pathogenic gene mutation was found by whole exon gene sequencing. Recombinant human thrombopoietin(rhTPO) treatment shortened the time of thrombocytopenia and increased the minimum platelet value. The average age of onset of CTP was 35 years old, some patients had severe bleeding, and more than half of the patients were misdiagnosed as primary immune thrombocytopenia. At present, the pathogenesis of CTP has not been clarified and there is no effective treatment. The experience of this patient suggests that rhTPO may be effective. This case of CTP complicated with periodic anemia is the first report. The exploration of its pathogenesis provides important information for understanding CTP.
RESUMEN
ABSTRACT: The occurrence of diseases transmitted by ticks in dogs is very frequent in Brazil, among these diseases we can highlight the ehrlichiosis and anaplasmosis, which are caused by Ehrlichia canis and Anaplasma platys, respectively. The objective of this study was to survey the occurrence of these pathogens in blood samples from domiciled and stray dogs from the city of Belém, Pará. Two hundred and seventy six dogs were sampled for convenience, and the DNA extracted from the blood of these animals was submitted to nested-PCR for research of E. canis and A. platys. E. canis DNA was detected in 39.4% (109/276) and A. platys DNA in 23.1% (64/276) of the samples, there was a statistically significant difference between the frequency of these agents (P<0.0001), and there was coinfection in 13.4% (37/276) of animals. The frequency of detection of these parasites was higher in stray dogs than in those domiciled for both E. canis (OR=2.84) and A. platys (OR=10.5). Considering the results, it was possible to conclude that E. canis and A. platys are present in the studied population, with stray dogs being more affected by these parasites.
RESUMO: A ocorrência de doenças transmitidas por carrapatos em cães é muito frequente no Brasil, dentre estas enfermidades podemos destacar a erliquiose e a anaplasmose, que são causadas por Ehrlichia canis e Anaplasma platys, respectivamente. O objetivo deste trabalho foi fazer um levantamento da ocorrência destes patógenos em amostras de sangue de cães domiciliados e errantes do município de Belém, Pará. Foram amostrados 276 cães por conveniência, sendo que o DNA extraído do sangue desses animais foi submetido à nested-PCR para a pesquisa de E. canis e A. platys. O DNA de E. canis foi detectado em 39,4% (109/276), e o DNA de A. platys em 23,1% (64/276) dos cães amostrados. Houve diferença estatisticamente significante entre a frequência desses agentes (p<0,0001), pois foi encontrada coinfecção entre os agentes em 13,4% (37/276) dos animais. A frequência de detecção desses parasitos foi maior em cães errantes do que nos domiciliados tanto para E. canis (OR=2,84) quanto para A. platys (OR=10,5). Diante dos resultados, foi possível concluir que E. canis e A. platys estão presentes na população canina estudada, sendo os cães errantes mais acometidos por esses parasitos.
RESUMEN
Cyclic thrombocytopenia is a rare disorder with cyclic change of the platelet counts. Although the pathogenesis of the disorder has not been clarified, recent reports suggest that periodic destruction and/or ineffective production of platelets may be important causes of the disease. We report a 24-year-old female with the episodes of severe thrombocytopenia (minimum platelet count 2x109/L) followed by normal or higher platelet counts (maximum platelet count 877x109/L). The period of platelet count fluctuation was about 20-40 days. Morphological examination of bone marrow showed the cyclic disappearance of mature and immature megakaryocytes. These findings indicate that the cause of platelet fluctuation is periodic failure of megakaryocytopoiesis.