{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T11:28:56Z","timestamp":1785583736572,"version":"3.56.0"},"reference-count":13,"publisher":"Department of Medicine, Warren Alpert Medical School at Brown University","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Cyclic thrombocytopenia (CTP) is a rare hematologic disorder characterized by fluctuating platelet counts and is often misdiagnosed as immune thrombocytopenia. We present the case of a 51-year-old woman with a history of severe thrombocytopenia and mucocutane-ous bleeding since 2012, initially treated as immune thrombocytopenia with corticoster-oids, splenectomy, and azathioprine, without sustained response. Over time, she devel-oped pronounced cyclic fluctuations in platelet counts (&lt;10,000\/mm\u00b3 to &gt;150,000\/mm\u00b3) every 21 days. Treatment with eltrombopag resulted in deep venous thrombosis and a major pulmonary bleeding episode associated with anticoagulation. After secondary causes and bone marrow disorders were excluded, cyclic thrombocytopenia was diag-nosed. Rituximab (375 mg\/m\u00b2 weekly for four weeks) led to a significant reduction in platelet oscillations, with no further significant bleeding. This case highlights the diagnos-tic challenges of CTP, underscores the thrombotic risks of thrombopoietin receptor agonists, and supports rituximab as a potential treatment for refractory cases with high thrombo-hemorrhagic risk.<\/jats:p>","DOI":"10.56305\/001c.162033","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:43:17Z","timestamp":1782909797000},"source":"Crossref","is-referenced-by-count":1,"title":["Cyclic Thrombocytopenia Complicated by Thrombosis and Successfully Treated With Rituximab: A Diagnostic and Therapeutic Challenge"],"prefix":"10.56305","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9139-2414","authenticated-orcid":true,"given":"Jandir Mendon\u00e7a","family":"Nicacio","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00devjr72","id-type":"ROR","asserted-by":"publisher"}],"name":"Federal University of S\u00e3o Francisco Valley","department":["Department of Medicine"]},{"name":"Hematology Service, University Hospital, Federal University of Vale do S\u00e3o Francisco (HU-UNIVASF\/EBSERH)","department":["Division of Hematology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7240-3851","authenticated-orcid":false,"given":"Lucyo Fl\u00e1vio Bezerra","family":"Diniz","sequence":"additional","affiliation":[{"name":"Hematology Service, University Hospital, Federal University of Vale do S\u00e3o Francisco (HU-UNIVASF\/EBSERH)","department":["Division of Hematology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5848-4883","authenticated-orcid":false,"given":"Andre Luis Magalh\u00e3es","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Hematology Service, Hospital Regional Juazeiro","department":["Division of Hematology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"35509","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"issue":"1","key":"ref1","doi-asserted-by":"publisher","first-page":"2240140","DOI":"10.1080\/16078454.2023.2240140","article-title":"Cyclic thrombocytopenia associated with estradiol: a case report","volume":"28","author":"N. Pang","year":"2023","journal-title":"Hematology (Amsterdam, Netherlands)"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"103581","DOI":"10.1016\/j.critrevonc.2022.103581","article-title":"Risk of thrombosis with thrombopoietin receptor agonists for ITP patients: A systematic review and meta-analysis","volume":"171","author":"M. Tjepkema","year":"2022","journal-title":"Critical reviews in oncology\/hematology"},{"issue":"2","key":"ref3","doi-asserted-by":"publisher","first-page":"62","DOI":"10.14740\/jh964","article-title":"Cyclical Thrombocytopenia Synchronized With the Patient's Menstrual Cycle Treated With Danazol","volume":"11","author":"S. R. Menakuru","year":"2022","journal-title":"Journal of hematology"},{"issue":"3","key":"ref4","doi-asserted-by":"publisher","first-page":"01","DOI":"10.36106\/ijsr\/1500374","article-title":"Cyclical thrombocytopenia: A diagnostic dilemma","volume":"14","author":"B. 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