Abstract
The patient was a 70-year-old man undergoing medical treatment in our hospital hematology department for cyclic thrombocytopenia whose platelet count had hovered between 5?30×10４/μl for about 1 month. Because he was found to have black stools during the same period as the thrombocytopenia in 2008, he underwent upper and lower gastrointestinal endoscopy, but the source of bleeding could not be identified. Capsule endoscopy showed findings suspicious of ulcer or erosion with bleeding, and drug-related damage to the small intestinal mucosa caused by aspirin was suspected. Administration of irsogladine maleate 4 mg/day and rebamipide 300 mg/day was begun, and then by changing to a low-residue diet to match the cyclic phase of the thrombocytopenia of about once per month, no progression of the anemia was seen for about 1 year. However, since he was admitted to our hospital immediately after he experienced a large amount of bloody bowel discharge, administration of packed red blood cell preparation and platelet concentrates was required, and in consultation with the Department of Cardiology, we stopped the aspirin and continued to administer only sarpogrelate hydrochloride. There has been no further progression of the anemia. Cyclic thrombocytopenia is a very rare disease, and a curative treatment is unclear. Therefore, it was difficult to respond to gastrointestinal bleeding associated with drug-related damage of the small intestinal mucosa.
