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Constantinescu-Bercu A, McCann S, Hmaid A, de Groot R, Singh D, Gohil SH, Thomas M, Scully M, Westwood JP. Acquired Glanzmann's thrombasthenia with IgG and IgA against activated α IIb β 3. Br J Haematol 2023; 202:e58-e61. [PMID: 37401038 DOI: 10.1111/bjh.18966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Adela Constantinescu-Bercu
- Haemostasis Research Unit, Institute of Cardiovascular Science, University College London (UCL), London, UK
| | - Sabina McCann
- Special Coagulation, Health Services Laboratories, London, UK
| | - Amjad Hmaid
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rens de Groot
- Haemostasis Research Unit, Institute of Cardiovascular Science, University College London (UCL), London, UK
| | - Deepak Singh
- Special Coagulation, Health Services Laboratories, London, UK
| | - Satyen H Gohil
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mari Thomas
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Marie Scully
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - John-Paul Westwood
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
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2
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Compton F, Sarode R, Rutherford C, Curtis B, De Simone N. Acquired Glanzmann's thrombasthenia: Diagnosis aided by platelet aggregation mixing study. Haemophilia 2020; 26:e41-e43. [PMID: 31985103 DOI: 10.1111/hae.13914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/06/2019] [Accepted: 12/02/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Frances Compton
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas
| | - Ravi Sarode
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas.,Department of Internal Medicine (Hematology/Oncology), UT Southwestern Medical Center, Dallas, Texas
| | - Cynthia Rutherford
- Department of Internal Medicine (Hematology/Oncology), UT Southwestern Medical Center, Dallas, Texas
| | | | - Nicole De Simone
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas
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Alberelli MA, Bacci M, Marchetti M, Ferrazzi P, Dragani A, Gamba S, Landolfi R, Falanga A, Lodigiani C, De Candia E. Rituximab for treatment of autoimmune acquired platelet function disorders: description of two cases of acquired Glanzmann thrombasthenia and one case of acquired delta storage pool disease. Br J Haematol 2019; 187:e87-e91. [PMID: 31612461 DOI: 10.1111/bjh.16243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Maria Adele Alberelli
- Unità Malattie Emorragiche e Trombotiche, Fondazione Policlinico Universitario Agostino Gemeli IRCCS, Roma, Italy
| | - Monica Bacci
- Centro Trombosi e Malattie Emorragiche, Humanitas Clinical and Research Centre IRCCS, Rozzano (Mi), Italy
| | - Marina Marchetti
- Department of Immunohaematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Paola Ferrazzi
- Centro Trombosi e Malattie Emorragiche, Humanitas Clinical and Research Centre IRCCS, Rozzano (Mi), Italy
| | - Alfredo Dragani
- Rare Blood Disease Centre, Department of Haematology, Santo Spirito Hospital, Pescara, Italy
| | - Sara Gamba
- Department of Immunohaematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Raffaele Landolfi
- Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Falanga
- Department of Immunohaematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy.,School of Medicine and Surgery, Università di Milano Bicocca, Monza, Italy
| | - Corrado Lodigiani
- Centro Trombosi e Malattie Emorragiche, Humanitas Clinical and Research Centre IRCCS, Rozzano (Mi), Italy.,Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Erica De Candia
- Unità Malattie Emorragiche e Trombotiche, Fondazione Policlinico Universitario Agostino Gemeli IRCCS, Roma, Italy.,Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy
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Acquired platelet function disorders. Thromb Res 2019; 196:561-568. [PMID: 31229273 DOI: 10.1016/j.thromres.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 06/08/2019] [Accepted: 06/14/2019] [Indexed: 12/16/2022]
Abstract
The possibility of an acquired platelet function disorder should be considered in patients who present with recent onset muco-cutaneous bleeding. Despite the availability of newer and faster platelet function assays, light transmission aggregometry (LTA) remains the preferred diagnostic test. This review examines and discusses the causes of acquired platelet dysfunction; most commonly drugs, dietary factors, medical disorders and procedures. In addition to well-known antiplatelet therapies, clinicians should be alert for newer drugs which can affect platelets, such as ibrutinib. There is little clinical trial evidence to guide the management of acquired platelet function defects, but we summarise commonly employed strategies, which include addressing the underlying cause, antifibrinolytic agents, desmopressin infusions, and in selected patients, platelet transfusions.
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Nurden AT. Acquired Glanzmann thrombasthenia: From antibodies to anti-platelet drugs. Blood Rev 2019; 36:10-22. [PMID: 31010659 DOI: 10.1016/j.blre.2019.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 02/06/2023]
Abstract
In contrast to the inherited platelet disorder given by mutations in the ITGA2B and ITGB3 genes, mucocutaneous bleeding from a spontaneous inhibition of normally expressed αIIbβ3 characterizes acquired Glanzmann thrombasthenia (GT). Classically, it is associated with autoantibodies or paraproteins that block platelet aggregation without causing a fall in platelet count. However, inhibitory antibodies to αIIbβ3 are widely associated with primary immune thrombocytopenia (ITP), occur in secondary ITP associated with leukemia and related disorders, solid cancers and myeloma, other autoimmune diseases, following organ transplantation while cytoplasmic dysregulation of αIIbβ3 function features in myeloproliferative and myelodysplastic syndromes. Antibodies to αIIbβ3 occur during viral and bacterial infections, while drug-dependent antibodies reacting with αIIbβ3 are a special case. Direct induction of acquired GT is a feature of therapies that block platelets in coronary artery disease. This review looks at these conditions, emphasizing molecular mechanisms, therapy, patient management and future directions for research.
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Affiliation(s)
- Alan T Nurden
- Institut de Rhythmologie et de Modélisation Cardiaque, Plateforme Technologique d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
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Akuta K, Kashiwagi H, Yujiri T, Nishiura N, Morikawa Y, Kato H, Honda S, Kanakura Y, Tomiyama Y. A unique phenotype of acquired Glanzmann thrombasthenia due to non-function-blocking anti-αIIbβ3 autoantibodies. J Thromb Haemost 2019; 17:206-219. [PMID: 30388316 DOI: 10.1111/jth.14323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/27/2018] [Indexed: 11/29/2022]
Abstract
Essentials Acquired Glanzmann thrombasthenia (aGT) is generally caused by function-blocking antibodies (Abs). We demonstrated a unique aGT case due to marked reduction of αIIbβ3 with anti-αIIbβ3 Abs. The anti-αIIbβ3 Abs of the patient did not inhibit platelet function but reduced surface αIIbβ3. Internalization of αIIbβ3 induced by the Abs binding may be responsible for the phenotype. SUMMARY: Background Acquired Glanzmann thrombasthenia (aGT) is a bleeding disorder generally caused by function-blocking anti-αIIbβ3 autoantibodies. Aim We characterize an unusual case of aGT caused by marked reduction of surface αIIbβ3 with non-function-blocking anti-αIIbβ3 antibodies (Abs). Methods A 72-year-old male suffering from immune thrombocytopenia since his 50s showed exacerbation of bleeding symptom despite mild thrombocytopenia. Platelet aggregation was absent with all agonists but ristocetin. Analysis of αIIbβ3 expression and genetic analysis were performed. We also analyzed effects of anti-αIIbβ3 Abs of the patient on platelet function and αIIbβ3 expression. Results Surface αIIbβ3 expression was markedly reduced to around 5% of normal, whereas his platelets contained αIIbβ3 to the amount of 40-50% of normal. A substantial amount of fibrinogen was also detected in his platelets. There were no abnormalities in ITGA2B and ITGB3 cDNA. These results indicated that reduced surface αIIbβ3 expression caused a GT phenotype, and active internalization of αIIbβ3 was suggested. Anti-αIIbβ3 IgG Abs were detected in platelet eluate and plasma. These Abs did not inhibit PAC-1 binding, indicating that the Abs were non-function-blocking. Surface αIIbβ3 expression of a megakaryocytic cell line and cultured megakaryocytes tended to be impaired by incubation with the patient's Abs. After 2 years of aGT diagnosis, his bleeding symptom improved and surface αIIbβ3 expression was recovered to 20% of normal with reduction of anti-αIIbβ3 Abs. Conclusion We demonstrated a unique aGT phenotype due to marked reduction of surface αIIbβ3. Internalization induced by anti-αIIbβ3 Abs may be responsible in part for the phenotype.
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Affiliation(s)
- K Akuta
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - H Kashiwagi
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - T Yujiri
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Japan
| | - N Nishiura
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Morikawa
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - H Kato
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - S Honda
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Y Kanakura
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Tomiyama
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Blood Transfusion, Osaka University Hospital, Suita, Japan
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Mayne ES, Tait M, Jacobson BF, Pillay E, Louw SJ. Combination of acquired von Willebrand syndrome (AVWS) and Glanzmann thrombasthenia in monoclonal gammopathy of uncertain significance (MGUS), a case report. Thromb J 2018; 16:30. [PMID: 30534006 PMCID: PMC6260759 DOI: 10.1186/s12959-018-0184-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Autoimmune paraphenomena, are associated with B-cell lymphoproliferative disorders, including monoclonal gammopathy of uncertain significance. These paraphenomena can rarely include acquired bleeding disorders. Case presentation This case study reports an unusual clinical presentation of 2 acquired bleeding disorders, Acquired von Willebrand syndrome (disease) and Acquired Glanzmann's thrombasthenia, in an elderly patient with monoclonal gammopathy of uncertain significance. Conclusions Acquired bleeding disorders are often underdiagnosed and a high degree of clinical suspicion is required. The patient in this study demonstrated platelet aggregometry which was atypical for isolated Glanzmann's thrombosthenia because of the severe concomitant endogenous decrease in von Willebrand factor. There was an absence of platelet aggregation to all tested agonists including ristocetin. Once the diagnosis was made, however, the patient showed a partial response to intravenous immunoglobulin confirming the immunological pathogenesis in this case. This case highlights the need to consider acquired bleeding disorders in patients with a possible predisposing factor.
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Affiliation(s)
- Elizabeth Sarah Mayne
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersr and National Health Laboratory Services, 7 York Road, Parktown, Johannesburg, 2196 South Africa
| | - Malcolm Tait
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersr and National Health Laboratory Services, 7 York Road, Parktown, Johannesburg, 2196 South Africa
| | - Barry Frank Jacobson
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersr and National Health Laboratory Services, 7 York Road, Parktown, Johannesburg, 2196 South Africa
| | - Evashin Pillay
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersr and National Health Laboratory Services, 7 York Road, Parktown, Johannesburg, 2196 South Africa
| | - Susan J Louw
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersr and National Health Laboratory Services, 7 York Road, Parktown, Johannesburg, 2196 South Africa
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Sauer K, Winkler B, Eyrich M, Schlegel PG, Wiegering V. Indication for allogeneic stem cell transplantation in Glanzmann’s thrombasthenia. Hamostaseologie 2017; 33:305-12. [DOI: 10.5482/hamo-12-08-0014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 06/28/2013] [Indexed: 11/05/2022] Open
Abstract
SummaryGlanzmann’s thrombasthenia (GT) is an autosomal recessive disorder characterized by a lack of thrombocyte aggregation due to the absence of thrombocyte glycoproteins IIb and αIIbβ3. The role of haematopoietic stem cell transplantation (HSCT) in GT remains controversial. However, HSCT offers the only curative approach for patients with a severe clinical phenotype.In this review, we will discuss the limitation of current status evidence and the specific risk of GT, in particular the alloimmunization and refractoriness to thrombocyte infusions. 19 successful HSCT in 18 GT type I patients have been reported. Mean age at transplantation was 5 years. All patients are still alive. The majority received sibling bone marrow transplant with busulfan and cyclophosphamid conditioning. GvHD incidence was within the normal range, but 10 patients showed alloimmunization of thrombocytes. Median follow up is 25 months.
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Gangaraju R, Rets A, Smock KJ, Heikal NM. Rare complication of treated immune thrombocytopenia. Am J Hematol 2017; 92:1262-1266. [PMID: 28801925 DOI: 10.1002/ajh.24884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 08/03/2017] [Accepted: 08/09/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Radhika Gangaraju
- Division of Hematology-Oncology; Department of Medicine, University of Utah; Salt Lake City Utah
| | - Anton Rets
- Department of Pathology; University of Utah Health Sciences Center, and ARUP Laboratories Institute for Clinical and Experimental Pathology; Salt Lake City Utah 84108
| | - Kristi J. Smock
- Department of Pathology; University of Utah Health Sciences Center, and ARUP Laboratories Institute for Clinical and Experimental Pathology; Salt Lake City Utah 84108
| | - Nahla M. Heikal
- Department of Pathology; University of Utah Health Sciences Center, and ARUP Laboratories Institute for Clinical and Experimental Pathology; Salt Lake City Utah 84108
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