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Hemostatic Abnormalities in Gaucher Disease: Mechanisms and Clinical Implications. J Clin Med 2022; 11:jcm11236920. [PMID: 36498496 PMCID: PMC9735904 DOI: 10.3390/jcm11236920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
Gaucher disease (GD) is a rare inherited lysosomal metabolism disorder, characterized by an accumulation into lysosomes of reticuloendothelial cells, especially in the bone marrow, spleen, and liver of β-glucosylceramide and glucosyl sphingosine, which is its deacylated product. Impaired storage is responsible for a chronic inflammatory state at the sites of accumulation and together represents the pathophysiological cause of GD. GD is a progressive, multi-organ chronic disorder. Type 1 GD is the most prevalent form, with heterogeneous multisystem involvement and different severity of symptoms at any age. Hematological involvement is consistent, and a bleeding tendency is frequent, particularly at diagnosis. Several coagulation and primary hemostasis abnormalities are observed in GD. Bleeding manifestations are rarely severe and usually mucocutaneous. Post-operative, delivery, and post-partum hemorrhages are also common. Thrombocytopenia, platelet function defects, and clotting abnormalities, alone or variably associated, contribute to increase the risk of bleeding in GD. Enzyme replacement therapy (ERT) or substrate reduction therapy (SRT) are the two specific available treatments effective in improving typical hematological symptoms and abnormalities, including those of hemostasis. However, the use of medication to potentiate hemostasis may be also useful in defined clinical situations: recent starting of ERT/SRT, surgery, delivery, and life-threatening bleeding.
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Platelet function defects in patients with Gaucher disease on long term ERT- implications for evaluation at bleeding challenges. Blood Cells Mol Dis 2020; 80:102371. [DOI: 10.1016/j.bcmd.2019.102371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/22/2019] [Indexed: 11/24/2022]
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Serratrice C, Cherin P, Lidove O, Noel E, Masseau A, Leguy-Seguin V, Jaussaud R, Marie I, Lavigne C, Maillot F. Coagulation Parameters in Adult Patients With Type-1 Gaucher Disease. J Hematol 2019; 8:121-124. [PMID: 32300455 PMCID: PMC7153659 DOI: 10.14740/jh543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 08/16/2019] [Indexed: 02/05/2023] Open
Abstract
Background Gaucher disease is a rare inborn error of lysosomal metabolism, characterized by lysosomal storage of the β-glucosylceramide. Bleedings observed in type-1 Gaucher disease (GD1) are commonly attributed to a low platelet count, but they can also occur when the platelet count is normal or slightly low. Abnormal platelet function has been described and deficiencies in coagulation factors too, such as factors II, V, VII, VIII, IX, X, XI, XII, and von Willebrand factor. However, studies are few in number, involving few patients and having varying conclusions. The aim of this study was to analyze clotting factor deficiencies in a larger cohort of French patients with GD1. Methods This is an observational national study. The coagulation parameters were collected during routine GD1 monitoring and described retrospectively. Results We highlighted low levels of various coagulation factors in 46% of the patients with GD1. The most frequent coagulation abnormalities encountered were factor V, X, XI, and XII deficiencies. Deficits were usually mild and coagulation abnormalities tended to be more frequent in non-splenectomized patients. Conclusions In conclusion, frequent and varied coagulation abnormalities were found in a high proportion of GD1 patients.
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Affiliation(s)
- Christine Serratrice
- Department of Internal Medicine of the Aged, University Hospital of Geneva, 1226 Thonex, Switzerland
| | - Patrick Cherin
- Department of Internal Medicine, Pitie-Salpetriere Hospital Group, 75013 Paris, France
| | - Olivier Lidove
- Internal Medicine Department, Groupe Hospitalier Diaconesses Croix Saint Simon, 75020 Paris, France
| | - Esther Noel
- Department of Internal Medicine, University Hospital of Strasbourg, 67091 Strasbourg, France
| | - Agathe Masseau
- Internal Medicine Department, University Hospital Hotel Dieu, 44093 Nantes, France
| | - Vanessa Leguy-Seguin
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon, 21079, Dijon, France
| | - Roland Jaussaud
- Department of Internal Medicine, CHRU Nancy, 54511 Vandoeuvre les Nancy, France
| | - Isabelle Marie
- Department of Internal Medicine, University Hospital of Rouen, INSERM U 905, 76031 Rouen, France
| | - Christian Lavigne
- Internal Medicine and Vascular Diseases Department, Angers University Hospital, 49933 Angers, France
| | - Francois Maillot
- Internal Medicine Department, Tours University Hospital, University of Tours, UMR INSERM 1253, 37044 Tours, France
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Abstract
Gaucher disease (GD) is an inherited lysosomal disorder, originating from deficient activity of the lysosomal enzyme glucocerebrosidase (GCase). Normally, GCase hydrolyzes glucocerebroside (GC) to glucose and ceramide; however, impaired activity of this enzyme leads to the accumulation of GC in macrophages, termed "Gaucher cells." Gaucher disease is associated with hepatosplenomegaly, cytopenias, skeletal complications and in some forms involves the central nervous system. Coagulation abnormalities are common among GD patients due to impaired production and chronic consumption of coagulation factors. Bleeding phenomena are variable (as are other symptoms of GD) and include mucosal and surgical hemorrhages. FOUR MAIN ETIOLOGICAL FACTORS ACCOUNT FOR THE HEMOSTATIC DEFECT IN GD: thrombocytopenia, abnormal platelet function, reduced production of coagulation factors, and activation of fibrinolysis. Thrombocytopenia relates not only to hypersplenism and decreased megakaryopoiesis by the infiltrated bone marrow but also to immune thrombocytopenia. Autoimmunity, especially the induction of platelet antibody production, might cause persistent thrombocytopenia. Enzyme replacement therapy reverses only part of the impaired coagulation system in Gaucher disease. Other therapeutic and supportive measures should be considered to prevent and/or treat bleeding in GD. Gaucher patients should be evaluated routinely for coagulation abnormalities especially prior to surgery and dental and obstetric procedures.
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Affiliation(s)
- Hanna Rosenbaum
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel and ; Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Thomas AS, Mehta A, Hughes DA. Gaucher disease: haematological presentations and complications. Br J Haematol 2014; 165:427-40. [PMID: 24588457 DOI: 10.1111/bjh.12804] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gaucher disease (GD) is an autosomal recessive lysosomal storage disease, caused by deficiency of the enzyme glucocerebrosidase, required for the degradation of glycosphingolipids. Clinical manifestations include hepatosplenomegaly, thrombocytopenia, bone disease and a bleeding diathesis, frequently resulting in presentation to haematologists. Historically managed by splenectomy, transfusions and orthopaedic surgery, the development of specific therapy in the form of intravenous enzyme replacement therapy in the 1990s has resulted in dramatic improvements in haematological and visceral disease. Recognition of complications, including multiple myeloma and Parkinson disease, has challenged the traditional macrophage-centric view of the pathophysiology of this disorder. The pathways by which enzyme deficiency results in the clinical manifestations of this disorder are poorly understood; altered inflammatory cytokine profiles, bioactive sphingolipid derivatives and alterations in the bone marrow microenvironment have been implicated. Further elucidating these pathways will serve to advance our understanding not only of GD, but of associated disorders.
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Affiliation(s)
- Alison S Thomas
- Lysosomal Storage Disorders Unit, Royal Free Hospital, London, UK
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Abstract
Gaucher disease is an inborn error of metabolism due to a deficiency of the lysosomal enzyme glucocerebrosidase. As a result of this deficiency, the substrate glucocerebroside accumulates in the liver, spleen, bone and bone marrow. Bone involvement can lead to abnormalities in bone growth, bone remodeling, bone infarcts, aseptic necrosis, osteonecrosis, increased fracture risk and lytic bone lesions. Patients may experience bone pain and bone crises related to bone infarcts. There is evidence of abnormal bone metabolism in both bone resorption and bone formation based upon biochemical abnormalities found in patients. In addition, both immunological and coagulation abnormalities have in part been implicated in the causation of bone disease. Treatment with enzyme replacement therapy and substrate reduction therapy has led to improvement in both the symptoms and the radiographic abnormalities seen in these patients. It is unknown whether these treatments lower fracture risk.
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Affiliation(s)
- Barry E Rosenbloom
- a Cedars-Sinai Medical Center, Tower Hematology Oncology, 9090 Wilshire Blvd, #200, Beverly Hills, CA 90211, USA
| | - Neal J Weinreb
- b University Research Foundation for Lysosomal Diseases, Dr John T. Macdonald Foundation, University of Miami Miller School of Medicine, 8170 Royal Palm Blvd, Coral Springs, FL 33065, USA
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Mitrovic M, Antic D, Elezovic I, Janic D, Miljic P, Sumarac Z, Nikolic T, Suvajdzic N. Haemostatic abnormalities in treatment-naïve patients with Type 1 Gaucher's disease. Platelets 2011; 23:143-9. [PMID: PMID: 21767238 DOI: 10.3109/09537104.2011.597526] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is a paucity of data on the effects of enzyme replacement therapy (ERT) on the coagulation abnormalities and platelet function of patients with Gaucher's disease (GDPs) and much of this data are controversial. This study investigates the haemostatic parameters in treatment-naïve GDPs and the effects of ERT. 31 Serbian treatment-naïve type 1 GDPs (M/F 17/14; median age 49 years, splenectomized 9/31) were studied. The complete blood count, prothrombin time (PT), activated partial tromboplastin time (aPTT) and coagulation factors were measured using the standard methods. Platelet aggregation was assessed with a whole-blood aggregometer. Splenic volumes were assessed using computer tomography. Twenty-one patients were treated with ERT (Imiglucerase). The haemostatic parameters were assessed after 6, 12 and 24 months (ERT(6, 12, 24)). Initially bleeding episodes were registered in 10/31 GDPs. Median platelet count was 108 × 10(9)/L; 22/31 GDPs were thrombocytopenic. The PT and aPTT values were abnormal in 16/31 and 13/31 GDPs, respectively. Platelet aggregation abnormalities were recorded in 19/31GDPs. Median platelet aggregation was reduced in response to adenosine-diphosphate 5 µmol/L (ADP(5) 0.46) and collagen 5 µmol/L (Col(5) 0.47). Splenic volume inversely correlated with the platelet count and a reduced response to arachidonic acid (AA), Col(5) and ADP(5) (p < 0.05). The splenectomized GDPs had a significantly lower platelet aggregation to Col(10) (p < 0.05). Bleeding GDPs had a significantly lower platelet count, higher chitotriosidase levels and a greater splenic volume compared to non-bleeding patients (p < 0.01). ERT: The number of bleeding GDPs had significantly decreased by ERT(6) (1/10; p < 0.01). The platelet count had significantly increased by ERT(6) (ERT(6) 180 × 10(9)/L, p < 0.01). The PT increased significantly from ERT(0) to ERT(24) (PT(0) 65%, PT(24) 81%; p < 0.05). The von Willebrand factor had increased significantly by ERT(6) and ERT(24) (ERT(0) 56%, ERT(6) 70%, ERT(12) 70%, ERT(24) 86%; p < 0.01). The number of GDPs with abnormal platelet aggregation had decreased significantly by ERT(6) (10/19; p < 0.05). Platelet aggregation on ADP(10) and AA significantly increased by ERT(6) (ADP(10): ERT(0) 0.75, ERT(6) 0.8 p < 0.01; AA: ERT(0) 0.7, ERT(6) 0.8 p < 0.05). In conclusion, platelet dysfunction and coagulation abnormalities were found in a considerable number of our GDPs. The absence of severe bleeding episodes suggests that the haemostatic system is sufficiently balanced and therefore the exact mechanism of the etiology of these abnormalities need to be fully clarified. ERT resulted in the cessation of bleeding and marked increase in platelet count, PT, vWF and platelet aggregation.
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Spectre G, Roth B, Ronen G, Rosengarten D, Elstein D, Zimran A, Varon D, Revel-Vilk S. Platelet adhesion defect in type I Gaucher Disease is associated with a risk of mucosal bleeding. Br J Haematol 2011; 153:372-8. [PMID: 21401572 DOI: 10.1111/j.1365-2141.2011.08613.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patients with type I Gaucher Disease (GD) may have a clinically significant bleeding tendency that is disproportionate to their platelet count. We hypothesized that impaired platelet adhesion might contribute to bleeding tendency. Adult patients with type I GD with platelet counts ≥130×10(9) /l and haematocrit ≥30% (n=48), obligatory carriers (n=52), and healthy controls (n=19) were studied. Platelet adhesion, using the IMPACT-R (Cone and Plate(let) Analyser), and platelet aggregation were determined. Type I GD patients had significantly lower platelet adhesion [surface coverage %, median (interquartile range)] 4·6 (3·2-7·5), compared to controls, 8·7 (7·6-10·3), or carriers, 8·1 (6·5-9·4; P=0·001). Platelet adhesion was not affected by the use of disease-specific enzyme replacement therapy but was improved in patients after splenectomy, 7·2 (5·8-9·3). Mixing tests showed that the reduced adhesion was an intrinsic platelet defect. Mucosal bleeding was reported in 17 (35·4%) patients and was associated with abnormal adhesion [P=0·037, with an Odds Ratio (95% confidence interval) of 5·73 (1·1-29·6)]. Five patients (22%) had reduced platelet aggregation, all of whom had reduced platelet adhesion. Platelet aggregation defect was not associated with mucosal bleeding. In conclusion, platelet adhesion defect is a major thrombocytopathy in type I GD patients and can explain part of the increased tendency to bleeding.
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Affiliation(s)
- Galia Spectre
- Coagulation Unit Paediatric Haematology/Oncology Department, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
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Giona F, Palumbo G, Amendola A, Santoro C, Mazzuconi MG. Platelet function and coagulation abnormalities in type 1 Gaucher disease patients: effects of enzyme replacement therapy (ERT). J Thromb Haemost 2006; 4:1831-3. [PMID: 16879228 DOI: 10.1111/j.1538-7836.2006.02037.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Deghady A, Marzouk I, El-Shayeb A, Wali Y. Coagulation abnormalities in type 1 Gaucher disease in children. Pediatr Hematol Oncol 2006; 23:411-7. [PMID: 16728361 DOI: 10.1080/08880010600623232] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Gaucher disease is the most prevalent inherited lysosomal storage disorder caused by deficiency of beta-glucocerebrosidase enzyme. Clinically, 3 forms of Gaucher disease are recognized, of which type 1 is the mild to moderately severe, slowly progressive, nonneuropathic form. Bleeding disorders in Gaucher disease are believed to be due to thrombocytopenia but there may be additional factors that influence coagulation and fibrinolysis in Gaucher disease patients. The aim of the present work was to study some coagulation parameters in the Egyptian children with type 1 Gaucher disease. Five newly diagnosed patients and another 5 patients on enzyme replacement therapy (ERT) were enrolled in the study. Their coagulation profile, including coagulation factors, was evaluated. The results showed that in newly diagnosed cases factors II and VII were deficient in 40%, factor V was deficient in 20%, and all the cases had low levels of serum fibrinogen. In patients on ERT, factors VII and VIII were deficient in 60%, factor XI was deficient in 40% and factors V, X, and XII were deficient in 20% of cases. In conclusion, Egyptian patients with type 1 Gaucher disease, whether newly diagnosed or receiving enzyme replacement therapy, experience coagulation factor abnormalities regardless the clinical expression of bleeding diathesis. This should be taken into consideration before these patients are subjected to surgery for, e.g., splenectomy, which is common in these patients.
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Affiliation(s)
- Akram Deghady
- Department of Clinical Pathology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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Kaleem Z, Hassan A. Multiple lytic bone lesions in an 85-year-old man: type 1 Gaucher disease, adult onset (nonneuronopathic form). Arch Pathol Lab Med 2005; 129:e148-50. [PMID: 15913444 DOI: 10.5858/2005-129-e148-mlblia] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zahid Kaleem
- Department of Pathology and Immunology, Washington University Medical Center, St Louis, Mo, USA.
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Aerts JM, Hollak CE. Plasma and metabolic abnormalities in Gaucher's disease. BAILLIERE'S CLINICAL HAEMATOLOGY 1997; 10:691-709. [PMID: 9497858 DOI: 10.1016/s0950-3536(97)80034-0] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An overview of the most important plasma abnormalities that can be found in Gaucher's disease is presented in this chapter. Attention is focussed on their practical applications and possible clinical relevance. In addition, the result of studies on metabolic alterations in Gaucher's disease are reviewed.
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Affiliation(s)
- J M Aerts
- Department of Biochemistry, University of Amsterdam, The Netherlands
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Sölder B, Pechlaner C, Sperl W, Skladal D, Kunz F, Shin YS. Factor XI and phosphorylase b kinase deficiency. J Inherit Metab Dis 1995; 18:89-90. [PMID: 7623455 DOI: 10.1007/bf00711386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- B Sölder
- Department of Pediatrics, University of Innsbruck, Austria
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