Clinical trial of a new disposable bleeding-time device

Thrombocytopenia, giant platelets, and leukocyte inclusion bodies (May-Hegglin anomaly): clinical and laboratory findings

PURPOSE

May-Hegglin anomaly is a rare hereditary condition characterized by the triad of thrombocytopenia, giant platelets, and inclusion bodies in leukocytes. Clinical features and the pathogenesis of bleeding in this disease are poorly defined.

PATIENTS AND METHODS

From 1988 to 1996 we studied 15 new May-Hegglin anomaly patients from 7 unrelated Italian families. In addition to clinical examination and routine laboratory testing, we measured bleeding time, platelet aggregation and release reaction, and platelet staining for tubulin, and performed ultrastructural study of polymorphonuclear leukocytes.

RESULTS

Although the mean age of our patients was 33 years, May-Hegglin anomaly had not been previously recognized in any of them. Bleeding diatheses ranged from severe to absent, and platelet count from 26 to 178 x 10(9)/L. No correlation was found between bleeding tendency and platelet count. Previous therapy with corticosteroids, high-dose immunoglobulins, and splenectomy had no effect on platelet count or bleeding diathesis. Desmopressin infusion greatly shortened the bleeding time in the most severely affected patient. The in vitro function of platelets was normal except for the absence of shape change in all subjects and defective response to epinephrine in 8 of 15 patients. Platelet tubulin was distributed unevenly instead of being organized in a circumferential band at the cell periphery.

CONCLUSION

The diagnosis of May-Hegglin is easily missed, and its frequency is probably underestimated. A qualitative defect of platelets may be responsible for mild bleeding diathesis even in the absence of thrombocytopenia, while severe bleeding results from both qualitative and quantitative platelet defects. May-Hegglin anomaly should be suspected whenever a patient has a low platelet count or a bleeding diathesis of unknown origin.

Clinical application of a new in vitro bleeding time device on surgical patients

A new in vitro bleeding time (BT) device was applied to various surgical patients. After setting the optimal assay condition, the normal in vitro bleeding time (T2) and volume (V2) were obtained from healthy volunteers, being 114.7 secs +/- 25.8 (SD) and 272.2 microliter +/- 69.1 (SD), respectively. When the T2 was below 210 secs, the platelet count was inversely proportional to the T2 and V2 of the in vitro BT with p less than 0.01. The value of the in vitro BT was not affected by heparin. Agents, which modify platelet functions, such as PGI2, DN9693 (an inhibitor of phosphodiesterase) and aspirin, prolonged the in vitro BT (T2, V2) dose-dependently. Administration of aspirin (660 mg) to volunteers prolonged the T2 from 108 to over 300 secs and the V2 from 253 to over 600 microliter but ticlopidine (500 mg/day for 3 days) had no effect. In 8 patients with liver cirrhosis who underwent hepatectomy, one patient with a prolonged T2 (260 secs) and a normal skin BT bled postoperatively, however, 3 patients with a prolonged skin BT (greater than 15 min) and a normal T2 had no hemorrhagic complications. From these observations it was concluded that in vitro BT is a convenient and useful tool to examine primary hemostasis or platelet function.