Abnormal platelet-collagen reaction in Ehlers-Danlos syndrome

Vascular type Ehlers-Danlos syndrome is associated with platelet dysfunction and low vitamin D serum concentration

Background

The vascular type represents a very rare, yet the clinically most fatal entity of Ehlers-Danlos syndrome (EDS). Patients are often admitted due to arterial bleedings and the friable tissue and the altered coagulation contribute to the challenge in treatment strategies. Until now there is little information about clotting characteristics that might influence hemostasis decisively and eventually worsen emergency situations.

Results

22 vascular type EDS patients were studied for hemoglobin, platelet volume and count, Quick and activated partial thromboplastin time, fibrinogen, factor XIII, von Willebrand disease, vitamin D and platelet aggregation by modern standard laboratory methods. Results show a high prevalence of over 50 % for platelet aggregation disorders in vascular type EDS patients, especially for collagen and epinephrine induced tests, whereas the plasmatic cascade did not show any alterations. Additionally, more than half of the tested subjects showed low vitamin D serum levels, which might additionally affect vascular wall integrity.

Conclusion

The presented data underline the importance of detailed laboratory screening methods in vascular type EDS patients in order to allow for targeted application of platelet-interacting substances that might be of decisive benefit in the emergency setting.

Electronic supplementary material

The online version of this article (doi:10.1186/s13023-016-0491-2) contains supplementary material, which is available to authorized users.

Platelet and coagulation studies in Ehlers-Danlos syndrome

Fifty-one patients with Ehlers-Danlos syndrome were investigated for abnormalities of platelets and coagulation. Thirty-eight were examined prospectively and 13 retrospectively. A bleeding history was taken from all patients; only four (8%) gave no history of a bruising or bleeding tendency. Nine patients (18%) had significant haemostatic abnormalities of whom four (8%) had a platelet release defect, three (6%) had a factor XI deficiency and two (4%) had a factor XIII deficiency. Additionally 16 patients (31%) had mild abnormalities of uncertain significance of whom four (8%) had prolonged bleeding times (three in association with platelet aggregation abnormalities), 13 (26%) had platelet aggregation abnormalities and two had a positive Hess test. Twenty-four patients (47%) had normal tests for haemostasis of whom 20 (39%) had a bleeding diathesis and four (8%) had no such tendency. Results were analysed according to the type of Ehlers-Danlos syndrome, but there was no pattern to the abnormalities. The high frequency of a bleeding tendency in Ehlers-Danlos patients with normal tests for haemostasis (83%) supports the conventional explanation for this clinical feature, that defects in the structural integrity of skin and blood vessels lead to easy bruising.

Coronary artery vein grafting in a case of Ehlers-Danlos syndrome

A 64 year old man with Ehlers-Danlos syndrome type 2 was admitted to hospital with severe angina of effort. Aortocoronary vein grafting was performed successfully.

Collagen and bleeding diathesis in Ehlers-Danlos syndrome

There are at least 7 variants of Ehlers-Danlos syndrome (EDS). One family with type 1, one with type 3 and one isolated case with an undefined type of EDS are described. They all had bleeding symptoms, but surgery had been performed without complications. Collagen is believed to be defective in EDS. However, in our cases the platelet aggregating power of the collagen was normal. The bleeding time (Ivy) was slightly prolonged. Extensive examination of the haemostatic process revealed a decreased platelet adhesiveness in only 2 of the patients, a finding believed to be coincidental. The history of former operations on the patients and on affected relatives is considered to be the best guide in determining the risk of an operation, but preoperative estimation of the bleeding time is recommended.

Collagen-induced platelet aggregation and bleeding time in adolescent idiopathic scoliosis

Collagen is the main supportive protein of connective tissue. Another of its functions is the initiation of haemostasis by activation of the platelets. It has been suggested that collagen is abnormal in idiopathic scoliosis. The present study lends further support to this view: collagen of fascia specimens from patients with adolescent idiopathic scoliosis was found to aggregate platelets less readily than collagen from non-scoliotic controls and suspensions of fascia patients with adolescent idiopathic scoliosis contained more collagen than those from the controls. The collagen abnormality is probably also reflected in a prolonged bleeding time. The changes in the collagen in patients with scoliosis persist at least for some years after the cessation of growth.

Acquired von Willebrand's syndrome and Ehlers-Danlos syndrome presenting with gastro-intestinal bleeding

The clinical and laboratory findings in a patient with severe gastro-intestinal bleeding and the Ehlers-Danlos syndrome are described. Coagulation studies and a lack of history of previous haemorrhage were consistent with a diagnosis of acquired von Willebrand's syndrome. His response to treatment with blood transfusion, Factor VIII, cimetidine, tranexamic acid and cyclophosphamide is described. Family studies revealed other members with Ehlers-Danlos syndrome but normal coagulation.