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Alessi MC, Sié P, Payrastre B. Strengths and Weaknesses of Light Transmission Aggregometry in Diagnosing Hereditary Platelet Function Disorders. J Clin Med 2020; 9:jcm9030763. [PMID: 32178287 PMCID: PMC7141357 DOI: 10.3390/jcm9030763] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/17/2020] [Accepted: 03/03/2020] [Indexed: 12/15/2022] Open
Abstract
Hereditary defects in platelet function are responsible for sometimes severe mucocutaneous hemorrhages. They are a heterogeneous group of abnormalities whose first-line diagnosis typically involves interpreting the results of in vitro light transmission aggregometry (LTA) traces. Interpretation of LTA is challenging. LTA is usually performed in specialized laboratories with expertise in platelet pathophysiology. This review updates knowledge on LTA, describing the various platelet aggregation profiles typical of hereditary platelet disorders to guide the physician in the diagnosis of functional platelet disorders.
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Affiliation(s)
- Marie-Christine Alessi
- Aix Marseille Univ, Inserm, Inrae, C2VN, 13385 Marseille CEDEX, France
- Correspondence: ; Tel.: +33-4-91-32-45-06
| | - Pierre Sié
- CHU de Toulouse, Laboratoire d’Hématologie, 31059 Toulouse CEDEX, France;
| | - Bernard Payrastre
- Inserm U1048, I2MC et Université Paul Sabatier, 31024 Toulouse CEDEX, France;
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2
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An Unusual Cause of Bleeding in a Patient with Chronic Myeloid Leukemia Chronic Phase. Case Rep Hematol 2019; 2019:5674193. [PMID: 31583142 PMCID: PMC6754873 DOI: 10.1155/2019/5674193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/19/2019] [Accepted: 08/09/2019] [Indexed: 01/18/2023] Open
Abstract
Chronic myelogenous leukemia (CML) is a clonal myeloproliferative neoplasm (MPN) characterized by dysregulated and uncontrolled proliferation of mature and maturing granulocytes with normal differentiation. A genetic hallmark of CML is the presence of the fusion gene product BCR-ABL. Bleeding diathesis in CML patients is rare (<10%) and primarily caused by acquired platelet dysfunction. We report a rare case of an adult CML chronic phase patient who presented with spontaneous muscle hematoma due to acquired Glanzmann's thrombasthenia (GT). On laboratory workup, a GT was confirmed along with the diagnosis of CML in chronic phase. The muscle hematoma was completely resolved following imatinib therapy. The present case demonstrates that bleeding is a complication of MPNs and highlights the importance of both acquired GT diagnosis to determine the cause of bleeding in CML and of prompt treatment with imatinib to reverse this condition.
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Pillois X, Guy A, Choquet É, James C, Tuffigo M, Viallard JF, Garcia C, Bordet JC, Jandrot-Perrus M, Payrastre B, Fiore M. First description of an IgM monoclonal antibody causing α IIb β 3 integrin activation and acquired Glanzmann thrombasthenia associated with macrothrombocytopenia. J Thromb Haemost 2019; 17:795-802. [PMID: 30868743 DOI: 10.1111/jth.14424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Indexed: 12/25/2022]
Abstract
Essentials Acquired Glanzmann thrombasthenia (GT) is generally caused by anti-αIIb β3 autoantibodies. We report the case of a man with an acquired GT phenotype associated with macrothrombocytopenia. Perturbed platelet function were associated with an activating anti-αIIb β3 IgM autoantibody. This novel clinical entity raises interesting questions about the αIIb β3 integrin signaling. SUMMARY: Background Acquired Glanzmann thrombasthenia (GT) is a bleeding disorder generally caused by anti-αIIb β3 autoantibodies. Objectives We aimed to characterize the molecular mechanism leading to a progressive GT-like phenotype in a patient with chronic immune thrombocytopenia. Patient, Methods, and Results The patient suffered from repeated episodes of gastrointestinal bleeding; further studies indicated a moderate platelet aggregation defect. A few months later, platelet function showed abolished aggregation using all agonists, but normal agglutination with ristocetin. No platelet-bound antibodies were detected, but the presence of large amounts of an IgM type antibody detected together with αIIb β3 in the patient permeabilized platelets suggested that this IgM was an autoantibody causing the internalization of the complex. This was confirmed by the fact that the patient IgM bound to normal platelets but not to platelets from GT type I patients. Moreover, patient's plasma activated αIIb β3 on controls' platelets as evidenced by increased PAC-1 binding. We also demonstrated that the patient plasma triggered αIIb β3 outside-in signaling, as β3 Tyr773 and FAK were phosphorylated, and increased the rate of actin polymerization in resting platelets reflecting an impairment of cytoskeletal reorganization. Because different signs of dysmegakaryopoiesis were also observed in our patient, we evaluated the ability of its serum to impair proplatelets formation and showed that it significantly decreased the number of proplatelet-bearing megakaryocytes in controls' bone marrow stem cells culture compared with normal serum. Conclusions We present the case of a patient with a progressive and severely perturbed platelet function associated with the presence of an IgM activating autoantibody directed against αIIb β3 .
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Affiliation(s)
- Xavier Pillois
- Cardiovascular Adaptation to Ischemia, INSERM U1034, Pessac, France
- Reference Center for Platelet Disorders, Pessac, France
| | - Alexandre Guy
- Cardiovascular Adaptation to Ischemia, INSERM U1034, Pessac, France
- Laboratory Hematology, University Hospital of Bordeaux, Pessac, France
| | - Émeline Choquet
- Laboratory Hematology, University Hospital of Bordeaux, Pessac, France
- INSERM U1211 - University of Bordeaux, Maladies Rares: Génétique et Métabolisme, Bordeaux, France
- Victor Segalen, University of Bordeaux, Bordeaux, France
| | - Chloé James
- Cardiovascular Adaptation to Ischemia, INSERM U1034, Pessac, France
- Laboratory Hematology, University Hospital of Bordeaux, Pessac, France
- Victor Segalen, University of Bordeaux, Bordeaux, France
| | - Marie Tuffigo
- Laboratory Hematology, University Hospital of Bordeaux, Pessac, France
- Victor Segalen, University of Bordeaux, Bordeaux, France
| | - Jean-François Viallard
- Cardiovascular Adaptation to Ischemia, INSERM U1034, Pessac, France
- Victor Segalen, University of Bordeaux, Bordeaux, France
- Internal Medecine and Infectious Diseases Department, University Hospital of Bordeaux, Pessac, France
| | - Cédric Garcia
- Laboratoire d'Hématologie, CHU de Toulouse, Toulouse, France
| | - Jean-Claude Bordet
- Hôpital Cardiologique Louis Pradel, Université Claude Bernard, Lyon 1, Lyon, France
| | - Martine Jandrot-Perrus
- INSERM U1148, Université Paris Diderot, Centre Hospitalier Universitaire Bichat, Paris, France
| | - Bernard Payrastre
- Laboratoire d'Hématologie, CHU de Toulouse, Toulouse, France
- INSERM, U1048 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Toulouse, France
| | - Mathieu Fiore
- Reference Center for Platelet Disorders, Pessac, France
- Laboratory Hematology, University Hospital of Bordeaux, Pessac, France
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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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Tuffigo M, Lazaro E, James C, Subtil C, Viallard JF, Fiore M. Successful use of recombinant factor VIIa in a patient with acquired Glanzmann thrombasthenia. Haemophilia 2014; 21:e116-8. [DOI: 10.1111/hae.12589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Tuffigo
- Laboratoire d'Hématologie; CHU de Bordeaux; Pessac France
| | - E. Lazaro
- Service de Médecine Interne et Maladies Infectieuses; CHU de Bordeaux; Pessac France
- Université de Bordeaux; Bordeaux France
- INSERM U1034; Adaptation cardiovasculaire à l'ischémie; Pessac France
| | - C. James
- Laboratoire d'Hématologie; CHU de Bordeaux; Pessac France
- Université de Bordeaux; Bordeaux France
- INSERM U1034; Adaptation cardiovasculaire à l'ischémie; Pessac France
| | - C. Subtil
- Service de gastro-entérologie; CHU de Bordeaux; Pessac France
| | - J.-F. Viallard
- Service de Médecine Interne et Maladies Infectieuses; CHU de Bordeaux; Pessac France
- Université de Bordeaux; Bordeaux France
- INSERM U1034; Adaptation cardiovasculaire à l'ischémie; Pessac France
| | - M. Fiore
- Laboratoire d'Hématologie; CHU de Bordeaux; Pessac France
- Université de Bordeaux; Bordeaux France
- INSERM U1034; Adaptation cardiovasculaire à l'ischémie; Pessac France
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Fiore M, Nurden AT, Nurden P, Seligsohn U. Clinical utility gene card for: Glanzmann thrombasthenia. Eur J Hum Genet 2012; 20:ejhg2012151. [PMID: 22781097 DOI: 10.1038/ejhg.2012.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mathieu Fiore
- Centre de Référence des Pathologies Plaquettaires, Plateforme Technologique d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France
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Awidi A, Maqablah A, Dweik M, Bsoul N, Abu-Khader A. Comparison of platelet aggregation using light transmission and multiple electrode aggregometry in Glanzmann thrombasthenia. Platelets 2009; 20:297-301. [PMID: 19548178 DOI: 10.1080/09537100903006246] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examined platelet aggregation in platelet-rich plasma (PRP) and in whole blood in nine patients with Thrombasthenia Glanzmann (TG). In PRP, aggregation was measured by monitoring the changes in light absorbance that occurred in response to adenosine 5-diphosphate (ADP), collagen and ristocetin. To measure platelet aggregation in whole blood, we used multiple electrode Impedance aggregometry using the same aggregating agents. In PRP, the patient's platelets showed defective aggregation in response to ADP, collagen, epinephrine and partially to ristocetin in all patients. In whole blood, platelet aggregation in response to the same aggregating agents showed similar response and appeared to be very similar to that which occurred in PRP. Whole blood impedance aggregometry seems to give similar results to PRP light transmission aggregometry in patients with TG. Multiple electrode aggregometry (MEA) is faster and more convenient to use in these patients.
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Affiliation(s)
- Abdalla Awidi
- Department of Medicine, Hemostasis and Thrombosis Laboratory, Faculty of medicine, Amman, Jordan.
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Porcelijn L, Huiskes E, Maatman R, de Kreuk A, de Haas M. Acquired Glanzmann's thrombasthenia caused by glycoprotein IIb/IIIa autoantibodies of the immunoglobulin G1 (IgG1), IgG2 or IgG4 subclass: a study in six cases. Vox Sang 2008; 95:324-30. [DOI: 10.1111/j.1423-0410.2008.01093.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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