Statistical analysis of Glanzmann's thrombasthenia in Japan

Treatment and outcomes for epistaxis in children with Glanzmann's thrombasthenia

OBJECTIVES/HYPOTHESIS

:To understand Glanzmann's thrombasthenia and provide insight to the management of epistaxis in children with this disease.

STUDY DESIGN

Retrospective chart review.

METHODS

All children diagnosed with Glanzmann's thrombasthenia and treated for epistaxis at Children's Hospitals and Clinics of Minnesota were identified and a retrospective chart review was performed. Outpatient charts, hospitalization records, and operative reports were reviewed from 1999 up to 2009 and appropriate data were extracted. The episodes of epistaxis, therapy used, complications, and success rates for controlling hemorrhage were noted.

RESULTS

Five children with a total of 63 clinical encounters for epistaxis were identified. Forty-seven encounters required hospitalization, close to half of which necessitated medical care in the intensive care unit. Nearly all encounters required infusion of hemostatic therapy with either single or multiple agents. Seventy-one procedures for life-threatening hemorrhage were performed. The most common (n = 24) intervention was administration of bovine collagen matrix, which was successful only half of the time (50%). Anterior and posterior nasal packing with or without hemostatic material completely resolved hemorrhage in 35% of the procedures.

CONCLUSIONS

To date, no form of medical or surgical intervention in children with this condition has consistently demonstrated its ability resolve nasal hemorrhage. The role of the otolaryngologist is to control bleeding during major episodes of nasal hemorrhage that do not respond to medical management. These patients usually have remarkable improvement in the frequency and severity of epistaxis in adolescence and then require much less aggressive therapy.

Glanzmann's thrombasthenia: an overview

Glanzmann's thrombasthenia (GT) is an autosomal recessive inherited bleeding disorder due to a defect in platelet function. The hallmark of this disease is severely reduced/absent platelet aggregation in response to multiple physiological agonists. Bleeding signs in GT include epistaxis, bruising, gingival hemorrhage, gastrointestinal hemorrhage, hematuria, menorrhagia, and hemarthrosis. Homozygous or compound heterozygous mutations in the genes of GPIIb and GPIIIa lead to GT. A patient with GT, with no possible causative mutations in GPIIb and GPIIIa genes, may harbor defects in a regulatory element affecting the transcription of these 2 genes. GT occurs in high frequency in certain ethnic populations with an increased incidence of consanguinity such as in Indians, Iranians, Iraqi Jews, Palestinian and Jordanian Arabs, and French Gypsies. Carrier detection in GT is important to control the disorder in family members. Carrier detection can be done both by protein analysis and direct gene analysis.