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Belali TM. Bleeding disorders in Saudi Arabia, causes and prevalence: a review. Blood Coagul Fibrinolysis 2024; 35:67-72. [PMID: 38358894 PMCID: PMC10990020 DOI: 10.1097/mbc.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 02/17/2024]
Abstract
As bleeding disorders are a worldwide health concern, Saudi Arabia is experiencing a notable prevalence of such disorders. Studying the frequency and cause of hemostatic disorders is the key to successful clinical interventions and instigating effective public policies that limit the spread of such disorders. The current review aims to highlight the major findings of the body of literature that has investigated the causes, prevalence, and major challenges associated with bleeding disorders in the country. The current review summarizes the major findings of different studies that have been conducted in Saudi Arabia regarding different bleeding disorders. Multiple causes and symptoms of bleeding disorders have been reported by different studies. Some studies investigated the genetic aspect of bleeding disorders and revealed specific mutations in coagulation factor genes influencing the symptoms of different bleeding disorders. Moreover, rare bleeding disorders such as Glanzmann thrombasthenia and Henoch-Schönlein purpura, have been reported in different regions of Saudi Arabia. Combining clinical presentations, genetic factors, and epidemiological data, the current review of the literature provides a comprehensive insight into bleeding disorders in the kingdom. This will help in advancing the diagnostic capabilities and genetic counseling enhancing management strategies and therapeutic interventions benefiting bleeding disorder patients and the kingdom.
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AlSaleh KA, Al-Numair NS, Alsuaiman A, Zolaly M, Khojah OT, AlZahrani FM, Siddiqui K, Al-Allaf FA, AlMomen A, Sajid R, Owaidah TM. Prevalence of bleeding symptoms among young adults in Saudi Arabia, a national survey. Medicine (Baltimore) 2021; 100:e27513. [PMID: 34713827 PMCID: PMC8556019 DOI: 10.1097/md.0000000000027513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 08/02/2021] [Accepted: 09/23/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Prevalence of bleeding disorders vary due to several factors including geographical location. Mild bleeding disorders can lead to iron deficiency, morbidity, and in severe cases mortality. Quantification of haemorrhagic symptoms is a key component in management of bleeding disorders and a challenging task for clinicians.An abridged version of MCMDM-1vWD questionnaire with validated Arabic translation was used to quantify bleeding disorders in adult students (n = 1138) in 4 different regions of Kingdom of Saudi Arabia. Statistical analysis was performed to indicate gender disparity and prevalence.74.5% of respondents answered at least 1 question with affirmation, with 32.3% affected in Riyadh showing the highest prevalence and 14.03% affected in Dammam showing the least prevalence (P-value < .001). Gender-wise, higher prevalence of bleeding disorders in females 54.9% than in males 45.1% was observed (P-value .01). Epistaxis prevalence was significantly higher in males 30.7% vs 23.2% in females (P-value .0004), while cutaneous symptoms were reported significantly more by female participants 29.7% vs 12.3% in males (P-value < .001). Menorrhagia was reported by 28% of females, with heavy bleeding experienced by 57.6% female participants for <7 days while in 42.4% of females for >7 days.The current study signifies the ethnic distribution and gender disparity of mild bleeding disorders, and highlights the need for national surveillance system in order to improve management of patients with bleeding disorders.
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Affiliation(s)
- Khalid A. AlSaleh
- Department of Medicine, College of Medicine, King Saud University, Riyadh, KSA
| | - Nouf S. Al-Numair
- Centre for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Saudi Arabia
| | - Ayman Alsuaiman
- Research center, King Faisal Specialist Hospital, Alfaisal University, Riyadh, KSA
| | | | - Osamah T. Khojah
- Pathology Department, College of Medicine, King Saud University
- Corporate Medical Affairs, Dr. Sulaiman Alhabib Medical Group
| | - Faisal M. AlZahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Khawar Siddiqui
- Department of Statistics, King Faisal Specialist Hospital, Alfaisal University, Riyadh, KSA
| | - Faisal A. Al-Allaf
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, KSA
| | - Abdulkareem AlMomen
- Department of Pathology, College of Medicine, King Saud University, Riyadh, KSA
| | - Raihan Sajid
- Department of Pathology, Alfaisal University, Riyadh, KSA
| | - Tarek M. Owaidah
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, KSA
- Alfaisal University, Riyadh, KSA
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Zolaly MA, Tarwah A, Albalawi M, Alwasaidi T, Owaidah T. The prevalence of self-reported bleeding tendency symptoms among adolescents in Almadinah Almunawwarah, Kingdom of Saudi Arabia. J Family Med Prim Care 2021; 10:826-830. [PMID: 34041084 PMCID: PMC8138373 DOI: 10.4103/jfmpc.jfmpc_1480_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/17/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022] Open
Abstract
Bleeding tendency is a common medical problem that is usually caused by either coagulation factors abnormalities, platelets disorders, or vasculopathy. Detection of patients with high bleeding risk through history taking and accurate diagnosis followed by appropriate management will help decreasing chances of significant complications. Methodology A cross-sectional survey of a random sample of adolescent students in the preparatory year at Taibah University in Almadinah Almunawwarah, Saudi Arabia were interviewed using a validated semi-structured condensed bleeding tendency questionnaire generated from Molecular and Clinical Markers for the Diagnosis and Management of (MCMDM-1). Results A total of 680 questionnaires were collected, the phase I data were analyzed to determine participants who gave a positive response to any related question while in Phase II respondents with at least one positive response of any bleeding symptom were interviewed. More than half 52.6% (358 out of 680) were positive for any bleeding symptoms. The incidence rose to 70.9% (482 out of 680) if "Mild" symptoms were also included. Epistaxis was positive in 21.8%, Cutaneous symptoms were reported by 22.65%, Bleeding from the oral cavity was reported in 39.6%, Gastrointestinal bleeding was observed by 5.9%, bleeding after the first surgery reported in 21% and Muscle hematomas/hemoarthrosis was observed by 3.2%, Among female papulation, 16.1% reported having 6-10 "Heavy Days" during their menstrual cycles. Discussion High prevalence of bleeding symptoms having the possibility of the presence of an Inherited Bleeding Disorders were observed in our study in comparison to other studies, this might be attributed to the high percentage of consanguinity marriages in our area. Recommendations Raising awareness among family doctors and pediatricians about the possibility of presence of bleeding tendency utilizing good history taking followed by appropriate examination and laboratory confirmatory testing will help in early detection and managements.
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Affiliation(s)
- Mohammed A Zolaly
- Department of Pediatrics, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | - Ahmad Tarwah
- Department of Pediatrics, Madinah Maternity Children Hospital, Almadinah Almunawwarah, Saudi Arabia
| | - Mohammed Albalawi
- Department of Internal Medicine, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | - Turki Alwasaidi
- Department of Internal Medicine, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | - Tarek Owaidah
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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AlSaleh KA, Al-Numair N, AlSuliman A, Zolaly M, Albanyan AM, AlOtaishan N, Abudouleh E, Bayoumy N, Tarawah A, AlZahrani F, AlAllaf F, AlMomen AK, Sajid R, Owaidah TM. Prevalence of Coagulation Factors Deficiency among Young Adults in Saudi Arabia: A National Survey. TH OPEN 2020; 4:e457-e462. [PMID: 33376945 PMCID: PMC7758154 DOI: 10.1055/s-0040-1721500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/27/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction
Inherited bleeding disorders vary in prevalence due to genetic disparity and ethnicity. Little is known about the prevalence of coagulation factor deficiency and bleeding disorders in middle-eastern population.
Methods
Young Saudi adults with at least one positive bleeding symptom reported in semi-structured validated condensed MCMDM-1vWD questionnaire were tested for complete blood count, routine and special coagulation tests, serum ferritin level, and capillary zone electrophoresis. After initial testing, those with prolonged prothrombin time (PT) or activated prothrombin time (APTT) had further testing to evaluate coagulation factors level. Platelet function was tested through platelet function analyzer (PFA)-100, and multiplate aggregometer (MEA) on patients suspected of having platelet disorders.
Results
Six-hundred-forty patients (male = 347, 54.2%) were included. A possible platelet function defect was diagnosed in three patients with one matching Glanzmann's thrombasthenia trait pattern, and one that of Bernard-Soulier trait pattern. One patient was diagnosed with von Willebrand disease. Deficiencies in coagulation factor levels were revealed as F-VIII in 14 (7.4%), F-IX in 15 (7.6%), F-II in two (3.3%), F-V in 17 (26.1%), FVII in two (3.1%), and F-X in one (1.8%) of study subjects; low vWF activity (<50%) was found in 14 (8%). Abnormal values were found for various laboratory tests with prolongation of platelet function analyzer-epinephrine (PFA-EPI) in 11%, PFA-ADP or arachidonic acid in 15.2%, PT in 35.9%, and APTT in 63.7%. Five-hundred-seventy-six patients (90%) had normal results in the coagulation factor assays and were categorized as patients with bleeding of unknown cause (BUC). A diagnosis of a bleeding disorder was more frequently made in men than in women (38 vs. 26). Iron deficiency anemia was found in 18 (25%) females positively associated with F-IX deficiency (
p
-value 0.000). Male gender (73.3%,
p
= 0.007) was independently associated with the diagnosis of coagulation factor deficiency.
Conclusion
The current study reports a higher prevalence of coagulation factors deficiency in Saudi population than reported in the western population.
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Affiliation(s)
- Khalid A AlSaleh
- Department of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Al-Numair
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ayman AlSuliman
- Research Center, King Faisal Specialist Hospital, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammed Zolaly
- Department of Pediatric, Taibah University, Medina, Saudi Arabia
| | | | - Nouf AlOtaishan
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Esra Abudouleh
- College of Medical Applied Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Nervana Bayoumy
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Tarawah
- Medina Maternity and Children Hospital, Medina, Saudi Arabia
| | - Faisal AlZahrani
- Department of Pathology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal AlAllaf
- Department of Molecular Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Abdul Kareem AlMomen
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Raihan Sajid
- Department of Pathology, Alfaisal University, Riyadh, Saudi Arabia
| | - Tarek M Owaidah
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Alfaisal University, Riyadh, Saudi Arabia
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Abstract
RAS (KRAS, NRAS and HRAS) is the most frequently mutated gene family in cancers, and, consequently, investigators have sought an effective RAS inhibitor for more than three decades. Even 10 years ago, RAS inhibitors were so elusive that RAS was termed 'undruggable'. Now, with the success of allele-specific covalent inhibitors against the most frequently mutated version of RAS in non-small-cell lung cancer, KRASG12C, we have the opportunity to evaluate the best therapeutic strategies to treat RAS-driven cancers. Mutation-specific biochemical properties, as well as the tissue of origin, are likely to affect the effectiveness of such treatments. Currently, direct inhibition of mutant RAS through allele-specific inhibitors provides the best therapeutic approach. Therapies that target RAS-activating pathways or RAS effector pathways could be combined with these direct RAS inhibitors, immune checkpoint inhibitors or T cell-targeting approaches to treat RAS-mutant tumours. Here we review recent advances in therapies that target mutant RAS proteins and discuss the future challenges of these therapies, including combination strategies.
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Prevalence of Bleeding Symptoms among Adolescents and Young Adults in the Capital City of Saudi Arabia. Adv Hematol 2018; 2018:1858241. [PMID: 29853900 PMCID: PMC5954960 DOI: 10.1155/2018/1858241] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/25/2018] [Indexed: 11/21/2022] Open
Abstract
Background Bleeding disorders vary in prevalence. While some are rare, some can be common in both sexes. Most bleeding disorders manifest as chronic bleeding tendencies or as an increase in bleeding during surgical procedures or trauma. The consequences of bleeding can be as simple as iron deficiency or catastrophic, resulting in severe morbidity and mortality. Bleeding disorders typically affect both sexes except hemophilia A and B, which mainly affects males. Method We conducted a questionnaire-based survey among adolescents and young adults (1901 [49%] boys, 1980 [51%] girls) in Riyadh city regarding bleeding symptoms. Of these, 1849 (47.6%) responded “Yes/Positive” for at least one question about the bleeding symptoms. Results The most common bleeding symptom was epistaxis (19.7% of the sample population) detected in Phase I of the study. A tandem survey was conducted among 525 adolescents who had responded “Yes/Positive” to any one of the questions inquiring about bleeding symptoms. Conclusion In this study, we report for the first time the prevalence of bleeding symptoms in a representative sample of Saudi adolescents and young adults.
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Gupta M, Bhattacharyya M, Choudhry VP, Saxena R. Spectrum of Inherited Bleeding Disorders in Indians. Clin Appl Thromb Hemost 2016; 11:325-30. [PMID: 16015418 DOI: 10.1177/107602960501100311] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of hereditary hemorrhagic disorders may vary according to the country and ethnic origin. Von Willebrand disease has emerged as the most common hereditary hemorrhagic disease in the industrialized world. In this series of 966 patients diagnosed to have inherited bleeding disorders, hemophilia A was the most common and was seen in 410 (42.4%) of the patients followed by platelet function defects seen in 380 (39.4%) of the patients. It is thus concluded that, similar to the white population, hemophilia A remains the most common bleeding disorder in the Indian population, although this is closely followed by platelet function defects in India, which are quite rare in whites. Von Willebrand disease is relatively rare in the Indian population.
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Affiliation(s)
- Meenal Gupta
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, 110 029, India
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9
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Anwer A, Hanley J, Kumarendran K. Proposed management of pregnancy and labour in an inherited platelet disorder, Glanzmann's thrombasthenia. J OBSTET GYNAECOL 2009; 27:421-3. [PMID: 17654200 DOI: 10.1080/01443610701325705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A Anwer
- Friarage Hospital and James Cook University Hospital, Middlesbrough, UK.
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Ahmad F, Kannan M, Ranjan R, Bajaj J, Choudhary VP, Saxena R. Inherited platelet function disorders versus other inherited bleeding disorders: an Indian overview. Thromb Res 2007; 121:835-41. [PMID: 17850851 DOI: 10.1016/j.thromres.2007.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 07/23/2007] [Accepted: 07/26/2007] [Indexed: 10/22/2022]
Abstract
Inherited deficiencies of plasma proteins involved in blood coagulation generally lead to lifelong bleeding disorders, whose severity is directly proportional to the degree of factor deficiency. Platelet and other coagulation factors play an important role in the haemostasis mechanism. We attempted to study the prevalence of inherited platelet function disorders (PFDs) and correlate with other coagulation factor disorders in the Indian population. Patients with PFDs and other coagulation factor disorders who presented at our hospital during the 5 year period (from January, 2001 to December, 2005) were the subjects of the study. A total of 1576 patients were diagnosed to have congenital bleeding disorders including PFDs, von Willebrand disease, haemophilia A and B and rare coagulation disorder cases. Haemophilia A (HA) was the most common and was seen in 52.31% of the patients followed by total PFDs seen in 27.77% of the patients. Based on severity of the disease, the results of PFDs were highly significant when compared to haemophilia and von Willebrand disease (VWD) (p=0.000). Severity was found higher in HA (77.8%) followed by HB (69.6%) and was found lower for PF3 availability defect (9.0%). It has been concluded that the prevalence of PFDs is relatively low as compared to coagulation factors related disorder and also it has been established that type-1 VWD is relatively less frequent in India as compared to the West.
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Affiliation(s)
- Firdos Ahmad
- Department of Haematology, IRCH Building 1st floor, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India
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Bolton-Maggs PHB, Chalmers EA, Collins PW, Harrison P, Kitchen S, Liesner RJ, Minford A, Mumford AD, Parapia LA, Perry DJ, Watson SP, Wilde JT, Williams MD. A review of inherited platelet disorders with guidelines for their management on behalf of the UKHCDO. Br J Haematol 2006; 135:603-33. [PMID: 17107346 DOI: 10.1111/j.1365-2141.2006.06343.x] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The inherited platelet disorders are an uncommon cause of symptomatic bleeding. They may be difficult to diagnose (and are likely to be under-diagnosed) and pose problems in management. This review discusses the inherited platelet disorders summarising the current state of the art with respect to investigation and diagnosis and suggests how to manage bleeding manifestations with particular attention to surgical interventions and the management of pregnancy.
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ROSENBERG N, HAUSCHNER H, PERETZ H, MOR-COHEN R, LANDAU M, SHENKMAN B, KENET G, COLLER BS, AWIDI AA, SELIGSOHN U. A 13-bp deletion in alpha(IIb) gene is a founder mutation that predominates in Palestinian-Arab patients with Glanzmann thrombasthenia. J Thromb Haemost 2005; 3:2764-72. [PMID: 16359514 PMCID: PMC1557653 DOI: 10.1111/j.1538-7836.2005.01618.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glanzmann thrombasthenia (GT) is a rare autosomal recessive bleeding disorder caused by lack or dysfunction of alpha(IIb)beta3 in platelets. GT is relatively frequent in highly inbred populations. We previously identified a 13-bp deletion in the alpha(IIb) gene that causes in-frame deletion of six amino acids in three Palestinian GT patients. In this study, we determined the molecular basis of GT in all known Palestinian patients, examined whether Jordanian patients harbor the same mutations, analyzed whether there is a founder effect for the 13-bp deletion, and determined the mechanism by which the 13-bp deletion abolishes alpha(IIb)beta3 surface expression. Of 11 unrelated Palestinian patients, eight were homozygous for the 13-bp deletion that displayed common ancestry by haplotype analysis, and was estimated to have occurred 300-600 years ago. Expression studies in baby hamster kidney cells showed that substitution of Cys107 or Trp110 located within the deletion caused defective alpha(IIb)beta3 maturation. Substitution of Trp110, but not of Cys107, prevented fibrinogen binding. The other Palestinian patients harbored three novel mutations: G2374 deletion in alpha(IIb) gene, TT1616-7 deletion in beta3 gene, and IVS14: -3C --> G in beta3 gene. The latter mutation caused cryptic splicing predicting an extended cytoplasmic tail of beta3 and was expressed as dysfunctional alpha(IIb)beta(3). None of 15 unrelated Jordanian patients carried any of the described mutations.
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Affiliation(s)
- N. ROSENBERG
- Amalia Biron Research Institute of Thrombosis and Hemostasis, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H. HAUSCHNER
- Amalia Biron Research Institute of Thrombosis and Hemostasis, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H. PERETZ
- Clinical Biochemistry Laboratory, Sourasky Medical Center, Tel Aviv, Israel
| | - R. MOR-COHEN
- Amalia Biron Research Institute of Thrombosis and Hemostasis, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M. LANDAU
- Department of Biochemistry, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - B. SHENKMAN
- Amalia Biron Research Institute of Thrombosis and Hemostasis, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - G. KENET
- Amalia Biron Research Institute of Thrombosis and Hemostasis, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - B. S. COLLER
- Laboratory of Blood and Vascular Biology, Rockefeller University New York, NY, USA; and
| | | | - U. SELIGSOHN
- Amalia Biron Research Institute of Thrombosis and Hemostasis, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Glanzmann Thrombasthenia Caused by an 11.2-kb Deletion in the Glycoprotein IIIa (β3 ) Is a Second Mutation in Iraqi Jews That Stemmed From a Distinct Founder. Blood 1997. [DOI: 10.1182/blood.v89.10.3654] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractGlanzmann thrombasthenia (GT) is a rare bleeding disorder resulting from mutations in either glycoprotein (GP) IIb or GPIIIa genes. The disease is relatively frequent in highly inbred populations such as Iraqi Jews. The molecular basis of GT in 6 unrelated Iraqi-Jewish patients was previously identified as an 11-bp deletion in exon 12 of the GPIIIa gene. We now describe a second mutation found in 3 unrelated Iraqi-Jewish families that consists of an 11.2-kb deletion between an Alu repeat in intron 9 and exon 13 of the GPIIIa gene. The mutant DNA is transcribed into mRNA in which exons 10 through 13 are absent. Splicing of exon 9 directly to exon 14 leads to a shift in the reading frame resulting in a stop codon. The predicted protein is truncated in the middle of the third cysteine-rich domain before the transmembrane domain. Simple DNA-based methods were devised for identification of both mutations in Iraqi Jews for the purpose of carrier detection and prenatal diagnosis enabling prevention of GT. A survey of the general Iraqi-Jewish population for the first 11-bp deletion and the second 11.2-kb deletion disclosed that the allele frequency of the first mutation was 0.0043, whereas none of 700 individuals examined bore the second mutation (allele frequency <0.0007). Among 40 GT patients of Iraqi-Jewish origin 31 were homozygous for the first mutation, 4 were compound heterozygotes for the first and second mutations, and 2 were homozygous for the second mutation. Haplotype analyses using 4 polymorphic markers in the GPIIIa gene showed that each mutation originated in a distinct founder.
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14
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Glanzmann Thrombasthenia Caused by an 11.2-kb Deletion in the Glycoprotein IIIa (β3 ) Is a Second Mutation in Iraqi Jews That Stemmed From a Distinct Founder. Blood 1997. [DOI: 10.1182/blood.v89.10.3654.3654_3654_3662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Glanzmann thrombasthenia (GT) is a rare bleeding disorder resulting from mutations in either glycoprotein (GP) IIb or GPIIIa genes. The disease is relatively frequent in highly inbred populations such as Iraqi Jews. The molecular basis of GT in 6 unrelated Iraqi-Jewish patients was previously identified as an 11-bp deletion in exon 12 of the GPIIIa gene. We now describe a second mutation found in 3 unrelated Iraqi-Jewish families that consists of an 11.2-kb deletion between an Alu repeat in intron 9 and exon 13 of the GPIIIa gene. The mutant DNA is transcribed into mRNA in which exons 10 through 13 are absent. Splicing of exon 9 directly to exon 14 leads to a shift in the reading frame resulting in a stop codon. The predicted protein is truncated in the middle of the third cysteine-rich domain before the transmembrane domain. Simple DNA-based methods were devised for identification of both mutations in Iraqi Jews for the purpose of carrier detection and prenatal diagnosis enabling prevention of GT. A survey of the general Iraqi-Jewish population for the first 11-bp deletion and the second 11.2-kb deletion disclosed that the allele frequency of the first mutation was 0.0043, whereas none of 700 individuals examined bore the second mutation (allele frequency <0.0007). Among 40 GT patients of Iraqi-Jewish origin 31 were homozygous for the first mutation, 4 were compound heterozygotes for the first and second mutations, and 2 were homozygous for the second mutation. Haplotype analyses using 4 polymorphic markers in the GPIIIa gene showed that each mutation originated in a distinct founder.
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15
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Al-Fawaz IM, Gader AM, Bahakim HM, Al-Mohareb F, Al-Momen AK, Harakati MS. Hereditary bleeding disorders in Riyadh, Saudi Arabia. Ann Saudi Med 1996; 16:257-61. [PMID: 17372424 DOI: 10.5144/0256-4947.1996.257] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The result of an eight-year retrospective analysis of patients with hereditary bleeding disorders (HBD) at King Khalid University Hospital, Riyadh, is presented. One hundred and sixty-eight patients referred for investigation for suspected bleeding disorders had bleeding symptoms which fulfilled the criteria for HBD and were categorized as follows: 1) coagulation factor deficiencies: 41 patients had hemophilia A, while 16 had hemophila B; two patients each had factors XI and XII deficiency; four patients each had factors V and VIII deficiency and one patient had factor VII deficiency. There were two patients with dysfibrinogenemias and one with afibrinogenemia. 2) Von Willerbrand's disease was the second most common cause of HBD-25 patients were encountered in 15 different families. 3) Qualitative platelet disorders consisted of Glanzmann's thrombasthenia, with 18 patients, Bernard-Soulier disease, with five patients, and other qualitative platelet disorders, with 33 patients. 4) In 14 patients who presented with a history of bleeding, the only abnormality noted was prolongation of the bleeding time and normal coagulation and platelet function, and no definitive diagnoses could be established. The distribution of hereditary bleeding disorders obtained in this study resembles what has already been established in Western countries, with the exception of an increase of platelet disorders, mostly due to the increased rate of consanguinity in the community.
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Affiliation(s)
- I M Al-Fawaz
- Departments of Pediatrics, Physiology, Internal Medicine, College of Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia
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Kalafatis M, Swords NA, Rand MD, Mann KG. Membrane-dependent reactions in blood coagulation: role of the vitamin K-dependent enzyme complexes. BIOCHIMICA ET BIOPHYSICA ACTA 1994; 1227:113-29. [PMID: 7986819 DOI: 10.1016/0925-4439(94)90086-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M Kalafatis
- Department of Biochemistry, College of Medicine, University of Vermont Burlington 05405
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Nathwani AC, Tuddenham EG. Epidemiology of coagulation disorders. BAILLIERE'S CLINICAL HAEMATOLOGY 1992; 5:383-439. [PMID: 1511181 DOI: 10.1016/s0950-3536(11)80025-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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