1
|
Marconi C, Pecci A, Palombo F, Melazzini F, Bottega R, Nardi E, Bozzi V, Faleschini M, Barozzi S, Giangregorio T, Magini P, Balduini CL, Savoia A, Seri M, Noris P, Pippucci T. Exome sequencing in 116 patients with inherited thrombocytopenia that remained of unknown origin after systematic phenotype-driven diagnostic workup. Haematologica 2023; 108:1909-1919. [PMID: 36519321 PMCID: PMC10316235 DOI: 10.3324/haematol.2022.280993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/29/2022] [Indexed: 11/01/2023] Open
Abstract
Inherited thrombocytopenias (IT) are genetic diseases characterized by low platelet count, sometimes associated with congenital defects or a predisposition to develop additional conditions. Next-generation sequencing has substantially improved our knowledge of IT, with more than 40 genes identified so far, but obtaining a molecular diagnosis remains a challenge especially for patients with non-syndromic forms, having no clinical or functional phenotypes that raise suspicion about specific genes. We performed exome sequencing (ES) in a cohort of 116 IT patients (89 families), still undiagnosed after a previously validated phenotype-driven diagnostic algorithm including a targeted analysis of suspected genes. ES achieved a diagnostic yield of 36%, with a gain of 16% over the diagnostic algorithm. This can be explained by genetic heterogeneity and unspecific genotype-phenotype relationships that make the simultaneous analysis of all the genes, enabled by ES, the most reasonable strategy. Furthermore, ES disentangled situations that had been puzzling because of atypical inheritance, sex-related effects or false negative laboratory results. Finally, ES-based copy number variant analysis disclosed an unexpectedly high prevalence of RUNX1 deletions, predisposing to hematologic malignancies. Our findings demonstrate that ES, including copy number variant analysis, can substantially contribute to the diagnosis of IT and can solve diagnostic problems that would otherwise remain a challenge.
Collapse
Affiliation(s)
- Caterina Marconi
- Department of Medical and Surgical Science, University of Bologna, Bologna
| | - Alessandro Pecci
- Department of Internal Medicine, University of Pavia, Pavia, Italy; Medicina Generale 1, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Flavia Palombo
- Department of Medical and Surgical Science, University of Bologna, Bologna
| | - Federica Melazzini
- Department of Internal Medicine, University of Pavia, Pavia, Italy; Medicina Generale 1, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Roberta Bottega
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste
| | - Elena Nardi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna
| | - Valeria Bozzi
- Medicina Generale 1, IRCCS Policlinico San Matteo Foundation, Pavia
| | | | - Serena Barozzi
- Medicina Generale 1, IRCCS Policlinico San Matteo Foundation, Pavia
| | | | - Pamela Magini
- Medical Genetics Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna
| | | | - Anna Savoia
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy; Department of Medical Sciences, University of Trieste, Trieste
| | - Marco Seri
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; Medical Genetics Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna.
| | - Patrizia Noris
- Department of Internal Medicine, University of Pavia, Pavia, Italy; Medicina Generale 1, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Tommaso Pippucci
- Medical Genetics Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna
| |
Collapse
|
2
|
Asperges E, Albi G, Zuccaro V, Sambo M, Pieri TC, Calia M, Colaneri M, Maiocchi L, Melazzini F, Lasagna A, Peri A, Mojoli F, Sacchi P, Bruno R. Dynamic NLR and PLR in Predicting COVID-19 Severity: A Retrospective Cohort Study. Infect Dis Ther 2023:10.1007/s40121-023-00813-1. [PMID: 37198387 DOI: 10.1007/s40121-023-00813-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION The hyperinflammation phase of severe SARS-CoV-2 is characterised by complete blood count alterations. In this context, the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) can be used as prognostic factors. We studied NLR and PLR trends at different timepoints and computed optimal cutoffs to predict four outcomes: use of continuous positive airways pressure (CPAP), intensive care unit (ICU) admission, invasive ventilation and death. METHODS We retrospectively included all adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia admitted from 23 January 2020 to 18 May 2021. Analyses included non-parametric tests to study the ability of NLR and PLR to distinguish the patients' outcomes at each timepoint. Receiver operating characteristic (ROC) curves were built for NLR and PLR at each timepoint (minus discharge) to identify cutoffs to distinguish severe and non-severe disease. Their statistical significance was assessed with the chi-square test. Collection of data under the SMACORE database was approved with protocol number 20200046877. RESULTS We included 2169 patients. NLR and PLR were higher in severe coronavirus disease 2019 (COVID-19). Both ratios were able to distinguish the outcomes at each timepoint. For NLR, the areas under the receiver operating characteristic curve (AUROC) ranged between 0.59 and 0.81, and for PLR between 0.53 and 0.67. From each ROC curve we computed an optimal cutoff value. CONCLUSION NLR and PLR cutoffs are able to distinguish severity grades and mortality at different timepoints during the course of disease, and, as such, they allow a tailored approach. Future prospects include validating our cutoffs in a prospective cohort and comparing their performance against other COVID-19 scores.
Collapse
Affiliation(s)
- Erika Asperges
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Albi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100, Pavia, Italy
| | - Valentina Zuccaro
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Margherita Sambo
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, Pavia, Italy
| | - Teresa C Pieri
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, Pavia, Italy
| | - Matteo Calia
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, Pavia, Italy
| | - Marta Colaneri
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Maiocchi
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Melazzini
- U.O.C. Medicina Interna Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Angioletta Lasagna
- U.O.C. Oncologia Medica Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Peri
- Dipartimento di Chirurgia Fondazione, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Mojoli
- U.O.C. Anestesia e Rianimazione Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Sacchi
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- U.O.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, Pavia, Italy.
| |
Collapse
|
3
|
Bergamaschi G, Barteselli C, Del Rio V, Borrelli de Andreis F, Pellegrino I, Mengoli C, Miceli E, Colaneri M, Zuccaro V, Di Stefano M, Bruno R, Di Sabatino A, Achilli G, Alimenti E, Alunno G, Antoci V, Aprile M, Argelli A, Aronico N, Ballesio A, Bellini G, Berbenni A, Bertolino G, Bianchi PI, Biserni S, Bonfichi A, Bosoni T, Brattoli M, Calabretta F, Callisti M, Cambiè G, Canta R, Canu P, Cebrelli C, Cecco A, Cicalini C, Clemente M, Clerici L, Codega S, Conca F, Coppola L, Costanzo F, Cremonte ME, Cresci R, Delliponti M, Del Rio V, Delogu C, Derosa G, Dionisi D, Di Terlizzi F, Dota M, Falaschi F, Fazzino E, Ferrami L, Ferrara S, Ferrari MG, Ferruccio N, Freddi G, Frenna C, Frigerio C, Fumoso F, Fusco A, Galeazzo A, Gaspari V, Gentile A, Giangreco A, Gori G, Grandi G, Gregorio V, Grimaldi P, Italia A, Lapia F, Latorre MA, Lenti MV, Lepore F, Lobello A, Lovati E, Lucotti PC, Lusetti F, Maimaris S, Mambella J, Martignoni A, Melazzini F, Mercanti C, Merli S, Moltisanti GC, Monti ME, Morbegno L, Mordà F, Mugellini A, Muggia C, Muscia R, Nardone A, Padovini L, Palumbo I, Parisi IM, Pecci A, Peroo GP, Petrucci C, Pieresca C, Pino G, Pitotti L, Poma S, Preti PS, Quadrelli A, Rascaroli A, Rigano G, Rossi CM, Rotola G, Ruggeri D, Russo MC, Sabatini U, Saglio S, Santacroce G, Savioli G, Savioli J, Scalia SS, Scalvini D, Shoval Y, Soffiantini C, Soriano S, Spadaro D, Staniscia A, Stefani D, Vai F, Varallo M, Vernero M. Impaired respiratory function reduces haemoglobin oxygen affinity in COVID-19. Br J Haematol 2023; 200:e44-e47. [PMID: 36572525 PMCID: PMC9880731 DOI: 10.1111/bjh.18620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/21/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Gaetano Bergamaschi
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Barteselli
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine & Medical Therapy, University of Pavia, Pavia, Italy
| | - Virginia Del Rio
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine & Medical Therapy, University of Pavia, Pavia, Italy
| | - Federica Borrelli de Andreis
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine & Medical Therapy, University of Pavia, Pavia, Italy
| | - Ivan Pellegrino
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine & Medical Therapy, University of Pavia, Pavia, Italy
| | - Caterina Mengoli
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuela Miceli
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Colaneri
- Division of Infectious and Tropical Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical Surgical Diagnostic & Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Valentina Zuccaro
- Division of Infectious and Tropical Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michele Di Stefano
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Division of Infectious and Tropical Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical Surgical Diagnostic & Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine & Medical Therapy, University of Pavia, Pavia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Perrone T, Falaschi F, Meloni F, Ballesio A, Sabatini U, Lenti MV, Melazzini F, Lettieri S, Novati S, Cutti S, Marioli CM, Klersy C, Bruno R, Oltrona Visconti L, Di Sabatino A. A mid-term follow-up with a lung ultrasonographic score correlates with the severity of COVID-19 acute phase. Intern Emerg Med 2023; 18:163-168. [PMID: 36469248 PMCID: PMC9734680 DOI: 10.1007/s11739-022-03144-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/21/2022] [Indexed: 12/09/2022]
Abstract
Lung ultrasound (LUS) has rapidly emerged in COVID-19 diagnosis and for the follow-up during the acute phase. LUS is not yet used routinely in lung damage follow-up after COVID-19 infection. We investigated the correlation between LUS score, and clinical and laboratory parameters of severity of SARS-COV-2 damage during hospitalization and at follow-up visit. Observational retrospective study including all the patients discharged from the COVID-19 wards, who attended the post-COVID outpatient clinic of the IRCCS Policlinico San Matteo in April-June 2020. 115 patients were enrolled. Follow-up visits with LUS score measurements were at a median of 38 days (IQR 28-48) after discharge. LUS scores were associated with the length of hospitalization (p < 0.001), patients' age (p = 0.036), use of non-invasive ventilation (CPAP p < 0.001 or HFNC p = 0.018), administration of corticosteroids therapy (p = 0.030), and laboratory parameters during the acute phase (WBC p < 0.001, LDH p < 0.001, CRP p < 0.001, D-dimer p = 0.008, IL-6 p = 0.045), and inversely correlated with lymphocyte count (p = 0.007). We found correlation between LUS score and both LDH (p = 0.001) and the antibody anti-SARS-CoV-2 titers (p value = 0.008). Most of these finding were confirmed by dichothomizing the LUS score (≤ 9 or > 9 points). We found a significantly higher LUS score at the follow-up in the patients with persistent dyspnea (7.00, IQR 3.00-11.00) when compared to eupnoeic patients (3.00, IQR 0-7.00 p < 0.001). LUS score at follow-up visit correlates with more severe lung disease. These findings support the hypothesis that ultrasound could be a valid tool in the follow-up medium-term COVID-19 lung damage.
Collapse
Affiliation(s)
- Tiziano Perrone
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Francesco Falaschi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federica Meloni
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Alessia Ballesio
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Umberto Sabatini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Sara Lettieri
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Stefano Novati
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Sara Cutti
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carola Maria Marioli
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Luigi Oltrona Visconti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| |
Collapse
|
5
|
Lenti MV, Uderzo S, Rossi CM, Melazzini F, Klersy C, Ferretti VV, Di Sabatino A. Determinants of COVID-19-related mortality in an internal medicine setting. Intern Emerg Med 2022; 17:2169-2173. [PMID: 35906347 PMCID: PMC9520996 DOI: 10.1007/s11739-022-03057-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Marco Vincenzo Lenti
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Stefano Uderzo
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Carlo Maria Rossi
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federica Melazzini
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Virginia Valeria Ferretti
- Clinical Epidemiology and Biometry, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| |
Collapse
|
6
|
Lenti MV, Rossi CM, Melazzini F, Gastaldi M, Bugatti S, Rotondi M, Bianchi PI, Gentile A, Chiovato L, Montecucco C, Corazza GR, Di Sabatino A. Seronegative autoimmune diseases: A challenging diagnosis. Autoimmun Rev 2022; 21:103143. [PMID: 35840037 DOI: 10.1016/j.autrev.2022.103143] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/10/2022] [Indexed: 12/19/2022]
Abstract
Autoimmune diseases (AID) are increasingly prevalent conditions which comprise more than 100 distinct clinical entities that are responsible for a great disease burden worldwide. The early recognition of these diseases is key for preventing their complications and for tailoring proper management. In most cases, autoantibodies, regardless of their potential pathogenetic role, can be detected in the serum of patients with AID, helping clinicians in making a definitive diagnosis and allowing screening strategies for early -and sometimes pre-clinical- diagnosis. Despite their undoubted crucial role, in a minority of cases, patients with AID may not show any autoantibody, a condition that is referred to as seronegative AID. Suboptimal accuracy of the available laboratory tests, antibody absorption, immunosuppressive therapy, immunodeficiencies, antigen exhaustion, and immunosenescence are the main possible determinants of seronegative AID. Indeed, in seronegative AID, the diagnosis is more challenging and must rely on clinical features and on other available tests, often including histopathological evaluation and radiological diagnostic tests. In this review, we critically dissect, in a narrative fashion, the possible causes of seronegativity, as well as the diagnostic and management implications, in several AID including autoimmune gastritis, celiac disease, autoimmune liver disease, rheumatoid arthritis, autoimmune encephalitis, myasthenia gravis, Sjögren's syndrome, antiphospholipid syndrome, and autoimmune thyroid diseases.
Collapse
Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Carlo Maria Rossi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Serena Bugatti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Unit of Rheumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Mario Rotondi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
| | - Paola Ilaria Bianchi
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Antonella Gentile
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Luca Chiovato
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Unit of Rheumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
| |
Collapse
|
7
|
Melazzini F, Calabretta F, Lenti MV, Di Sabatino A. Venous thromboembolism in chronic gastrointestinal disorders. Expert Rev Gastroenterol Hepatol 2022; 16:437-448. [PMID: 35502886 DOI: 10.1080/17474124.2022.2072295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic gastrointestinal disorders (including autoimmune gastritis, celiac disease, inflammatory bowel disease, and diverticular disease) are highly prevalent disorders, that may be associated with unpredictable, life-threatening complications, such as thromboembolic events. Venous thromboembolism (VTE) is one of the major causes of morbidity and mortality worldwide. Several conditions, including cancer, major trauma, surgery, prolonged immobilization, are well-established risk factors for VTE. Over the past decade, chronic inflammation has also been identified as an independent risk factor for VTE due to the prothrombotic effects of inflammatory cytokines and oxidative stress on the coagulation cascade. Other several mechanisms were shown to be associated with a higher incidence of VTE in patients with gastrointestinal disorders. AREAS COVERED We critically discuss the latest insights into the mechanisms responsible for thromboembolic manifestations in chronic gastrointestinal disorders, also focusing on the recognition of risk factors and treatment. EXPERT OPINION The occurrence of thrombotic complications is underestimated in patients with chronic gastrointestinal disorders. Identifying potential risk factors and concomitant predisposing conditions and to prevent VTE and guide treatment require a multidisciplinary approach, and this is critically important for clinicians, in order to provide the best care for such patients.
Collapse
Affiliation(s)
- Federica Melazzini
- Department of Internal Medicine, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Calabretta
- Department of Internal Medicine, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| |
Collapse
|
8
|
Melazzini F, Reduzzi M, Quaglini S, Fumoso F, Lenti MV, Di Sabatino A. Corrigendum: Diagnostic Delay of Pulmonary Embolism in COVID-19 Patients. Front Med (Lausanne) 2022; 9:884680. [PMID: 35402449 PMCID: PMC8985583 DOI: 10.3389/fmed.2022.884680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Federica Melazzini
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
- Federica Melazzini
| | - Margherita Reduzzi
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Silvana Quaglini
- Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Federica Fumoso
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
- *Correspondence: Antonio Di Sabatino
| |
Collapse
|
9
|
Baldi E, Rordorf R, Masiello L, D'Amore S, Ghio S, Seminari EM, Melazzini F, Fraolini E, Perlini S, Tavazzi G, Vicentini A. QTc prolongation and mortality in SARS-2-CoV-infected patients treated with azithromycin and hydroxychloroquine. J Cardiovasc Med (Hagerstown) 2022; 23:e21-e23. [PMID: 34341313 DOI: 10.2459/jcm.0000000000001238] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Enrico Baldi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology & Laboratory of Clinical & Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo
- Department of Molecular Medicine, Cardiology Unit, University of Pavia
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology & Laboratory of Clinical & Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo
| | - Lucrezia Masiello
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology & Laboratory of Clinical & Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo
- Department of Molecular Medicine, Cardiology Unit, University of Pavia
| | - Sabato D'Amore
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology & Laboratory of Clinical & Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo
- Department of Molecular Medicine, Cardiology Unit, University of Pavia
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo
| | | | | | - Elia Fraolini
- Division of Respiratory Diseases, Fondazione IRCCS Policlinico San Matteo & University of Pavia, Italy
| | - Stefano Perlini
- Emergency Department, Fondazione IRCCS Policlinico San Matteo
- Department of Internal Medicine
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic & Pediatric Sciences, Unit of Anesthesia & Intensive Care, University of Pavia
- Anaesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Vicentini
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology & Laboratory of Clinical & Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo
| |
Collapse
|
10
|
Lenti MV, Ferrari MG, Aronico N, Melazzini F, Klersy C, Corazza GR, Di Sabatino A. COVID-19-related symptom clustering in a primary care vs internal medicine setting. Intern Emerg Med 2022; 17:291-294. [PMID: 34043116 PMCID: PMC8156583 DOI: 10.1007/s11739-021-02764-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Nicola Aronico
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | | | - Catherine Klersy
- Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Piazzale Golgi 19, 27100, Pavia, Italy
| | | | | |
Collapse
|
11
|
Melazzini F, Colaneri M, Fumoso F, Freddi G, Lenti MV, Pieri TC, Piloni D, Noris P, Pieresca C, Preti PS, Russo M, Corsico A, Tavazzi G, Baldanti F, Triarico A, Mojoli F, Bruno R, Di Sabatino A. Correction to: Venous thromboembolism and COVID-19: a single center experience from an academic tertiary referral hospital of Northern Italy. Intern Emerg Med 2021; 16:1153. [PMID: 33400165 PMCID: PMC7782560 DOI: 10.1007/s11739-020-02613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Federica Melazzini
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marta Colaneri
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Federica Fumoso
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Giulia Freddi
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Teresa Chiara Pieri
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Davide Piloni
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Patrizia Noris
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Carla Pieresca
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Paola Stefania Preti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Mariaconcetta Russo
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Angelo Corsico
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Guido Tavazzi
- Department of Intensive Care, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Triarico
- Chief Medical Direction, San Matteo Hospital Foundation, Pavia, Italy
| | - Francesco Mojoli
- Department of Intensive Care, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
| |
Collapse
|
12
|
Melazzini F, Colaneri M, Fumoso F, Freddi G, Lenti MV, Pieri TC, Piloni D, Noris P, Pieresca C, Preti PS, Russo M, Corsico A, Tavazzi G, Baldanti F, Triarico A, Mojoli F, Bruno R, Di Sabatino A. Venous thromboembolism and COVID-19: a single center experience from an academic tertiary referral hospital of Northern Italy. Intern Emerg Med 2021; 16:1141-1152. [PMID: 33161478 PMCID: PMC7648897 DOI: 10.1007/s11739-020-02550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023]
Abstract
Preliminary evidence supports the notion that COVID-19 patients may have an increased susceptibility to develop venous thromboembolism (VTE). However, the magnitude of this association still needs to be defined. Furthermore, clinical predictors of thrombogenesis, and the relationship with the inflammatory status are currently unknown. On this basis, we conducted a retrospective, observational study on 259 consecutive COVID-19 patients admitted to an academic tertiary referral hospital in Northern Italy between March 19th and April 6th, 2020. Records of COVID-19 patients with a definite VTE event were reviewed for demographic information, co-morbidities, risk factors for VTE, laboratory tests, and anticoagulation treatment. Twenty-five cases among 259 COVID-19 patients developed VTE (9.6%), all of them having a Padua score > 4, although being under standard anticoagulation prophylaxis since hospital admission. In the VTE subcohort, we found a significant positive correlation between platelet count (PLT) and either C reactive protein (CRP) (p < 0.0001) or lactate dehydrogenase (LDH) (p = 0.0013), while a significant inverse correlation was observed between PLT and mean platelet volume (p < 0.0001). Platelet-to-lymphocyte ratio significantly correlated with CRP (p < 0.0001). The majority of VTE patients was male and younger compared to non-VTE patients (p = 0.002 and p = 0.005, respectively). No significant difference was found in D-dimer levels between VTE and non VTE patients, while significantly higher levels of LDH (p = 0.04) and IL-6 (p = 0.04) were observed in VTE patients in comparison to non-VTE patients. In conclusion, our findings showed a quite high prevalence of VTE in COVID-19 patients. Raised inflammatory indexes and increased serum levels of pro-inflammatory cytokines should raise the clinical suspicion of VTE.
Collapse
Affiliation(s)
- Federica Melazzini
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marta Colaneri
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Federica Fumoso
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Giulia Freddi
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Teresa Chiara Pieri
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Davide Piloni
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Patrizia Noris
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Carla Pieresca
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Paola Stefania Preti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Mariaconcetta Russo
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Angelo Corsico
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Guido Tavazzi
- Department of Intensive Care, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Triarico
- Chief Medical Direction, San Matteo Hospital Foundation, Pavia, Italy
| | - Francesco Mojoli
- Department of Intensive Care, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
| |
Collapse
|
13
|
Melazzini F, Reduzzi M, Quaglini S, Fumoso F, Lenti MV, Di Sabatino A. Diagnostic Delay of Pulmonary Embolism in COVID-19 Patients. Front Med (Lausanne) 2021; 8:637375. [PMID: 33996852 PMCID: PMC8119630 DOI: 10.3389/fmed.2021.637375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/09/2021] [Indexed: 01/03/2023] Open
Abstract
Pulmonary embolism (PE) is a frequent, life-threatening COVID-19 complication, whose diagnosis can be challenging because of its non-specific symptoms. There are no studies assessing the impact of diagnostic delay on COVID-19 related PE. The aim of our exploratory study was to assess the diagnostic delay of PE in COVID-19 patients, and to identify potential associations between patient- or physician-related variables and the delay. This is a single-center observational retrospective study that included 29 consecutive COVID-19 patients admitted to the San Matteo Hospital Foundation between February and May 2020, with a diagnosis of PE, and a control population of 23 non-COVID-19 patients admitted at our hospital during the same time lapse in 2019. We calculated the patient-related delay (i.e., the time between the onset of the symptoms and the first medical examination), and the physician-related delay (i.e., the time between the first medical examination and the diagnosis of PE). The overall diagnostic delay significantly correlated with the physician-related delay (p < 0.0001), with the tendency to a worse outcome in long physician-related diagnostic delay (p = 0.04). The delay was related to the presence of fever, respiratory symptoms and high levels of lactate dehydrogenase. It is important to rule out PE as soon as possible, in order to start the right therapy, to improve patient's outcome and to shorten the hospitalization.
Collapse
Affiliation(s)
- Federica Melazzini
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Margherita Reduzzi
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Silvana Quaglini
- Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Federica Fumoso
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| |
Collapse
|
14
|
Faleschini M, Papa N, Morel-Kopp MC, Marconi C, Giangregorio T, Melazzini F, Bozzi V, Seri M, Noris P, Pecci A, Savoia A, Bottega R. Dysregulation of oncogenic factors by GFI1B p32: investigation of a novel GFI1B germline mutation. Haematologica 2021; 107:260-267. [PMID: 33472357 PMCID: PMC8719102 DOI: 10.3324/haematol.2020.267328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Indexed: 11/10/2022] Open
Abstract
GFI1B is a transcription factor essential for the regulation of erythropoiesis and megakaryopoiesis, and pathogenic variants have been associated with thrombocytopenia and bleeding. Analysing thrombocytopenic families by whole exome sequencing, we identified a novel GFI1B variant (c.648+5G>A), which causes exon 9 skipping and overexpression of a shorter p32 isoform. We report the clinical data of our patients and critically review the phenotype observed in individuals with different GFI1B variants leading to the same effect on the p32 expression. Since p32 is increased in acute and chronic leukemia cells, we tested the expression level of genes playing a role in various type of cancers, including hematological tumors and found that they are significantly dysregulated, suggesting a potential role for GFI1B in carcinogenesis regulation. Increasing the detection of individuals with GFI1B variants will allow us to better characterize this rare disease and determine whether it is associated with an increased risk of developing malignancies.
Collapse
Affiliation(s)
| | - Nicole Papa
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste
| | - Marie-Christine Morel-Kopp
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital and Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney
| | - Caterina Marconi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna
| | | | - Federica Melazzini
- Biotechnology Research Laboratories, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Valeria Bozzi
- Biotechnology Research Laboratories, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Marco Seri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna
| | - Patrizia Noris
- Biotechnology Research Laboratories, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Alessandro Pecci
- Biotechnology Research Laboratories, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Anna Savoia
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy; Department of Medical Sciences, University of Trieste, Trieste.
| | - Roberta Bottega
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste
| |
Collapse
|
15
|
Bergamaschi G, Borrelli de Andreis F, Aronico N, Lenti MV, Barteselli C, Merli S, Pellegrino I, Coppola L, Cremonte EM, Croce G, Mordà F, Lapia F, Ferrari S, Ballesio A, Parodi A, Calabretta F, Ferrari MG, Fumoso F, Gentile A, Melazzini F, Di Sabatino A. Anemia in patients with Covid-19: pathogenesis and clinical significance. Clin Exp Med 2021; 21:239-246. [PMID: 33417082 PMCID: PMC7790728 DOI: 10.1007/s10238-020-00679-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/07/2020] [Indexed: 01/30/2023]
Abstract
COVID-19 patients typically present with lower airway disease, although involvement of other organ systems is usually the rule. Hematological manifestations such as thrombocytopenia and reduced lymphocyte and eosinophil numbers are highly prevalent in COVID-19 and have prognostic significance. Few data, however, are available about the prevalence and significance of anemia in COVID-19. In an observational study, we investigated the prevalence, pathogenesis and clinical significance of anemia among 206 patients with COVID-19 at the time of their hospitalization in an Internal Medicine unit. The prevalence of anemia was 61% in COVID-19, compared with 45% in a control group of 71 patients with clinical and laboratory findings suggestive of COVID-19, but nasopharyngeal swab tests negative for SARS-CoV-2 RNA (p = 0.022). Mortality was higher in SARS-CoV-2 positive patients. In COVID-19, females had lower hemoglobin concentration than males and a higher prevalence of moderate/severe anemia (25% versus 13%, p = 0.032). In most cases, anemia was mild and due to inflammation, sometimes associated with iron and/or vitamin deficiencies. Determinants of hemoglobin concentration included: erythrocyte sedimentation rate, serum cholinesterase, ferritin and protein concentrations and number of chronic diseases affecting each patient. Hemoglobin concentration was not related to overall survival that was, on the contrary, influenced by red blood cell distribution width, age, lactate dehydrogenase and the ratio of arterial partial oxygen pressure to inspired oxygen fraction. In conclusion, our results highlight anemia as a common manifestation in COVID-19. Although anemia does not directly influence mortality, it usually affects elderly, frail patients and can negatively influence their quality of life.
Collapse
Affiliation(s)
- Gaetano Bergamaschi
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.
| | - Federica Borrelli de Andreis
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Nicola Aronico
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Chiara Barteselli
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Stefania Merli
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Ivan Pellegrino
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Luigi Coppola
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Elisa Maria Cremonte
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Gabriele Croce
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Francesco Mordà
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Francesco Lapia
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Sara Ferrari
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Alessia Ballesio
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Alessandro Parodi
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Francesca Calabretta
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Maria Giovanna Ferrari
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Federica Fumoso
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Antonella Gentile
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, Piazzale Golgi, 27100, Pavia, Italy.,University of Pavia School of Medicine, Pavia, Italy
| | | |
Collapse
|
16
|
Lenti MV, Aronico N, Pellegrino I, Boveri E, Giuffrida P, Borrelli de Andreis F, Morbini P, Vanelli L, Pasini A, Ubezio C, Melazzini F, Rascaroli A, Antoci V, Merli S, Di Terlizzi F, Sabatini U, Cambiè G, Tenore A, Picone C, Vanoli A, Arcaini L, Baldanti F, Paulli M, Corazza GR, Di Sabatino A. Depletion of circulating IgM memory B cells predicts unfavourable outcome in COVID-19. Sci Rep 2020; 10:20836. [PMID: 33257775 PMCID: PMC7705651 DOI: 10.1038/s41598-020-77945-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
Impaired immune responses have been hypothesised to be a possible trigger of unfavourable outcomes in coronavirus disease 2019 (COVID-19). We aimed to characterise IgM memory B cells in patients with COVID-19 admitted to an internal medicine ward in Northern Italy. Overall, 66 COVID-19 patients (mean age 74 ± 16.6 years; 29 females) were enrolled. Three patients (4.5%; 1 female) had been splenectomised and were excluded from further analyses. Fifty-five patients (87.3%) had IgM memory B cell depletion, and 18 (28.6%) died during hospitalisation (cumulative incidence rate 9.26/100 person-week; 5.8-14.7 95% CI). All patients who died had IgM memory B cell depletion. A superimposed infection was found in 6 patients (9.5%), all of them having IgM memory B cell depletion (cumulative incidence rate 3.08/100 person-week; 1.3-6.8 95% CI). At bivariable analyses, older age, sex, number of comorbidities, and peripheral blood lymphocyte count < 1500/µl were not correlated with IgM memory B cell depletion. A discrete-to-marked reduction of the B-cell compartment was also noticed in autoptic spleen specimens of two COVID-19 patients. We conclude that IgM memory B cells are commonly depleted in COVID-19 patients and this correlates with increased mortality and superimposed infections.
Collapse
Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Nicola Aronico
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Ivan Pellegrino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Emanuela Boveri
- Anatomic Pathology Unit, Department of Molecular Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Paolo Giuffrida
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Patrizia Morbini
- Anatomic Pathology Unit, Department of Molecular Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Laura Vanelli
- Division of Hematology, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Alessandra Pasini
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Cristina Ubezio
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Alessandro Rascaroli
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Valentina Antoci
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Stefania Merli
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Francesco Di Terlizzi
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Umberto Sabatini
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Ginevra Cambiè
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Annamaria Tenore
- Division of Hematology, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Cristina Picone
- Division of Hematology, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Alessandro Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Luca Arcaini
- Division of Hematology, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Paulli
- Anatomic Pathology Unit, Department of Molecular Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
- Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Università Di Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
| |
Collapse
|
17
|
Lenti MV, Borrelli de Andreis F, Pellegrino I, Klersy C, Merli S, Miceli E, Aronico N, Mengoli C, Di Stefano M, Cococcia S, Santacroce G, Soriano S, Melazzini F, Delliponti M, Baldanti F, Triarico A, Corazza GR, Pinzani M, Di Sabatino A. Impact of COVID-19 on liver function: results from an internal medicine unit in Northern Italy. Intern Emerg Med 2020; 15:1399-1407. [PMID: 32651938 PMCID: PMC7348571 DOI: 10.1007/s11739-020-02425-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/27/2020] [Indexed: 01/08/2023]
Abstract
Little is known regarding coronavirus disease 2019 (COVID-19) clinical spectrum in non-Asian populations. We herein describe the impact of COVID-19 on liver function in 100 COVID-19 consecutive patients (median age 70 years, range 25-97; 79 males) who were admitted to our internal medicine unit in March 2020. We retrospectively assessed liver function tests, taking into account demographic characteristics and clinical outcome. A patient was considered as having liver injury when alanine aminotransferase (ALT) was > 50 mU/ml, gamma-glutamyl transpeptidase (GGT) > 50 mU/ml, or total bilirubin > 1.1 mg/dl. Spearman correlation coefficient for laboratory data and bivariable analysis for mortality and/or need for intensive care were assessed. A minority of patients (18.6%) were obese, and most patients were non- or moderate-drinkers (88.5%). Liver function tests were altered in 62.4% of patients, and improved during follow-up. None of the seven patients with known chronic liver disease had liver decompensation. Only one patient developed acute liver failure. In patients with altered liver function tests, PaO2/FiO2 < 200 was associated with greater mortality and need for intensive care (HR 2.34, 95% CI 1.07-5.11, p = 0.033). To conclude, a high prevalence of altered liver function tests was noticed in Italian patients with COVID-19, and this was associated with worse outcomes when developing severe acute respiratory distress syndrome.
Collapse
Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Ivan Pellegrino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, San Matteo Hospital Foundation, Pavia, Italy
| | - Stefania Merli
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Emanuela Miceli
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Nicola Aronico
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Caterina Mengoli
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Michele Di Stefano
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Sara Cococcia
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Giovanni Santacroce
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Simone Soriano
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Mariangela Delliponti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, San Matteo Hospital Foundation, Pavia, Italy
| | - Antonio Triarico
- Chief Medical Direction, San Matteo Hospital Foundation, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Massimo Pinzani
- UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and UCL, London, UK
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
- Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Viale Golgi 19, 27100, Pavia, Italy.
| |
Collapse
|
18
|
Paciullo F, Bury L, Noris P, Falcinelli E, Melazzini F, Orsini S, Zaninetti C, Abdul-Kadir R, Obeng-Tuudah D, Heller PG, Glembotsky AC, Fabris F, Rivera J, Lozano ML, Butta N, Favier R, Cid AR, Fouassier M, Podda GM, Santoro C, Grandone E, Henskens Y, Nurden P, Zieger B, Cuker A, Devreese K, Tosetto A, De Candia E, Dupuis A, Miyazaki K, Othman M, Gresele P. Antithrombotic prophylaxis for surgery-associated venous thromboembolism risk in patients with inherited platelet disorders. The SPATA-DVT Study. Haematologica 2019; 105:1948-1956. [PMID: 31558677 PMCID: PMC7327644 DOI: 10.3324/haematol.2019.227876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022] Open
Abstract
Major surgery is associated with an increased risk of venous thromboembolism (VTE), thus the application of mechanical or pharmacologic prophylaxis is recommended. The incidence of VTE in patients with inherited platelet disorders (IPD) undergoing surgical procedures is unknown and no information on the current use and safety of thromboprophylaxis, particularly of low-molecular-weight-heparin in these patients is available. Here we explored the approach to thromboprophylaxis and thrombotic outcomes in IPD patients undergoing surgery at VTE-risk participating in the multicenter SPATA study. We evaluated 210 surgical procedures carried out in 155 patients with well-defined forms of IPD (VTE-risk: 31% high, 28.6% intermediate, 25.2% low, 15.2% very low). The use of thromboprophylaxis was low (23.3% of procedures), with higher prevalence in orthopedic and gynecological surgeries, and was related to VTE-risk. The most frequently employed thromboprophylaxis was mechanical and appeared to be effective, as no patients developed thrombosis, including patients belonging to the highest VTE-risk classes. Low-molecular-weight-heparin use was low (10.5%) and it did not influence the incidence of post-surgical bleeding or of antihemorrhagic prohemostatic interventions use. Two thromboembolic events were registered, both occurring after high VTE-risk procedures in patients who did not receive thromboprophylaxis (4.7%). Our findings suggest that VTE incidence is low in patients with IPD undergoing surgery at VTE-risk and that it is predicted by the Caprini score. Mechanical thromboprophylaxis may be of benefit in patients with IPD undergoing invasive procedures at VTE-risk and low-molecular-weight-heparin should be considered for major surgery.
Collapse
Affiliation(s)
- Francesco Paciullo
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Loredana Bury
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Patrizia Noris
- Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Emanuela Falcinelli
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Federica Melazzini
- Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Sara Orsini
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Carlo Zaninetti
- Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy.,PhD program in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Rezan Abdul-Kadir
- Haemophilia Centre and Haemostasis Unit, The Royal Free Foundation Hospital and University College London, London, UK
| | - Deborah Obeng-Tuudah
- Haemophilia Centre and Haemostasis Unit, The Royal Free Foundation Hospital and University College London, London, UK
| | - Paula G Heller
- Hematología Investigación, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires,
Argentina.,CONICET, Universidad de Buenos Aires, Instituto de Investigaciones Médicas -IDIM-, Buenos Aires, Argentina
| | - Ana C Glembotsky
- Hematología Investigación, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires,
Argentina.,CONICET, Universidad de Buenos Aires, Instituto de Investigaciones Médicas -IDIM-, Buenos Aires, Argentina
| | - Fabrizio Fabris
- Clinica Medica 1 - Medicina Interna CLOPD, Dipartimento Assistenziale Integrato di Medicina, Azienda-Ospedale Università di Padova, Dipartimento di Medicina, Università di Padova, Padova, Italy
| | - Jose Rivera
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguery Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Maria Luisa Lozano
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguery Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Nora Butta
- Unidad de Hematología, Hospital Universitario La Paz-IDIPaz, Madrid, Spain
| | - Remi Favier
- Assistance Publique-Hôpitaux de Paris, Armand Trousseau Children's Hospital, French Reference Centre for Inherited Platelet Disorders, Paris, France
| | - Ana Rosa Cid
- Unidad de Hemostasia y Trombosis, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - Marc Fouassier
- Consultations d'Hémostase - CRTH, CHU de Nantes, Nantes, France
| | - Gian Marco Podda
- Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Cristina Santoro
- Hematology, Department of Translational and Precision Medicine, La Sapienza University of Rome, Rome, Italy
| | - Elvira Grandone
- Unità di Ricerca in Aterosclerosi e Trombosi, I.R.C.C.S. "Casa Sollievo della Sofferenza", S. Giovanni Rotondo, Foggia, Italy.,Ob/Gyn Department of the First I.M. Sechenov Moscow State Medical University, Moscow, The Russian Federation
| | - Yvonne Henskens
- Hematological Laboratory, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Paquita Nurden
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguery Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Barbara Zieger
- Division of Pediatric Hematology and Oncology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Adam Cuker
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katrien Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | | | - Erica De Candia
- Hemostasis and Thrombosis Unit, Insitute of Internal Medicine, Policlinico Agostino Gemelli Foundation, IRCCS, Rome, Italy.,Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Arnaud Dupuis
- Université de Strasbourg, Institut National de la Santé et de la Recherche Médicale, Etablissement Français du Sang Grand Est, Unité Mixte de Recherche-S 1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Koji Miyazaki
- Department of Transfusion and Cell Transplantation Kitasato University School of Medicine, Sagamihara, Japan
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Paolo Gresele
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| |
Collapse
|
19
|
Pecci A, Ragab I, Bozzi V, De Rocco D, Barozzi S, Giangregorio T, Ali H, Melazzini F, Sallam M, Alfano C, Pastore A, Balduini CL, Savoia A. Thrombopoietin mutation in congenital amegakaryocytic thrombocytopenia treatable with romiplostim. EMBO Mol Med 2019; 10:63-75. [PMID: 29191945 PMCID: PMC5760853 DOI: 10.15252/emmm.201708168] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Congenital amegakaryocytic thrombocytopenia (CAMT) is an inherited disorder characterized at birth by thrombocytopenia with reduced megakaryocytes, which evolves into generalized bone marrow aplasia during childhood. Although CAMT is genetically heterogeneous, mutations of MPL, the gene encoding for the receptor of thrombopoietin (THPO), are the only known disease‐causing alterations. We identified a family with three children affected with CAMT caused by a homozygous mutation (p.R119C) of the THPO gene. Functional studies showed that p.R119C affects not only ability of the cytokine to stimulate MPL but also its release, which is consistent with the relatively low serum THPO levels measured in patients. In all the three affected children, treatment with the THPO‐mimetic romiplostim induced trilineage hematological responses, remission of bleeding and infections, and transfusion independence, which were maintained after up to 6.5 years of observation. Recognizing patients with THPO mutations among those with juvenile bone marrow failure is essential to provide them with appropriate substitutive therapy and prevent the use of invasive and unnecessary treatments, such as hematopoietic stem cell transplantation or immunosuppression.
Collapse
Affiliation(s)
- Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Iman Ragab
- Hematology-Oncology Unit, Pediatric Hospital, Ain Shams University, Cairo, Egypt
| | - Valeria Bozzi
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Daniela De Rocco
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Serena Barozzi
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | | | - Heba Ali
- Hematology-Oncology Unit, Pediatric Hospital, Ain Shams University, Cairo, Egypt
| | - Federica Melazzini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Mohamed Sallam
- Department of Clinical Pathology, Ain Shams University, Cairo, Egypt
| | - Caterina Alfano
- Maurice Wohl Clinical Neuroscience Institute, King's College, London, UK.,Fondazione Ri.MED, Palermo, Italy
| | - Annalisa Pastore
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Carlo L Balduini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Anna Savoia
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy .,Department of Medical Sciences, University of Trieste, Trieste, Italy
| |
Collapse
|
20
|
Faleschini M, Melazzini F, Marconi C, Giangregorio T, Pippucci T, Cigalini E, Pecci A, Bottega R, Ramenghi U, Siitonen T, Seri M, Pastore A, Savoia A, Noris P. ACTN1 mutations lead to a benign form of platelet macrocytosis not always associated with thrombocytopenia. Br J Haematol 2018; 183:276-288. [PMID: 30351444 DOI: 10.1111/bjh.15531] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/19/2018] [Indexed: 12/27/2022]
Abstract
The inherited thrombocytopenias (IT) are a heterogeneous group of diseases resulting from mutations in more than 30 different genes. Among them, ACTN1-related thrombocytopenia (ACTN1-RT; Online Mendelian Inheritance in Man: 615193) is one of the most recently identified forms. It has been described as a mild autosomal dominant macrothrombocytopenia caused by mutations in ACTN1, a gene encoding for one of the two non-muscle isoforms of α-actinin. We recently identified seven new unrelated families with ACTN1-RT caused by different mutations. Two of them are novel missense variants (p.Trp128Cys and p.Pro233Leu), whose pathogenic role has been confirmed by in vitro studies. Together with the 10 families we have previously described, our cohort of ACTN1-RT now consists of 49 individuals carrying ACTN1 mutations. This is the largest case series ever collected and enabled a critical evaluation of the clinical aspects of the disease. We concluded that ACTN1-RT is the fourth most frequent form of IT worldwide and it is characterized by platelet macrocytosis in all affected subjects and mild thrombocytopenia in less than 80% of cases. The risk of bleeding, either spontaneous or upon haemostatic challenge, is negligible and there are no other associated defects, either congenital or acquired. Therefore, ACTN1-RT is a benign form of IT, whose diagnosis provides affected individuals and their families with a good prognosis.
Collapse
Affiliation(s)
- Michela Faleschini
- Institute for Maternal and Child Health - "IRCCS Burlo Garofolo", Trieste, Italy
| | - Federica Melazzini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Caterina Marconi
- Department of Medical Science, Medical Genetics Unit, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | | | - Tommaso Pippucci
- Department of Medical Science, Medical Genetics Unit, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Elena Cigalini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Roberta Bottega
- Institute for Maternal and Child Health - "IRCCS Burlo Garofolo", Trieste, Italy
| | - Ugo Ramenghi
- Pediatric Department, Hematology Unit, University of Torino, Torino, Italy
| | - Timo Siitonen
- Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - Marco Seri
- Department of Medical Science, Medical Genetics Unit, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Annalisa Pastore
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Anna Savoia
- Institute for Maternal and Child Health - "IRCCS Burlo Garofolo", Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Patrizia Noris
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| |
Collapse
|
21
|
Affiliation(s)
- Carlo L Balduini
- Department of Medicine, Università of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Melazzini
- Department of Medicine, Università of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
22
|
Zaninetti C, Melazzini F, Croci GA, Boveri E, Balduini CL. Extramedullary hematopoiesis: a new feature of inherited thrombocytopenias? J Thromb Haemost 2017; 15:2226-2229. [PMID: 28921865 DOI: 10.1111/jth.13850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Indexed: 01/12/2023]
Abstract
Essentials Extramedullary hematopoiesis (EMH) represents a pathologic finding in adult life. We report a mass-like EMH in the presacral space in a patient with ANKRD26-related thrombocytopenia. We found possible correlation between EMH and conditions causing lifelong thrombocytopenia. EMH can cause masses of unknown origin in patients with inherited thrombocytopenias. SUMMARY Most commonly located in the liver and spleen, extramedullary hematopoiesis (EMH) is the presence of hematopoietic tissue outside the bone marrow. MYH9-related thrombocytopenia (MYH9-RD) and ANKRD26-related thrombocytopenia (ANKRD26-RT) are two of the most frequent forms of inherited thrombocytopenia (IT). Until recently, EMH has been associated with neoplastic and non-neoplastic hematologic conditions in which ITs were not included. We describe a case of mass-like EMH in the presacral space in a patient affected with ANKRD26-RT, comparing it with another case of paravertebral EMH we recently described in a subject with MYH9-RD. The surprisingly similitude of such a finding in the context of a group of rare disorders induces us to speculate about the possible pathogenic relationship between EMH and conditions causing lifelong thrombocytopenia, particularly the entity of ITs. Finally, we suggest that EMH has to be taken into consideration in the diagnostic work-up of masses of unknown origin in subjects affected with ITs.
Collapse
Affiliation(s)
- C Zaninetti
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - F Melazzini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - G A Croci
- Unit of Anatomic Pathology, Department of Molecular Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - E Boveri
- Unit of Anatomic Pathology, Department of Molecular Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - C L Balduini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| |
Collapse
|
23
|
Melazzini F, Zaninetti C, Balduini CL. Bleeding is not the main clinical issue in many patients with inherited thrombocytopaenias. Haemophilia 2017; 23:673-681. [PMID: 28594466 DOI: 10.1111/hae.13255] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2017] [Indexed: 02/01/2023]
Abstract
Bleeding diathesis has been considered for a long time the main clinical issue impacting the lives of patients affected by inherited thrombocytopaenias. However, the number of known inherited thrombocytopaenias greatly increased in recent years, and careful evaluation of hundreds of patients affected by these 'new' disorders revealed that most of them are at risk of developing additional life-threatening disorders during childhood or adult life. These additional disorders are usually more serious and dangerous than low platelet count. For instance, it is known that mutations in RUNX1, ANKRD26 and ETV6 cause congenital thrombocytopaenia, but we now know that they also predispose to haematological malignancies. Similarly, MYH9 mutations result in congenital thrombocytopaenia and increase the risk of developing kidney failure, cataracts and hearing loss at a later stage, while MPL mutations cause a congenital thrombocytopaenia that almost always evolves into deadly bone marrow failure. Thus, identification of patients with these disorders is essential for evaluation of their prognosis, enabling effective genetic counselling, personalizing follow-up and giving appropriate treatments in case of development of additional diseases. Careful clinical evaluation and peripheral blood film examination are extremely useful tools in guiding the diagnostic process and identifying the candidate genes to be sequenced.
Collapse
Affiliation(s)
- F Melazzini
- IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - C Zaninetti
- IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - C L Balduini
- IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| |
Collapse
|
24
|
De Rocco D, Melazzini F, Marconi C, Pecci A, Bottega R, Gnan C, Palombo F, Giordano P, Coccioli MS, Glembotsky AC, Heller PG, Seri M, Savoia A, Noris P. Mutations of RUNX1 in families with inherited thrombocytopenia. Am J Hematol 2017; 92:E86-E88. [PMID: 28240786 DOI: 10.1002/ajh.24703] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Daniela De Rocco
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo; Trieste Italy
| | - Federica Melazzini
- Department of Internal Medicine; IRCCS Policlinico San Matteo Foundation and University of Pavia; Pavia Italy
| | - Caterina Marconi
- Department of Medical and Surgical Science; Policlinico Sant'Orsola Malpighi and University of Bologna; Bologna Italy
| | - Alessandro Pecci
- Department of Internal Medicine; IRCCS Policlinico San Matteo Foundation and University of Pavia; Pavia Italy
| | - Roberta Bottega
- Department of Medical Sciences; University of Trieste; Trieste Italy
| | - Chiara Gnan
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo; Trieste Italy
| | - Flavia Palombo
- Department of Medical and Surgical Science; Policlinico Sant'Orsola Malpighi and University of Bologna; Bologna Italy
| | - Paola Giordano
- Department of Biomedical Science and Human Oncology; Clinical Pediatrics “B. Trambusti,” University of Bari; Bari Italy
| | | | - Ana C. Glembotsky
- IDIM-CONICET; Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires; Buenos Aires Argentina
| | - Paula G. Heller
- IDIM-CONICET; Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires; Buenos Aires Argentina
| | - Marco Seri
- Department of Medical and Surgical Science; Policlinico Sant'Orsola Malpighi and University of Bologna; Bologna Italy
| | - Anna Savoia
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo; Trieste Italy
- Department of Medical Sciences; University of Trieste; Trieste Italy
| | - Patrizia Noris
- Department of Internal Medicine; IRCCS Policlinico San Matteo Foundation and University of Pavia; Pavia Italy
| |
Collapse
|
25
|
Zaninetti C, Boveri E, Melazzini F. Massive mediastinal enlargement due to extramedullary haematopoiesis in a patient with MYH9-related thrombocytopenia. Br J Haematol 2017; 178:10. [PMID: 28516481 DOI: 10.1111/bjh.14676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Carlo Zaninetti
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Emanuela Boveri
- Department of Human Pathology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| |
Collapse
|
26
|
Noris P, Marconi C, De Rocco D, Melazzini F, Pippucci T, Loffredo G, Giangregorio T, Pecci A, Seri M, Savoia A. A new form of inherited thrombocytopenia due to monoallelic loss of function mutation in the thrombopoietin gene. Br J Haematol 2017; 181:698-701. [PMID: 28466964 DOI: 10.1111/bjh.14694] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Patrizia Noris
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Caterina Marconi
- Department of Medical and Surgical Science, Policlinico Sant'Orsola Malpighi and University of Bologna, Bologna, Italy
| | - Daniela De Rocco
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Federica Melazzini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Tommaso Pippucci
- Department of Medical and Surgical Science, Policlinico Sant'Orsola Malpighi and University of Bologna, Bologna, Italy
| | - Giuseppe Loffredo
- Department of Oncology, Azienda Ospedaliera "Santobono-Pausilipon", Pausilipon Hospital, Naples, Italy
| | - Tania Giangregorio
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Marco Seri
- Department of Medical and Surgical Science, Policlinico Sant'Orsola Malpighi and University of Bologna, Bologna, Italy
| | - Anna Savoia
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
| |
Collapse
|
27
|
Orsini S, Noris P, Bury L, Heller PG, Santoro C, Kadir RA, Butta NC, Falcinelli E, Cid AR, Fabris F, Fouassier M, Miyazaki K, Lozano ML, Zúñiga P, Flaujac C, Podda GM, Bermejo N, Favier R, Henskens Y, De Maistre E, De Candia E, Mumford AD, Ozdemir GN, Eker I, Nurden P, Bayart S, Lambert MP, Bussel J, Zieger B, Tosetto A, Melazzini F, Glembotsky AC, Pecci A, Cattaneo M, Schlegel N, Gresele P. Bleeding risk of surgery and its prevention in patients with inherited platelet disorders. Haematologica 2017; 102:1192-1203. [PMID: 28385783 PMCID: PMC5566025 DOI: 10.3324/haematol.2016.160754] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 04/04/2017] [Indexed: 11/16/2022] Open
Abstract
Excessive bleeding at surgery is a feared complication in patients with inherited platelet disorders. However, very few studies have evaluated the frequency of surgical bleeding in these hemorrhagic disorders. We performed a worldwide, multicentric, retrospective study to assess the bleeding complications of surgery, the preventive and therapeutic approaches adopted, and their efficacy in patients with inherited platelet disorders: the Surgery in Platelet disorders And Therapeutic Approach (SPATA) study. We rated the outcome of 829 surgical procedures carried out in 423 patients with well-defined forms of inherited platelet disorders: 238 inherited platelet function disorders and 185 inherited platelet number disorders. Frequency of surgical bleeding was high in patients with inherited platelet disorders (19.7%), with a significantly higher bleeding incidence in inherited platelet function disorders (24.8%) than in inherited platelet number disorders (13.4%). The frequency of bleeding varied according to the type of inherited platelet disorder, with biallelic Bernard Soulier syndrome having the highest occurrence (44.4%). Frequency of bleeding was predicted by a pre-operative World Health Organization bleeding score of 2 or higher. Some types of surgery were associated with a higher bleeding incidence, like cardiovascular and urological surgery. The use of pre-operative pro-hemostatic treatments was associated with a lower bleeding frequency in patients with inherited platelet function disorders but not in inherited platelet number disorders. Desmopressin, alone or with antifibrinolytic agents, was the preventive treatment associated with the lowest bleedings. Platelet transfusions were used more frequently in patients at higher bleeding risk. Surgical bleeding risk in inherited platelet disorders is substantial, especially in inherited platelet function disorders, and bleeding history, type of disorder, type of surgery and female sex are associated with higher bleeding frequency. Prophylactic pre-operative pro-hemostatic treatments appear to be required and are associated with a lower bleeding incidence.
Collapse
Affiliation(s)
- Sara Orsini
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Patrizia Noris
- Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Loredana Bury
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Paula G Heller
- Hematología Investigación, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, CONICET, Argentina
| | | | - Rezan A Kadir
- Haemophilia Centre and Haemostasis Unit, Royal Free Hospital, London, UK
| | - Nora C Butta
- Unidad de Hematología, Hospital Universitario La Paz-IDIPaz, Madrid, Spain
| | - Emanuela Falcinelli
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Ana Rosa Cid
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Fabrizio Fabris
- Clinica Medica 1 - Medicina Interna CLOPD, Dipartimento Assistenziale Integrato di Medicina, Azienda-Ospedale Università di Padova and Dipartimento di Medicina, Università di Padova, Italy
| | | | - Koji Miyazaki
- Department of Hematology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Maria Luisa Lozano
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguery Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, Murcia 30003 and Grupo de Investigación CB15/00055 del Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Pamela Zúñiga
- Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claire Flaujac
- Service d'Hématologie Biologique Cochin Hospital, Paris, France
| | - Gian Marco Podda
- Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Nuria Bermejo
- Department of Hematology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Remi Favier
- Assistance Publique-Hôpitaux de Paris, Armand Trousseau Children's Hospital, French Reference Centre for Inherited Platelet Disorders, Paris, France
| | - Yvonne Henskens
- Hematological Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Emmanuel De Maistre
- Department of Biology and Haematology, Centre Hospitalier Universitaire Dijon, France
| | - Erica De Candia
- Hemostasis and Thrombosis Unit, Institute of Internal Medicine, Policlinico Agostino Gemelli-Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Gul Nihal Ozdemir
- Cerrahpasa Medical Faculty, Pediatric Hematology Department, Istanbul, Turkey
| | - Ibrahim Eker
- Gülhane Military Medical Faculty, Pediatric Hematology Department, Ankara, Turkey
| | - Paquita Nurden
- Reference Centre for Platelet Disorders, Bordeaux University Hospital Centre, Rythmology and Cardiac Modeling Institute (LIRYC), Xavier Arnozan Hospital, Pessac, France
| | - Sophie Bayart
- Centre Régional de Traitement des Hémophiles, Centre Hospitalier Universitaire de Rennes, France
| | - Michele P Lambert
- 1 Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PN, USA
| | - James Bussel
- Department of Pediatrics, Division of Hematology, Weill Cornell Medicine, New York, NY, USA
| | - Barbara Zieger
- Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Germany
| | | | - Federica Melazzini
- Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Ana C Glembotsky
- Hematología Investigación, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, CONICET, Argentina
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Marco Cattaneo
- Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Nicole Schlegel
- Centre de Référence des Pathologies Plaquettaires (CRPP), Service d'Hématologie Biologique, CHU Robert Debré, AP-HP, Paris, France
| | - Paolo Gresele
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | | |
Collapse
|
28
|
Marconi C, Canobbio I, Bozzi V, Pippucci T, Simonetti G, Melazzini F, Angori S, Martinelli G, Saglio G, Torti M, Pastan I, Seri M, Pecci A. 5'UTR point substitutions and N-terminal truncating mutations of ANKRD26 in acute myeloid leukemia. J Hematol Oncol 2017; 10:18. [PMID: 28100250 PMCID: PMC5242010 DOI: 10.1186/s13045-016-0382-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/26/2016] [Indexed: 11/10/2022] Open
Abstract
Thrombocytopenia 2 (THC2) is an inherited disorder caused by monoallelic single nucleotide substitutions in the 5’UTR of the ANKRD26 gene. Patients have thrombocytopenia and increased risk of myeloid malignancies, in particular, acute myeloid leukemia (AML). Given the association of variants in the ANKRD26 5’UTR with myeloid neoplasms, we investigated whether, and to what extent, mutations in this region contribute to apparently sporadic AML. To this end, we studied 250 consecutive, non-familial, adult AML patients and screened the first exon of ANKRD26 including the 5’UTR. We found variants in four patients. One patient had the c.−125T>G substitution in the 5’UTR, while three patients carried two different variants in the 5’ end of the ANKRD26 coding region (c.3G>A or c.105C>G). Review of medical history showed that the patient carrying the c.−125T>G was actually affected by typical but unrecognized THC2, highlighting that some apparently sporadic AML cases represent the evolution of a well-characterized familial predisposition disorder. As regards the c.3G>A and the c.105C>G, we found that both variants result in the synthesis of N-terminal truncated ANKRD26 isoforms, which are stable and functional in cells, in particular, have a strong ability to activate the MAPK/ERK signaling pathway. Moreover, investigation of one patient with the c.3G>A showed that mutation was associated with strong ANKRD26 overexpression in vivo, which is the proposed mechanism for predisposition to AML in THC2 patients. These data provide evidence that N-terminal ANKRD26 truncating mutations play a potential pathogenetic role in AML. Recognition of AML patients with germline ANKRD26 pathogenetic variants is mandatory for selection of donors for bone marrow transplantation.
Collapse
Affiliation(s)
- Caterina Marconi
- Medical Genetics Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ilaria Canobbio
- Department of Biology and Biotechnology, Laboratories of Biochemistry, University of Pavia, Pavia, Italy
| | - Valeria Bozzi
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Tommaso Pippucci
- Medical Genetics Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giorgia Simonetti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. and A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Federica Melazzini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Silvia Angori
- Medical Genetics Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. and A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Mauro Torti
- Department of Biology and Biotechnology, Laboratories of Biochemistry, University of Pavia, Pavia, Italy
| | - Ira Pastan
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marco Seri
- Medical Genetics Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy.
| |
Collapse
|
29
|
Melazzini F, Palombo F, Balduini A, De Rocco D, Marconi C, Noris P, Gnan C, Pippucci T, Bozzi V, Faleschini M, Barozzi S, Doubek M, Di Buduo CA, Kozubik KS, Radova L, Loffredo G, Pospisilova S, Alfano C, Seri M, Balduini CL, Pecci A, Savoia A. Clinical and pathogenic features of ETV6-related thrombocytopenia with predisposition to acute lymphoblastic leukemia. Haematologica 2016; 101:1333-1342. [PMID: 27365488 PMCID: PMC5394865 DOI: 10.3324/haematol.2016.147496] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/29/2016] [Indexed: 11/09/2022] Open
Abstract
ETV6-related thrombocytopenia is an autosomal dominant thrombocytopenia that has been recently identified in a few families and has been suspected to predispose to hematologic malignancies. To gain further information on this disorder, we searched for ETV6 mutations in the 130 families with inherited thrombocytopenia of unknown origin from our cohort of 274 consecutive pedigrees with familial thrombocytopenia. We identified 20 patients with ETV6-related thrombocytopenia from seven pedigrees. They have five different ETV6 variants, including three novel mutations affecting the highly conserved E26 transformation-specific domain. The relative frequency of ETV6-related thrombocytopenia was 2.6% in the whole case series and 4.6% among the families with known forms of inherited thrombocytopenia. The degree of thrombocytopenia and bleeding tendency of the patients with ETV6-related thrombocytopenia were mild, but four subjects developed B-cell acute lymphoblastic leukemia during childhood, resulting in a significantly higher incidence of this condition compared to that in the general population. Clinical and laboratory findings did not identify any particular defects that could lead to the suspicion of this disorder from the routine diagnostic workup. However, at variance with most inherited thrombocytopenias, platelets were not enlarged. In vitro studies revealed that the maturation of the patients' megakaryocytes was defective and that the patients have impaired proplatelet formation. Moreover, platelets from patients with ETV6-related thrombocytopenia have reduced ability to spread on fibrinogen. Since the dominant thrombocytopenias due to mutations in RUNX1 and ANKRD26 are also characterized by normal platelet size and predispose to hematologic malignancies, we suggest that screening for ETV6, RUNX1 and ANKRD26 mutations should be performed in all subjects with autosomal dominant thrombocytopenia and normal platelet size.
Collapse
Affiliation(s)
- Federica Melazzini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - Flavia Palombo
- Department of Medical and Surgical Science, Policlinico Sant'Orsola Malpighi and University of Bologna, Italy
| | - Alessandra Balduini
- Department of Molecular Medicine, University of Pavia, Italy
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Daniela De Rocco
- Department of Medical, Surgical and Health Sciences, IRCCS Burlo Garofolo and University of Trieste, Italy
| | - Caterina Marconi
- Department of Medical and Surgical Science, Policlinico Sant'Orsola Malpighi and University of Bologna, Italy
| | - Patrizia Noris
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - Chiara Gnan
- Department of Medical, Surgical and Health Sciences, IRCCS Burlo Garofolo and University of Trieste, Italy
| | - Tommaso Pippucci
- Department of Medical and Surgical Science, Policlinico Sant'Orsola Malpighi and University of Bologna, Italy
| | - Valeria Bozzi
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - Michela Faleschini
- Department of Medical, Surgical and Health Sciences, IRCCS Burlo Garofolo and University of Trieste, Italy
| | - Serena Barozzi
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - Michael Doubek
- University Hospital and Masaryk University, Brno, Czech Republic
| | | | - Katerina Stano Kozubik
- Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Lenka Radova
- Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Giuseppe Loffredo
- Department of Oncology, Azienda "Santobono-Pausilipon", Pausilipon Hospital, Napoli, Italy
| | - Sarka Pospisilova
- Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | | | - Marco Seri
- Department of Medical and Surgical Science, Policlinico Sant'Orsola Malpighi and University of Bologna, Italy
| | - Carlo L Balduini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - Anna Savoia
- Department of Medical, Surgical and Health Sciences, IRCCS Burlo Garofolo and University of Trieste, Italy
| |
Collapse
|
30
|
|
31
|
Abstract
Since the beginning of the century, our knowledge of inherited thrombocytopenias greatly advanced, and we presently know 30 forms with well-defined genetic defects. This great advancement changed our view of these disorders, as we realized that most patients have only mild thrombocytopenia with inconspicuous bleeding or no bleeding tendency at all. However, better knowledge of inherited thrombocytopenias also revealed that some of the most prevalent forms expose to the risk of acquiring during infancy or adulthood additional disorders that endanger the life of patients much more than hemorrhages. Thus, inherited thrombocytopenias are complex disorders with quite different clinical features and prognosis. Identification of novel genes whose mutations result in low platelet count greatly advanced also our knowledge of the megakaryocyte biology and proved beyond any doubt that the defective proteins play an essential role in platelet biogenesis or survival in humans. Based on the study of inherited thrombocytopenias, we better understood the sequence of molecular events regulating megakaryocyte differentiation, maturation, and platelet release. Since nearly 50% of patients have as yet unidentified genetic or molecular mechanisms underlying their inherited thrombocytopenia, further studies are expected to reveal new clinical entities and new molecular mechanisms of platelet production.
Collapse
Affiliation(s)
- Carlo L Balduini
- a Department of Medicine , IRCCS Policlinico San Matteo Foundation - University of Pavia , Pavia , Italy
| | - Federica Melazzini
- a Department of Medicine , IRCCS Policlinico San Matteo Foundation - University of Pavia , Pavia , Italy
| | - Alessandro Pecci
- a Department of Medicine , IRCCS Policlinico San Matteo Foundation - University of Pavia , Pavia , Italy
| |
Collapse
|
32
|
Bongetta D, Zoia C, Melazzini F, Lafe E, Zappoli Thyrion F, Gaetani P. Letter: Safety and Efficacy Issues of Tirofiban Use in Endovascular Procedures: What Are the Actual Indications? Neurosurgery 2016; 78:E895-6. [PMID: 27035840 DOI: 10.1227/neu.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Daniele Bongetta
- *Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy ‡PhD Program in Experimental Medicine, Università degli Studi di Pavia, Pavia, Italy §Platelets Physiopathology Laboratory, Department of Internal Medicine ¶Interventional Neuroradiology Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | | | | | | |
Collapse
|
33
|
Zaninetti C, Biino G, Noris P, Melazzini F, Civaschi E, Balduini CL. Personalized reference intervals for platelet count reduce the number of subjects with unexplained thrombocytopenia. Haematologica 2015; 100:e338-40. [PMID: 25957395 DOI: 10.3324/haematol.2015.127597] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Carlo Zaninetti
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation-University of Pavia, Pavia, Italy
| | - Ginevra Biino
- Institute of Molecular Genetics, National Research Council of Italy, Pavia, Italy
| | - Patrizia Noris
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation-University of Pavia, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation-University of Pavia, Pavia, Italy
| | - Elisa Civaschi
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation-University of Pavia, Pavia, Italy
| | - Carlo L Balduini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation-University of Pavia, Pavia, Italy
| |
Collapse
|
34
|
Civaschi E, Klersy C, Melazzini F, Pujol-Moix N, Santoro C, Cattaneo M, Lavenu-Bombled C, Bury L, Minuz P, Nurden P, Cid AR, Cuker A, Latger-Cannard V, Favier R, Nichele I, Noris P. Analysis of 65 pregnancies in 34 women with five different forms of inherited platelet function disorders. Br J Haematol 2015; 170:559-63. [PMID: 25899604 DOI: 10.1111/bjh.13458] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/15/2015] [Indexed: 12/01/2022]
Abstract
This study evaluated 65 pregnancies in 34 women with five different inherited platelet function disorders. Gestation was similar to that of the general population. Severe bleeds requiring blood transfusions were observed in 50% of deliveries in Glanzmann thrombasthenia (GT), but not in the patients with delta storage pool disease, Hermansky-Pudlak syndrome, P2Y12 defect or defect of thromboxane A2 receptor. Of note, severe haemorrhage also occurred in women with GT who had received prophylactic platelet transfusions, suggesting that better preventive treatments are required. Diagnosis and degree of spontaneous bleeding tendency before pregnancy were reliable parameters to predict the delivery-related bleeding risk.
Collapse
Affiliation(s)
- Elisa Civaschi
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Catherine Klersy
- Service of Biometry & Statistics, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Nuria Pujol-Moix
- Universitat Autònoma de Barcelona & Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain
| | - Cristina Santoro
- Ematologia, Policlinico Umberto 1, Università Sapienza, Rome, Italy
| | - Marco Cattaneo
- Dipartimento di Scienze della Salute, Medicina III, Ospedale San Paolo, Università degli Studi di Milano, Milano, Italy
| | - Cécile Lavenu-Bombled
- AP-HP, Hôpital Bicêtre, Hématologie Biologique/Centre de Référence Pathologies Plaquettaires, Le Kremlin Bicêtre, France
| | - Loredana Bury
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Pietro Minuz
- Department of Medicine, University of Verona, Verona, Italy
| | - Paquita Nurden
- Plateforme Technologique et d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France
| | - Ana R Cid
- Unidad de Hemostasia y Trombosis, La Fe University Hospital, Valencia, Spain
| | - Adam Cuker
- Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Véronique Latger-Cannard
- Centre de Compétence Nord-Est des Pathologies Plaquettaires from the Frame of the Reference French Centre and Service d'Hématologie Biologique, Centre Hospitalo-Universitaire, Nancy, France
| | - Remi Favier
- Haematological Laboratory, AP-HP, Armand Trousseau Children Hospital, French Reference Centre for Inherited Platelet Disorders, Paris, France.,Inserm U1170, Villejuif, France
| | - Ilaria Nichele
- Department of Cell Therapy and Haematology, San Bortolo Hospital, Vicenza, Italy
| | - Patrizia Noris
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | |
Collapse
|
35
|
Noris P, Klersy C, Gresele P, Giona F, Giordano P, Minuz P, Loffredo G, Pecci A, Melazzini F, Civaschi E, Mezzasoma A, Piedimonte M, Semeraro F, Veneri D, Menna F, Ciardelli L, Balduini CL. Platelet size for distinguishing between inherited thrombocytopenias and immune thrombocytopenia: a multicentric, real life study. Br J Haematol 2013; 162:112-9. [PMID: 23617394 PMCID: PMC3757308 DOI: 10.1111/bjh.12349] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 03/18/2013] [Indexed: 11/26/2022]
Abstract
The most frequent forms of inherited thrombocytopenia (IT) are characterized by platelet size abnormalities and it has been suggested that this parameter is useful for their differentiation from immune thrombocytopenia (ITP). Recently, a monocentric study identified cut-off values for mean platelet volume (MPV) and mean platelet diameter (MPD) with good diagnostic accuracy in this respect. To validate these cut-off values in a different and larger case series of patients, we enrolled 130 subjects with ITP and 113 with IT in six different centres. The platelet count and MPV was each measured by the instrument routinely used in each institution. In some centres, platelet count was also measured by optical microscopy. MPD was evaluated centrally by image analysis of peripheral blood films. The previously identified cut-off value for MPV had 91% specificity in distinguishing ITP from inherited macrothrombocytopenias (mono and biallelic Bernard-Soulier, MYH9-related disease), while its sensitivity was greatly variable depending on the instrument used. With an appropriate instrument, specificity was 83%. The diagnostic accuracy of MPD was lower than that obtained with MPV. We concluded that MPV is a useful parameter for differentiating ITP from IT provided that it is measured by appropriate cell counters.
Collapse
Affiliation(s)
- Patrizia Noris
- Departments of Internal Medicine, Clinical Chemistry Laboratory, Biometry and Clinical Epidemiology Service, University of Pavia and IRCCS Policlinico San Matteo Foundation, Piazzale Golgi, Pavia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Noris P, Perrotta S, Bottega R, Pecci A, Melazzini F, Civaschi E, Russo S, Magrin S, Loffredo G, Di Salvo V, Russo G, Casale M, De Rocco D, Grignani C, Cattaneo M, Baronci C, Dragani A, Albano V, Jankovic M, Scianguetta S, Savoia A, Balduini CL. Clinical and laboratory features of 103 patients from 42 Italian families with inherited thrombocytopenia derived from the monoallelic Ala156Val mutation of GPIbα (Bolzano mutation). Haematologica 2011; 97:82-8. [PMID: 21933849 DOI: 10.3324/haematol.2011.050682] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Bernard-Soulier syndrome is a very rare form of inherited thrombocytopenia that derives from mutations in GPIbα, GPIbβ, or GPIX and is typically inherited as a recessive disease. However, some years ago it was shown that the monoallelic c.515C>T transition in the GPIBA gene (Bolzano mutation) was responsible for macrothrombocytopenia in a few Italian patients. DESIGN AND METHODS Over the past 10 years, we have searched for the Bolzano mutation in all subjects referred to our institutions because of an autosomal, dominant form of thrombocytopenia of unknown origin. RESULTS We identified 42 new Italian families (103 cases) with a thrombocytopenia induced by monoallelic Bolzano mutation. Analyses of the geographic origin of affected pedigrees and haplotypes indicated that this mutation originated in southern Italy. Although the clinical expression was variable, patients with this mutation typically had a mild form of Bernard-Soulier syndrome with mild thrombocytopenia and bleeding tendency. The most indicative laboratory findings were enlarged platelets and reduced GPIb/IX/V platelet expression; in vitro platelet aggregation was normal in nearly all of the cases. CONCLUSIONS Our study indicates that monoallelic Bolzano mutation is the most frequent cause of inherited thrombocytopenia in Italy, affecting 20% of patients recruited at our institutions during the last 10 years. Because many people from southern Italy have emigrated during the last century, this mutation may have spread to other countries.
Collapse
Affiliation(s)
- Patrizia Noris
- Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Savoia A, Pastore A, De Rocco D, Civaschi E, Di Stazio M, Bottega R, Melazzini F, Bozzi V, Pecci A, Magrin S, Balduini CL, Noris P. Clinical and genetic aspects of Bernard-Soulier syndrome: searching for genotype/phenotype correlations. Haematologica 2010; 96:417-23. [PMID: 21173099 DOI: 10.3324/haematol.2010.032631] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Bernard-Soulier syndrome is a severe bleeding disease due to a defect of GPIb/IX/V, a platelet complex that binds the von Willebrand factor. Due to the rarity of the disease, there are reports only on a few cases compromising any attempt to establish correlations between genotype and phenotype. In order to identify any associations, we describe the largest case series ever reported, which was evaluated systematically at the same center. DESIGN AND METHODS Thirteen patients with the disease and seven obligate carriers were enrolled. We collected clinical aspects and determined platelet features, including number and size, expression of membrane glycoproteins, and ristocetin induced platelet aggregation. Mutations were identified by direct sequencing of the GP1BA, GP1BB, and GP9 genes and their effect was shown by molecular modeling analyses. RESULTS Patients all had a moderate thrombocytopenia with giant platelets and a bleeding tendency whose severity varied among individuals. Consistent with expression levels of GPIbα always lower than 10% of control values, platelet aggregation was absent or severely reduced. Homozygous mutations were identified in the GP1BA, GP1BB and GP9 genes; six were novel alterations expected to destabilize the conformation of the respective protein. Except for obligate carriers of a GP9 mutation with a reduced GPIb/IX/V expression and defective aggregation, all the other carriers had no obvious anomalies. CONCLUSIONS Regardless of mutations identified, the patients' bleeding diathesis did not correlate with thrombocytopenia, which was always moderate, and platelet GPIbα expression, which was always severely impaired. Obligate carriers had features similar to controls though their GPIb/IX/V expression showed discrepancies. Aware of the limitations of our cohort, we cannot define any correlations. However, further investigations should be encouraged to better understand the causes of this rare and underestimated disease.
Collapse
Affiliation(s)
- Anna Savoia
- Department of Reproductive and Developmental Sciences and Public Medicine Sciences, University of Trieste, Trieste, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Noris P, Klersy C, Zecca M, Arcaini L, Pecci A, Melazzini F, Terulla V, Bozzi V, Ambaglio C, Passamonti F, Locatelli F, Balduini CL. Platelet size distinguishes between inherited macrothrombocytopenias and immune thrombocytopenia. J Thromb Haemost 2009; 7:2131-6. [PMID: 19740094 DOI: 10.1111/j.1538-7836.2009.03614.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Distinguishing inherited thrombocytopenias from immune thrombocytopenia (ITP) can be difficult, and patients are therefore at risk of misdiagnosis and inappropriate treatments. Although it is known that the most common inherited forms of thrombocytopenia are characterized by increased platelet size, the diagnostic power of this feature has never been investigated. OBJECTIVES The aim of this study was to test the hypothesis that platelet size can be used to differentiate ITP from inherited macrothrombocytopenias. PATIENTS/METHODS We measured mean platelet volume (MPV) and mean platelet diameter (MPD), within 2 h of blood sampling, in 35 patients with inherited macrothrombocytopenias [15 MYH9-related disease (MYH9-RD), three biallelic and 17 monoallelic Bernard-Soulier syndrome (BSS)], and 56 with ITP. Using receiving operating characteristic analysis, we searched for the best cut-off values to differentiate between these conditions. RESULTS As expected, platelets were larger in inherited macrothrombocytopenias than in ITP. An MPD larger than 3.3 mum differentiated MYH9-RD and BSS from ITP with 0.89 sensitivity and 0.88 specificity, and an MPV larger than 12.4 fL had 0.83 sensitivity and 0.89 specificity. Combining MPD with MPV increased sensitivity and specificity to 0.97 and 0.89, respectively. CONCLUSION Platelet size evaluation by both an appropriate cell counter and blood film examination is useful for differentiating inherited macrothrombocytopenias from ITP.
Collapse
Affiliation(s)
- P Noris
- Department of Internal Medicine, University of Pavia, Pavia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|