1
|
Kim B. Diagnostic workup of inherited platelet disorders. Blood Res 2022; 57:11-19. [PMID: 35483920 PMCID: PMC9057669 DOI: 10.5045/br.2022.2021223] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Inherited platelet disorders (IPDs) can cause mucocutaneous bleeding due to impaired primary hemostatic function of platelets, thrombocytopenia, or both. Recent advances in molecular technology can help identify many genes related to platelet biology, control the overall steps of megakaryopoiesis, and cause IPD. In this article, currently available laboratory tools for diagnosing IPDs with the characteristic laboratory features of each IPD are reviewed, and a general diagnostic approach for the evaluation of IPD patients is presented.
Collapse
Affiliation(s)
- Bohyun Kim
- Department of Laboratory Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| |
Collapse
|
2
|
Abstract
Inherited platelet disorders (IPDs), which manifest as primary hemostasis defects, often underlie abnormal bleeding and a family history of thrombocytopenia, bone marrow failure, hematologic malignancies, undefined mucocutaneous bleeding disorder, or congenital bony defects. Wide heterogeneity in IPD types with regard to the presence or absence of thrombocytopenia, platelet dysfunction, bone marrow failure, and dysmegakaryopoiesis is observed in patients. The individual processes involved in platelet production and hemostasis are genetically controlled; to date, mutations of more than 50 genes involved in various platelet biogenesis steps have been implicated in IPDs. Representative IPDs resulting from defects in specific pathways, such as thrombopoietin/MPL signaling; transcriptional regulation; granule formation, trafficking, and secretion; proplatelet formation; cytoskeleton regulation; and transmembrane glycoprotein signaling are reviewed, and the underlying gene mutations are discussed based on the National Center for Biotechnology Information database and Online Mendelian Inheritance in Man accession number. Further, the status and prevalence of genetically confirmed IPDs in Korea are explored based on searches of the PubMed and KoreaMed databases. IPDs are congenital bleeding disorders that can be dangerous due to unexpected bleeding and require genetic counseling for family members and descendants. Therefore, the pediatrician should be suspicious and aware of IPDs and perform the appropriate tests if the patient has unexpected bleeding. However, all IPDs are extremely rare; thus, the domestic incidences of IPDs are unclear and their diagnosis is difficult. Diagnostic confirmation or differential diagnoses of IPDs are challenging, time-consuming, and expensive, and patients are frequently misdiagnosed. Comprehensive molecular characterization and classification of these disorders should enable accurate and precise diagnosis and facilitate improved patient management.
Collapse
Affiliation(s)
- Ye Jee Shim
- Department of Pediatrics, Keimyung University School of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| |
Collapse
|
3
|
Favier R, Roussel X, Audia S, Bordet JC, De Maistre E, Hirsch P, Neuhart A, Bedgedjian I, Gkalea V, Favier M, Daguindau E, Nurden P, Deconinck E. Correction of Severe Myelofibrosis, Impaired Platelet Functions and Abnormalities in a Patient with Gray Platelet Syndrome Successfully Treated by Stem Cell Transplantation. Platelets 2019; 31:536-540. [PMID: 31502501 DOI: 10.1080/09537104.2019.1663809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Gray platelet syndrome (GPS) is an inherited disorder. Patients harboring GPS have thrombocytopenia with large platelets lacking α-granules. A long-term complication is myelofibrosis with pancytopenia. Hematopoietic stem cell transplant (HSCT) could be a curative treatment. We report a male GPS patient with severe pancytopenia, splenomegaly and a secondary myelofibrosis needing red blood cells transfusion. He received an HSCT from a 10/10 matched HLA-unrelated donor after a myeloablative conditioning regimen. Transfusion independence occurred at day+21, with a documented neutrophil engraftment. At day+ 180, we added ruxolitinib to cyclosporine and steroids for a moderate chronic graft versus host disease (GVHD) and persistent splenomegaly. At day+240 GVHD was controlled and splenomegaly reduced. Complete donor chimesrism was documented in blood and marrow and platelets functions and morphology normalized. At day+ 720, the spleen size normalized and there was no evidence of marrow fibrosis on the biopsy. In GPS, HSCT may be a curative treatment in selected patients with pancytopenia and myelofibrosis.
Collapse
Affiliation(s)
- Rémi Favier
- French National Reference Center for Inherited Platelet Disorders, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris , Paris, France.,Inserm UMR1170, Gustave Roussy Institute , Villejuif, France
| | - Xavier Roussel
- Department of Hematology, Besançon Hospital, Franche-Comté University , Besançon, France
| | - Sylvain Audia
- Department of Internal Medecine and Immunology, Dijon-Bourgogne University , Dijon, France
| | | | | | - Pierre Hirsch
- AP-HP, Sorbonne University, Inserm, Centre de Recherche Saint-Antoine CRSA, Saint-Antoine Hospital , Paris, France
| | - Anne Neuhart
- Department of Pathology, University Dijon Hospital , Dijon, France
| | - Isabelle Bedgedjian
- Department of Pathology, Besançon Hospital, Franche-Comté University , Besançon, France
| | - Vasiliki Gkalea
- French National Reference Center for Inherited Platelet Disorders, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris , Paris, France
| | - Marie Favier
- French National Reference Center for Inherited Platelet Disorders, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris , Paris, France
| | - Etienne Daguindau
- Department of Hematology, Besançon Hospital, Franche-Comté University , Besançon, France.,Interactions Hôte-Greffon Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, Inserm EFS BFC,UMR1098 , Besançon, France
| | - Paquita Nurden
- LIRYC Institute, Xavier Arnozan Hospital , Pessac, France
| | - Eric Deconinck
- Department of Hematology, Besançon Hospital, Franche-Comté University , Besançon, France.,Interactions Hôte-Greffon Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, Inserm EFS BFC,UMR1098 , Besançon, France
| |
Collapse
|
4
|
Abstract
Homozygosity/compound heterozygosity for loss of function mutations in neurobeachin-like 2 (NBEAL2) is causative for Gray platelet syndrome (GPS; MIM #139090), characterized by thrombocytopenia and large platelets lacking α-granules and cargo. Most GPS-associated NBEAL2 mutations generate nonsense codons; frameshifts causing premature translation termination and/or changes in mRNA splicing have also been observed. Data regarding NBEAL2 protein expression in GPS patients is limited. We observed absence of NBEAL2 in platelets from GPS patients with 3 different genotypes, and reduced/truncated platelet NBEAL2 has been reported for others. GPS is commonly associated with mild bleeding, but lifethreatening bleeding has been reported in some cases. A common long-term complication in GPS patients is myelofibrosis; splenomegaly is less common but sometimes of sufficient severity to merit splenectomy. Like GPS patients, mice lacking NBEAL2 expression exhibit macrothrombocytopenia, deficiency of platelet α-granules, splenomegaly, myelofibrosis, impaired platelet function and abnormalities in megakaryocyte development. Animal studies have also reported impaired platelet function in vivo using laser injury and thrombo-inflammation models. NBEAL2 is a large gene with 54 exons, and several putative functional domains have been identified in NBEAL2, including PH (pleckstrin homology) and BEACH (beige and Chediak-Higashi) domains shared with other members of a protein family that includes LYST and LRBA, also expressed by hematopoietic cells. Potential NBEAL2-interacting proteins have recently been identified, and it is expected that current and future efforts will reveal the cellular mechanisms by which NBEAL2 facilitates platelet development and supports hemostatic function.
Collapse
Affiliation(s)
- Fred G Pluthero
- a Cell Biology Program , Research Institute, Hospital for Sick Children , Toronto , ON , Canada
| | - Jorge Di Paola
- b Department of Pediatrics and Human Genetics and Genomics Program , University of Colorado, Anschutz Medical Campus , Aurora , CO , USA
| | - Manuel D Carcao
- c Division of Haematology/Oncology, Department of Paediatrics , University of Toronto and The Hospital for Sick Children , Toronto , ON , Canada.,d Child Health Evaluative Sciences , Research Institute, Hospital for Sick Children , Toronto , ON , Canada
| | - Walter H A Kahr
- a Cell Biology Program , Research Institute, Hospital for Sick Children , Toronto , ON , Canada.,c Division of Haematology/Oncology, Department of Paediatrics , University of Toronto and The Hospital for Sick Children , Toronto , ON , Canada.,e Department of Biochemistry , University of Toronto , Toronto , ON , Canada
| |
Collapse
|