1
|
Hammami E, Fath L, Debry C, Desprez D. Double jeopardy, glomangiopericytoma and Glanzmann thrombasthenia resulting in recurrent epistaxis: a case report. Blood Coagul Fibrinolysis 2024; 35:62-65. [PMID: 38179703 DOI: 10.1097/mbc.0000000000001272] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 01/06/2024]
Abstract
Glanzmann thrombasthenia is a rare bleeding disorder induced by inherited defects of the platelet membrane αIIbβ3 glycoprotein. Glomangiopericytoma, on the other hand, is a very rare sinonasal tumor demonstrating a perivascular myoid phenotype. We herein report the first described case in the literature of Glanzmann thrombasthenia and glomangiopericytoma. The patient is a 40-year-old man diagnosed with type 1 Glanzmann thrombasthenia who presented with repetitive and profuse posterior epistaxis initially managed with platelet transfusions and recombinant activated factor VII (rFVIIa). Due to the unresolved epistaxis, nasal endoscopy was performed revealing a vascularized tumor. Subsequently, a sphenopalatine artery embolization followed by a surgical excision of the tumor was performed. The pathology report diagnosis of the tumor was glomangiopericytoma. This case sheds the lights on a very rare cause of epistaxis in a patient with Glanzmann thrombasthenia, with a challenging multidisciplinary management. A local cause of epistaxis should always be considered even in case of a diagnosed bleeding disorder, especially when the bleeding is recurrent.
Collapse
Affiliation(s)
- Emna Hammami
- Groupe Hospitalier de la Région de Mulhouse et Sud Alsace, Laboratory Hematology
- Centre de Ressource et Compétence des Maladies Hémorragiques Constitutionnelles, Hôpitaux Universitaires de Strasbourg
| | - Léa Fath
- Strasbourg University Hospitals Head Neck CETD Center, Ear, nose and Throat (ENT) Department, Strasbourg, Grand Est, France
| | - Christian Debry
- Strasbourg University Hospitals Head Neck CETD Center, Ear, nose and Throat (ENT) Department, Strasbourg, Grand Est, France
| | - Dominique Desprez
- Centre de Ressource et Compétence des Maladies Hémorragiques Constitutionnelles, Hôpitaux Universitaires de Strasbourg
| |
Collapse
|
2
|
Hernandez MM, Buckley A, Mills A, Meislin R, Cromwell C, Bianco A, Strong N, Arinsburg S. Multidisciplinary management of a pregnancy complicated by Glanzmann thrombasthenia: A case report. Transfusion 2023; 63:2384-2391. [PMID: 37952246 DOI: 10.1111/trf.17594] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Glanzmann thrombasthenia (GT) is a rare, autosomal recessive disorder of platelet glycoprotein IIb-IIIa receptors. Pregnant patients with GT are at increased risk of maternal and fetal bleeding. There is a paucity of literature on the peripartum management of patients. CASE DESCRIPTION We present the antepartum through the postpartum course of a patient with GT who was managed by a multidisciplinary approach that included communication across maternal-fetal medicine, hematology, transfusion medicine, and anesthesiology services. In addition to routine prepartum obstetric imaging and hematologic laboratory studies, we proactively monitored the patient for anti-platelet antibodies every 4-6 weeks to gauge the risk for neonatal alloimmune thrombocytopenia. Furthermore, we prioritized uterotonics, tranexamic acid, and transfusion of HLA-matched platelets to manage bleeding for mother and fetus intrapartum through the postpartum periods. CONCLUSION To date, there are limited guidelines for managing bleeding or preventing alloimmunization during pregnancy in patients with GT. Here, we present a complex case with aggressive management of bleeding prophylactically for the mother while serially monitoring both mother and fetus for peripartum bleeding risks and events. Moreover, future studies warrant continued evaluation of these approaches to mitigate increased bleeding risks in subsequent pregnancies.
Collapse
Affiliation(s)
- Matthew M Hernandez
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ayisha Buckley
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Ariana Mills
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Rachel Meislin
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Caroline Cromwell
- Division of Hematology/Oncology, Department of Medicine, Icahn School of Medicine at Mount, New York, New York, USA
| | - Angela Bianco
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Noel Strong
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Suzanne Arinsburg
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
3
|
Saladino A, Gonzalez ML, Chuliber FA, Serra MM. Glanzmann's thrombasthenia associated with gastrointestinal angiodysplasias successfully treated with bevacizumab. Blood Coagul Fibrinolysis 2023; 34:545-548. [PMID: 37942747 DOI: 10.1097/mbc.0000000000001249] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/10/2023]
Abstract
Glanzmann's Thrombasthenia (GT) is a rare hemorrhagic condition caused by a platelet surface receptor disorder of the glycoprotein (GP) IIb/IIIa. Symptoms of GT are various forms of hemorrhages, such as purpura, epistaxis and menorrhagia. Gastrointestinal bleeding (GIB) is a rare expression of the condition and may occur due to traumas in the GI tract or as a consequence of gastrointestinal angiodysplasia (GIADs). In this case report, we present a middle-aged woman with recurrent GIB consequent to GIADs with persistent melena and iron deficiency anemia. After several unsuccessful therapeutic interventions, the patient was studied by the hereditary hemorrhagic telangiectasia's (HHT - Osler-Weber-Rendu disease) unit, where she received bevacizumab, showing a complete improvement in symptoms as well as a reduction in her GIADs. This case shows that bevacizumab could be a possible line of treatment for patients with coagulation disorders with GIADs.
Collapse
Affiliation(s)
- Agustina Saladino
- Hospital Italiano de Buenos Aires
- Argentine Rendu Study Group
- Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
| | - María L Gonzalez
- Hospital Italiano de Buenos Aires
- Argentine Rendu Study Group
- Hereditary Hemorrhagic Telangiectasia Unit
- Gastroenterology Department
- Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
| | | | - Marcelo M Serra
- Hospital Italiano de Buenos Aires
- Argentine Rendu Study Group
- Hereditary Hemorrhagic Telangiectasia Unit
- Internal Medicine Department
- Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
| |
Collapse
|
4
|
Jiménez Castillo RA, Benavides-Salgado DE, Jáquez-Quintana JO, González González JA, Cortez Hernández CA, Náñez-Terreros H, Maldonado-Garza HJ. Glanzmann thrombasthenia: an uncommon cause of acute upper gastrointestinal bleeding. Rev Esp Enferm Dig 2023; 115:149. [PMID: 35899703 DOI: 10.17235/reed.2022.9081/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The major function of platelets is to contribute to hemostasis. If an impairment in their production and/or function occurs, abnormal bleeding can develop. An 18-year-old male presented to our hospital after four episodes of hematemesis. His medical history was relevant for Glanzmann thrombasthenia diagnosed during early childhood. On initial examination, he appeared pale and with normal blood pressure. His complete blood count included a hemoglobin concentration of 11.0 g/dL, additional laboratory tests were within the normal ranges. The initial approach consisted of a high dose of proton pump inhibitors. Hours later, esophagogastroduodenoscopy revealed diffuse oozing bleeding from gastric mucosa with no other visible lesions such as peptic ulcers or varices.
Collapse
|
5
|
Laguna P. Use of rFVIIa in Preventing Recurrent Intra-articular Hemorrhages in a 15-Year-Old Patient With Glanzmann Thrombasthenia. J Pediatr Hematol Oncol 2021; 43:e1120-e1123. [PMID: 33625096 DOI: 10.1097/mph.0000000000002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 01/03/2021] [Indexed: 11/25/2022]
Abstract
Glanzmann thrombasthenia is a rare congenital thrombocytopathy. The first-line treatment in severe life-threatening bleeding is a transfusion of platelet concentrate or recombinant factor VIIa in the case of platelet transfusion refractoriness. We present the case of a 16-year-old boy with Glanzmann thrombasthenia who was admitted to hospital with severe bleeding into the quadriceps femoris muscle. At the age of 15 years, he was hospitalized again because of chronic bleeding into the right ankle joint, resulting in joint destruction. Here we give a scheme of management and treatment of this patient. Hemostatic therapy followed by radiosynovectomy of the right ankle joint and introduction of secondary preventive treatment with recombinant factor VIIa proved to be efficacious and safe.
Collapse
Affiliation(s)
- Pawel Laguna
- Department of Oncology, Haematology, Bone Marrow Transplantation and Paediatrics, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
6
|
Abstract
Platelet transfusion is the standard treatment to control or prevent bleeding in patients with Glanzmann's thrombasthenia (GT), but platelets are often unavailable. Recombinant activated factor VII (rFVIIa) is an effective alternative to platelets in patients with GT with past/present refractoriness to platelet transfusions and antibodies to platelets. However, there is an unmet need for an alternative to platelets in patients without antibodies. This report summarizes evidence of efficacy and safety of rFVIIa in patients with GT without refractoriness or antibodies to platelets from three different sources: the Glanzmann's Thrombasthenia Registry (GTR), published literature (January 01, 1999 to December 01, 2017), and the Novo Nordisk safety surveillance database. In the GTR, 133 patients received rFVIIa for the treatment of 333 bleeding episodes and prevention of bleeding in 157 surgical procedures. Overall efficacy rates were 79 and 88%, respectively, in patients treated for bleeding episodes or for the prevention of bleeding during surgery; effectiveness was generally similar across refractoriness/antibody status categories. Median dose per infusion of rFVIIa was close to that recommended for patients with GT (90 µg/kg). Data from 14 published case reports also demonstrated that rFVIIa is effective with an acceptable safety profile in patients with GT without antibodies to platelets. Analysis of adverse events reported in GTR and in Novo Nordisk safety surveillance database did not raise any new safety concerns. These data supported the label extension of rFVIIa to include cases where platelets are not readily available, which was approved by the European Medicines Agency in December 2018.
Collapse
Affiliation(s)
- Man-Chiu Poon
- Department of Medicine, Pediatrics and Oncology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Medical Centre, Calgary, Alberta, Canada
| |
Collapse
|
7
|
Félix LC, Moreira MM, Forte Oliveira FA, Fernandes CP, Lima Mota MR, Nunes Alves APN, Sousa FB. Oral tranexamic acid associated with platelet transfusion to prevent hemorrhage in a patient with Glanzmann thrombasthenia. Gen Dent 2019; 67:61-65. [PMID: 30644834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Glanzmann thrombasthenia (GT) is a rare genetic disorder that alters platelet function. The clinical manifestations include purpura, epistaxis, gingival bleeding, and menorrhagia. For patients with GT, conventional surgical dental treatment may result in hemorrhagic complications. There are many reported ways to prevent hemorrhage in patients with GT during surgical procedures but no standardized recommendations. In this case study, a woman diagnosed with GT required 2 types of surgery (periodontal surgery and third molar extractions), which were performed on separate days. Preoperative evaluation and planning with a hematology service led to the transfusion of 1 pack of platelet concentrate immediately before each surgery. Additionally, the patient was prescribed oral tranexamic acid, which was started 1 day before each surgery and continued for 3 additional days. A distal wedge procedure was performed for the mandibular right third molar, and later the maxillary and mandibular left third molars were extracted. The use of oral tranexamic acid associated with a single platelet bag was effective in the present case, and no bleeding or thrombotic events were observed after either surgery. Although this coagulopathy is rare, dentists must be aware of its implications, which necessitate specific precautions for oral surgical procedures. Multidisciplinary integration and surgical planning can reduce the risk of complications for the patient.
Collapse
|
8
|
Buckley F, Norris A, Kerr R. Management of Abdominoperineal Excision of the Rectum in a Patient with Glanzmann Thrombasthenia. Acta Haematol 2018; 139:243-246. [PMID: 29945125 DOI: 10.1159/000489114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/09/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Frances Buckley
- Haematology Department, Ninewells Hospital, Dundee, United Kingdom
| | - Alan Norris
- Scottish National Blood Transfusion Service, Ninewells Hospital, Dundee, United Kingdom
| | - Ron Kerr
- Haematology Department, Ninewells Hospital, Dundee, United Kingdom
| |
Collapse
|
9
|
Nurden AT. Should studies on Glanzmann thrombasthenia not be telling us more about cardiovascular disease and other major illnesses? Blood Rev 2017; 31:287-299. [PMID: 28395882 DOI: 10.1016/j.blre.2017.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 01/25/2017] [Accepted: 03/23/2017] [Indexed: 12/17/2022]
Abstract
Glanzmann thrombasthenia (GT) is a rare inherited bleeding disorder caused by loss of αIIbβ3 integrin function in platelets. Most genetic variants of β3 also affect the widely expressed αvβ3 integrin. With brief mention of mouse models, I now look at the consequences of disease-causing ITGA2B and ITGB3 mutations on the non-hemostatic functions of platelets and other cells. Reports of arterial thrombosis in GT patients are rare, but other aspects of cardiovascular disease do occur including deep vein thrombosis and congenital heart defects. Thrombophilic and other risk factors for thrombosis and lessons from heterozygotes and variant forms of GT are discussed. Assessed for GT patients are reports of leukemia and cancer, loss of fertility, bone pathology, inflammation and wound repair, infections, kidney disease, autism and respiratory disease. This survey shows an urgent need for a concerted international effort to better determine how loss of αIIbβ3 and αvβ3 influences health and disease.
Collapse
Affiliation(s)
- Alan T Nurden
- Institut de Rhythmologie et de Modélisation Cardiaque, Plateforme Technologique d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
| |
Collapse
|
10
|
Segna E, Artoni A, Sacco R, Giannì AB. Oral Surgery in Patients With Glanzmann Thrombasthenia: A Case Series. J Oral Maxillofac Surg 2017; 75:256-259. [PMID: 28341450 DOI: 10.1016/j.joms.2016.09.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 07/03/2015] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/18/2022]
Abstract
Glanzmann thrombasthenia is a severe defect of platelet function caused by an inherited deficiency or dysfunction of the glycoprotein IIb/IIIa complex, the platelet fibrinogen receptor. Patients with Glanzmann thrombasthenia experience lifelong spontaneous and post-traumatic mucocutaneous bleeding diathesis. Surgery is usually very challenging, requiring close cooperation among surgeons, hematologists, and anesthesiologists. For anatomic reasons, oral surgery is particularly difficult owing to the inherent risk of hemorrhage and the difficulty in achieving local hemostasis. In the present report, we describe 3 successful cases of oral surgery in patients with Glanzmann thrombasthenia and report the surgical and hematologic management of each case.
Collapse
Affiliation(s)
- Eleonora Segna
- Resident, Department of Maxillofacial Surgery and Odontostomatology, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy.
| | - Andrea Artoni
- Consultant, Hemophilia and Thrombosis Center, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Raffaele Sacco
- Consultant, Department of Maxillofacial Surgery and Odontostomatology, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Aldo Bruno Giannì
- Professor, Department of Maxillofacial Surgery and Odontostomatology, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| |
Collapse
|
11
|
Imperiale L, Manganaro L, Ticino A, Piacenti I, Anastasi E, Resta S, Benedetti Panici P, Porpora MG. Endometriosis and Glanzmanns thrombasthenia. J BIOL REG HOMEOS AG 2016; 30:877-882. [PMID: 27655515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Glanzmanns thrombasthenia (GT) is a rare bleeding syndrome characterized by deficiency or defect of platelet aggregation complex. The pathogenesis of endometriosis is controversial but the strongest evidence leans towards retrograde menstruation. GT probably predisposes to endometriosis. The management of women affected by this disease can be difficult due to the risk of bleeding complications, especially during surgical treatment. We describe the cases of three sisters affected by endometriosis and GT, referred to our Department, who received different therapeutic management.
Collapse
Affiliation(s)
- L Imperiale
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| | - L Manganaro
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - A Ticino
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| | - I Piacenti
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| | - E Anastasi
- Department of Molecular Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - S Resta
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| | - P Benedetti Panici
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| | - M G Porpora
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| |
Collapse
|
12
|
Yazici ZM, Çelik M, Yegin Y, Güneş S, Kayhan FT. Glanzmann's thrombasthenia: a rare case of spontaneous bilateral hemotympanum. Braz J Otorhinolaryngol 2015; 81:224-5. [PMID: 25613489 PMCID: PMC9449038 DOI: 10.1016/j.bjorl.2014.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 11/01/2014] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Mustafa Çelik
- Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, Istanbul, Turkey.
| | - Yakup Yegin
- Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, Istanbul, Turkey
| | - Selçuk Güneş
- Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, Istanbul, Turkey
| | | |
Collapse
|
13
|
Obergfell A, Bjerre J. Comment on: Forde K, Mason C, Mathias M. Prolonged bleeding after exfoliation of a deciduous tooth in a patient with Glanzmann's thrombasthenia. Haemophilia 2012; 18: e58-59. Haemophilia 2012; 18:e347-e348. [PMID: 22747905 DOI: 10.1111/j.1365-2516.2012.02844.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
14
|
Domschke C, Strowitzki T, Huth-Kuehne A, Staritz P, Sohn C, Schuetz F. Successful in vitro fertilization and pregnancy in Glanzmann thrombasthenia. Haemophilia 2012; 18:e380-1. [PMID: 22672198 DOI: 10.1111/j.1365-2516.2012.02873.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2012] [Indexed: 11/30/2022]
|
15
|
Fadhlaoui A, Ben Salah N, Khrouf M, Boubaker M, Gouider E, Zhioua F, Chaker A. [Pregnancy and delivery in a patient with Glanzmann's thrombasthenia]. Tunis Med 2011; 89:951-952. [PMID: 22198884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
16
|
Affiliation(s)
- Melhem Solh
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota 55455, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Wertz D, Boveroux P, Péters P, Lenelle J, Franssen C. Surgical resection of a sphenoid wing meningioma in a patient with Glanzmann thrombasthenia. Acta Anaesthesiol Belg 2011; 62:83-86. [PMID: 21919374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Glanzmann thrombasthenia (GT) is a rare autosomal recessive disorder characterized by a deficiency or functional defect of platelet glycoprotein (GP) IIb/IIIa. Physiologically, this platelet receptor mediates aggregation of activated platelets by binding the adhesive proteins, fibrinogen, von Willebrand factor (VWF) and fibronectin. This facilitates attachment and aggregation of platelets at sites of vascular injury. We reported the management of a pterional meningioma resection in a patient with Glanzmann thrombasthenia, with recombinant factor VIIa (rFVIIa - NovoSeven) as haemostatic agent. A 48-year-old woman suffering from Glanzmann thrombasthenia was scheduled for spheno-orbital meningioma en plaque surgery. Because of repeated platelet transfusions, this patient developed isoantibodies against missing GPIIbIIIa and alloantibodies against Human Leukocyte Antigen (HLA) leading to refractoriness to platelet transfusions. We observed that Novoseven offered sufficient haemostasis conditions. Therefore, we noticed a deep vein thrombosis. This imposed us to use low weight molecular heparin despite recent surgery.
Collapse
Affiliation(s)
- D Wertz
- Département d'Anesthésie-Réanimation, Université de Liège, Belgique.
| | | | | | | | | |
Collapse
|
18
|
Zinke RA, Ornstein DL, Holmes CE. Factor VIII/von Willebrand factor concentrate for treatment of life threatening epistaxis in Glanzmann's thrombasthenia. Haemophilia 2010; 16:701-704. [PMID: 20331758 DOI: 10.1111/j.1365-2516.2010.02222.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
19
|
Hossain N, Farzana T, Khan NH, Shamsi TS, James AH. Adolescent menorrhagia due to platelet function disorder. J PAK MED ASSOC 2010; 60:127-129. [PMID: 20209700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The prevalence of menorrhagia in adolescent populations with bleeding disorders varies between 14% to 48%. The common conditions associated with menorrhagia include von Willebrand disease (VWD), platelet function disorders and coagulation factor deficiencies. The majority of studies, which have been conducted in the West, report VWD, as the most common inherited bleeding disorder leading to menorrhagia, whereas studies from South-East Asia have found platelet function disorder as the leading inherited bleeding disorder in women with menorrhagia. The other common conditions which can lead to increased blood loss in this age group are anovulatory bleeding and hormonal disorders. We report here three cases of adolescent menorrhagia due to platelet function disorders, along with review of literature.
Collapse
Affiliation(s)
- Nazli Hossain
- Department of Obstetrics & Gynecology Unit-3, Dow University of Health Sciences & Civil Hospital Karachi
| | | | | | | | | |
Collapse
|
20
|
Goksu S, Gul R, Ozen O, Yilmaz M, Buyukbebeci O, Oner U. Intravenous regional analgesia in a patient with Glanzmann thrombastenia. Middle East J Anaesthesiol 2010; 20:589-591. [PMID: 20394261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Glanzmann thrombastenia (GT) is a rare condition of an inherited autosomal recessive gene characterized with bleeding tendency. The condition is rarely met in the OR. and therefore it is essential that anesthesiologist be cognizant of the risk involved and be prepared with all necessary precautionary measures. We present a GT case in a 27-year-old male with a mass in the anticubital region of right wrist that was successfully excised using the non-invasive intravenous regional analgesia (IVRA). The use of platelet transfusion and the recombinant factor VIIa, are stressed.
Collapse
Affiliation(s)
- Sitki Goksu
- Department of Anesthesiology & Reanimation, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Javed A, Ayyub M, Abrar S, Mansoor M, Khan B, Hussain T. Control of severe bleeding episode in case of Glanzmann's thrombasthenia refractory to platelet transfusion therapy by administering recombinant factor VIIa. J Ayub Med Coll Abbottabad 2009; 21:171-173. [PMID: 20524499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Glanzmann's thrombasthenia is an autosomal recessive inherited platelet function defect. Though, quantitatively normal, the aggregation ability of platelets is reduced leading to bleeding episodes requiring transfusion of platelet concentrates. We describe a case of 13-year-old girl who had recurrent episodes of epistaxis since birth and was managed with multiple platelet concentrate transfusions and recently admitted with severe epistaxis refractory to platelet transfusion. At this stage administration of recombinant activated factor VII (fVIIa) was considered, which was initially given at 90 microg/kg dose with little control of bleeding but subsequent second dose of 120 microg/kg was administered with excellent response and immediate control of bleeding.
Collapse
Affiliation(s)
- Asim Javed
- Combined Military Hospital, Rawalpindi, Pakistan
| | | | | | | | | | | |
Collapse
|
23
|
Kittisupamongkol W. Duodenal hematoma in thrombasthenia. Arch Surg 2009; 144:93-94. [PMID: 19153336 DOI: 10.1001/archsurg.2008.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
24
|
Ranjith A, Nandakumar K. Glanzmann thrombasthenia: a rare hematological disorder with oral manifestations: a case report. J Contemp Dent Pract 2008; 9:107-113. [PMID: 18633476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM The aim of this report is to present a case of Glanzmann thrombasthenia (GT) with oral manifestations requiring periodontal management along with a discussion of the clinical, hematologic, and molecular level features of the disease. BACKGROUND GT is a rare hematological disorder with oral manifestations affecting platelets and clotting. It is characterized by spontaneous bleeding from mucosal tissues and excessive bleeding following skin damage. It belongs to the group of hereditary platelet disorders and is due to a defect in one of two genes, platelet membrane glycoprotein (GP) IIb/IIIa. REPORT A 22-year-old female patient with a history of Type I GT and long-term care using platelet transfusion was referred for management of her gingival bleeding. Dental treatment included scaling, polishing, oral hygiene instructions, along with a prescription for anti-plaque agents. There was pronounced improvement in her periodontal condition after treatment. Reduced gingival bleeding resulted in an increase in her hemoglobin level from a pre-treatment level of 2 gm% to 8 gm% during her last visit. The patient was followed for eight months with no further periodontal complications. SUMMARY A pronounced improvement in the periodontal condition of a GT patient occurred following routine scaling and polishing procedures along with proper oral hygiene maintenance instructions. The result was a reduction of the patient's gingivitis and associated spontaneous bleeding and an improvement in her hemoglobin status. GT patients should be managed for their periodontal problems following a hematological consultation. The importance of proper maintenance of oral hygiene as well as regular recall visits should be emphasized.
Collapse
Affiliation(s)
- Ambili Ranjith
- Department of Periodontics, PMS College of Dental Sciences and Research, Kerala, India.
| | | |
Collapse
|
25
|
Bakdash S, Lyons JM, Bastacky SI, Pezzone MA, McGee JB, Schoen RE, Regueiro M, Lee KK, Bontempo FA. Management of persistent gastric bleeding in a patient with Glanzmann's thrombasthenia. Am J Hematol 2008; 83:411-5. [PMID: 18186523 DOI: 10.1002/ajh.21122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Suzanne Bakdash
- Division of Transfusion Medicine, Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Sugihara S, Katsutani S, Hyodo H, Hyodo M, Kudo Y, Fujii T, Kimura A. [Postpartum hemorrhage successfully treated with recombinant factor VIIa in Glanzmann thromboasthenia]. Rinsho Ketsueki 2008; 49:46-50. [PMID: 18277596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Glanzmann thrombasthenia is an inherited hemorrhagic disorder characterized by severe reduction or absence of platelet aggregation in response to multiple physiologic agonists due to qualitative or quantitative abnormalities of platelet glycoprotein (GP) IIb/IIIa. Treatment of bleeding episodes may require platelet transfusion. However, repeated platelet transfusions may result in GPIIb/IIIa and/or HLA immunization, and development of platelet refractoriness. Recently, a number of reports have suggested that recombinant factor VIIa product (rFVIIa) may be a therapeutic alternative in these situations. We have used rFVIIa to treat a 34-year-old primigravida woman for postpartum bleeding. She had been diagnosed with Glanzmann thrombasthenia at 32 years of age. At 37 weeks gestation, she underwent elective caesarean section uneventfully with platelet transfusion. Nine days later, she developed vaginal bleeding and received twenty units of platelet concentrates every day, but bleeding persisted. Thereafter, 4.8 mg intravenous rFVIIa was administered three times, which immediately arrested the bleeding. These results demonstrate that rFVIIa is effective for severe bleeding in Glanzmann thrombasthenia patients, especially in those with antiplatelet antibodies and/or platelet transfusion refractoriness.
Collapse
Affiliation(s)
- Sayaka Sugihara
- Department of Hematology and Oncology, Division of Clinical and Experimental Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | | | | | | | | | | | | |
Collapse
|
27
|
Affiliation(s)
- Taro Ikeda
- Division of Pediatric Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
BACKGROUND Glanzmann thrombasthenia (GT) is an exceedingly rare but well-defined inherited disorder of platelet function caused by a defect in the glycoprotein IIb/IIIa complex. The association of GT with consanguinity has been noted, especially in geographic regions in which intermarriage is common. In most patients, GT is diagnosed during early infancy or before the age of 5 years. Common manifestations of this disorder are gingival hemorrhage, purpura, epistaxis, petechiae, and menorrhagia. Chronic, prolonged, untreated, or unsuccessfully treated bleeding may be life threatening. METHODS We report two female patients with GT who were referred by our hematology clinic to our periodontology department for the treatment of excessive gingival bleeding. The first patient was treated with a platelet transfusion and underwent periodontal therapy (scaling and root planing and dental polishing). The second patient, whose GT was undiagnosed at the time of her referral to our department, applied to our emergency service because of uncontrolled gingival bleeding that developed after scaling and root planing was performed by her dentist. Both patients had been called for regular dental visits. RESULTS All treated sites healed without complications. The first patient was monitored for 2 years, during which she practiced proper oral hygiene and experienced no periodontal complications. The other patient did not participate in follow-up. CONCLUSIONS Gingival bleeding is usually the first sign of most hematologic disorders, and dentists must be alert for the signs of unusual gingival bleeding. In such cases, collaboration with a hematologist is essential. Under the proper circumstances, periodontal treatment can be performed with an acceptable outcome. With proper oral hygiene, we believe that there will be no complications and no gingival bleeding.
Collapse
Affiliation(s)
- Hilal Uslu Toygar
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey.
| | | |
Collapse
|
29
|
|
30
|
Affiliation(s)
- Yesim Aydinok
- Division of Pediatric Hematology, Department of Pediatrics, School of Medicine, Ege University, Izmir, Turkey
| | | | | |
Collapse
|
31
|
Gunaydin B, Ozkose Z, Pezek S. Recombinant activated factor VII and epsilon aminocaproic acid treatment of a patient with Glanzmann's thrombasthenia for nasal polipectomy. J Anesth 2007; 21:106-7. [PMID: 17285428 DOI: 10.1007/s00540-006-0453-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 09/14/2006] [Indexed: 10/23/2022]
|
32
|
Zenciroglu A, Bas AY, Demirel N, Yarali N. Glanzmann thrombasthenia in a neonate. Indian Pediatr 2007; 44:40-2. [PMID: 17277431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Glanzmann thrombasthenia is a qualitative platelet function disorder manifested by skin bleeds, epistaxis, gingival bleeding, gastrointestinal hemorrhage, hematuria, hemarthrosis, intracranial hemorrhage and visceral hematomas. We report a six day old newborn presenting with hematuria following suprapubic aspiration, who was diagnosed as Glanzmann thrombasthenia. We believe it to be the youngest case reported in the literature.
Collapse
Affiliation(s)
- Aysegul Zenciroglu
- Department of Neonatology, and Pediatric Hematology, Dr. Sami Ulus Childrens Hospital, Ankara, Turkey
| | | | | | | |
Collapse
|
33
|
Tullu MS, Vaideeswar P, Pandit SP, Lahiri KR. Glanzmann thrombasthenia with endomyocardial fibrosis: A thrombotic paradox. Int J Cardiol 2007; 114:401-2. [PMID: 16630667 DOI: 10.1016/j.ijcard.2005.11.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Accepted: 11/16/2005] [Indexed: 11/25/2022]
Abstract
We report a paradoxical occurrence of left ventricular thrombus due to endomyocardial fibrosis in a six years male child diagnosed as Glanzmann thrombasthenia. Such an association has not been reported in literature.
Collapse
|
34
|
Cherian JV, Murali A, Vardarajan R, Joye Varghese S, Jayanthi V. An unusual cause of overt gastrointestinal bleeding. J Gastrointestin Liver Dis 2006; 15:321-2. [PMID: 17013461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
|
35
|
Casati V, D'Angelo A, Barbato L, Rossi E, Grasso MA, Spagnolo S, Panzeri E. Perioperative Management of a Heterozygous Carrier of Glanzmann’s Thrombasthenia Submitted to Coronary Artery Bypass Grafting With Cardiopulmonary Bypass. Anesth Analg 2006; 103:309-11, table of contents. [PMID: 16861409 DOI: 10.1213/01.ane.0000226087.11062.cd] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Glanzmann's thrombasthenia is a congenital hemorrhagic disorder transmitted as an autosomal recessive trait and characterized by altered production and/or assembly of the platelet membrane glycoprotein IIb/IIIa receptor. We describe the perioperative management of a heterozygous carrier of Glanzmann's thrombasthenia submitted to cardiac surgery with cardiopulmonary bypass and the case was complicated by early excessive postoperative bleeding.
Collapse
Affiliation(s)
- Valter Casati
- Division of Cardiovascular Anesthesia and Intensive Care, Policlinico di Monza, via Amati 111, Monza (20052), Italy.
| | | | | | | | | | | | | |
Collapse
|
36
|
Lombardo VT, Sottilotta G. Recombinant activated factor VII combined with desmopressin in preventing bleeding from dental extraction in a patient with Glanzmann's thrombasthenia. Clin Appl Thromb Hemost 2006; 12:115-6. [PMID: 16444446 DOI: 10.1177/107602960601200120] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The case of a 41-year-old woman with Glanzmann's thrombasthenia who underwent double dental extraction is presented. In the past, treatments with desmopressin (DDAVP) and tranexamic acid had often unsuccessful efficacy to stop or decrease bleeding. After ineffective DDAVP administration, the removal was performed successfully with recombinant activated factor VII (rFVIIa) infusion. rFVIIa infusion after DDAVP administration could be useful in patients with Glanzmann's thrombasthenia in which DDAVP and tranexamic acid weren't always effective.
Collapse
Affiliation(s)
- Vincenzo Trapani Lombardo
- Hemophilia Center--Thrombosis and Hemostasis Service, Hematology Department, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
| | | |
Collapse
|
37
|
Yee NS, Schuster SJ. Clinical remission of acquired thrombasthenia with low-dose methotrexate in a patient with systemic lupus erythematosus. Mayo Clin Proc 2006; 81:566-7. [PMID: 16610580 DOI: 10.4065/81.4.566-a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
38
|
Affiliation(s)
- Günhal Kamburoğlu
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | | |
Collapse
|
39
|
Malhotra N, Chanana C, Deka D. Pregnancy in a patient of Glanzmann's thrombasthenia. Indian J Med Sci 2006; 60:111-3. [PMID: 16569925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Glanzmann's thrombasthenia is a congenitally acquired platelet disorder with an autosomal recessive mode of inheritance. Though, quantitatively normal, the aggregation ability of platelets is reduced in this condition. Pregnancy and delivery are rare in these patients and have been associated with a high risk of severe post-partum hemorrhage. We describe a primigravida, who was diagnosed to have Glanzmann's thrombasthenia during adolescence. She developed secondary post-partum hemorrhage after an elective caesarean section, which was successfully managed by single donor platelet transfusion.
Collapse
Affiliation(s)
- Neena Malhotra
- Department of gynecology and obstetrics,All India Institute of medical sciences, New Delhi, India.
| | | | | |
Collapse
|
40
|
Poon MC, Zotz R, Di Minno G, Abrams ZS, Knudsen JB, Laurian Y. Glanzmann’s Thrombasthenia Treatment: A Prospective Observational Registry on the Use of Recombinant Human Activated Factor VII and Other Hemostatic Agents. Semin Hematol 2006; 43:S33-6. [PMID: 16427383 DOI: 10.1053/j.seminhematol.2005.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Glanzmann's thrombasthenia (GT) is a rare congenital bleeding disorder caused by deficiency or dysfunction of platelet surface glycoprotein (GP) IIb/IIIa receptor. Platelet transfusion is the standard treatment for bleeding that remains non-responsive to conservative measures, and for surgical coverage. Platelet transfusions, however, may result in the development of antibodies to GPIIb/IIIa and/or human leukocyte antigen (HLA), rendering further transfusions ineffective. Recombinant human activated factor VII (rFVIIa; NovoSeven/Niastase [Canada], Novo Nordisk, Bagsvaerd, Denmark) has documented efficacy in GT patients, and is approved in the European Union for the treatment of GT patients with platelet antibodies and platelet refractoriness. However, there are insufficient data to determine the optimal rFVIIa regimen (eg, for major surgery) or to allow thorough safety evaluation (eg, thrombotic risk). A post-marketing, prospective, observational, multinational registry has been developed to collect data on the efficacy and safety of rFVIIa in the treatment and prevention of bleeding in GT patients with platelet antibodies or platelet refractoriness. Patients treated with other hemostatic agents or rFVIIa to avoid the development of antibodies against GPIIb/IIIa will also be reported. Standardized data will be collected using a customized internet-based (www.glanzmann-reg.org) data collection tool. Data collection will begin in 2005 and continue for up to 6 years. Patients of all ages from any country are eligible for inclusion.
Collapse
Affiliation(s)
- Man-Chiu Poon
- University of Calgary, Southern Alberta Hemophilia Clinic, Calgary Health Region, Canada.
| | | | | | | | | | | |
Collapse
|
41
|
Afrasiabi A, Afrabiasi A, Artoni A, Karimi M, Peyvandi F, Ashouri E, Mannucci PM. Glanzmann thrombasthenia and Bernard-Soulier syndrome in south Iran. ACTA ACUST UNITED AC 2005; 27:324-7. [PMID: 16178914 DOI: 10.1111/j.1365-2257.2005.00725.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glanzmann thrombasthenia (GT) and Bernard-Soulier syndrome (BSS) are two rare inherited disorders of platelet function. In this study, we report the demographic, clinical and biological characteristics of 23 patients with GT and of seven patients with BSS from southern Iran who had been followed for many years but fully characterized only recently, when platelet aggregation tests and flow cytometric studies became available for the first time in the country. We found a high prevalence of both diseases that can be explained by the high rate of consanguineous marriages in south Iran. Patients affected by GT and BSS suffer mainly from mucocutaneous bleedings causing anemia and transfusion requirements.
Collapse
Affiliation(s)
- A Afrasiabi
- Haemostasis and Thrombosis Unit, Hematology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | | | | | | | | | | | | |
Collapse
|
42
|
Léticée N, Kaplan C, Lémery D. Pregnancy in mother with Glanzmann's thrombasthenia and isoantibody against GPIIb–IIIa: Is there a foetal risk? Eur J Obstet Gynecol Reprod Biol 2005; 121:139-42. [PMID: 16054952 DOI: 10.1016/j.ejogrb.2005.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 02/23/2004] [Revised: 12/06/2004] [Accepted: 02/18/2005] [Indexed: 10/25/2022]
Abstract
Glanzmann's thrombasthenia (GT) is a rare autosomal recessive platelet disorder caused by qualitative or quantitative abnormalities of a platelet glycoprotein complex (GPIIb-IIIa) leading to excessive bleeding. Platelet transfusions are the first-line therapy for severe or persistent bleeding and surgery. Isoantibody against GPIIb-IIIa complexes present on normal platelets can be observed in Glanzmann's thrombasthenia type I patients after platelet transfusion possibly leading to platelet transfusion refractoriness. Pregnancy in Glanzmann's thrombasthenia type I women is rare, and severe bleeding can be observed in the peripartum or late postpartum period. Moreover, pregnancy can contribute to the maternal isoimmunization by the passage of the foetal cells into the maternal circulation. The transplacental passage of the maternal isoantibodies can induce moderate to severe foetal thrombocytopenia. We discuss here the case of in utero death at 31 weeks of gestation due to intracranial haemorrhage in an immunized mother and review the literature. Presence of isoantibody prior to gestation or detected during the index pregnancy must be taken into account in evaluating risk for the mother and the foetus.
Collapse
Affiliation(s)
- Nadia Léticée
- Prenatal diagnosis Center, Institut de Puériculture et Périnatalalogie, Paris, France
| | | | | |
Collapse
|
43
|
Cohen HV, Wu P. Case report: Glanzmann thrombasthenia. Dental patient management for a rare platelet disorder. J N J Dent Assoc 2005; 76:17-8. [PMID: 16320915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
With today's medically complex population of ambulatory patients, it is essential that the dental clinician possess a working knowledge of those medical issues that may impact a practice. This is most critical in those patients who present with a bleeding risk. Acquiring a thorough history with necessary medical information and possessing a basic knowledge of bleeding disorders will guide the clinician in deciding whether to treat or to make an appropriate referral.
Collapse
Affiliation(s)
- Harold V Cohen
- Department of Diagnostic Sciences, UMDNJ-New Jersey Dental School, USA
| | | |
Collapse
|
44
|
Fujimoto TT, Kishimoto M, Ide K, Mizushima M, Mita M, Sezaki N, Kojima K, Shinagawa K, Niiya K, Tanimoto M, Fujimura K. Glanzmann Thrombasthenia with Acute Myeloid Leukemia Successfully Treated by Bone Marrow Transplantation. Int J Hematol 2005; 81:77-80. [PMID: 15717695 DOI: 10.1532/ijh97.04044] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report successful treatment by bone marrow transplantation (BMT) in an acute myeloid leukemia (AML) patient with Glanzmann thrombasthenia (GT). Genetic analysis revealed that a novel point mutation in exon 3 of the GPIIb gene led to abnormal splicing resulting in an amino acid substitution and an in-frame deletion of 3 amino acid residues. Expression studies suggested a rapid degradation of the uncomplexed protein within the cells. Induction therapy for AML was performed with frequent platelet transfusions because of the patient's severe hemorrhagic manifestations. In the second remission, the patient was successfully treated by BMT from an HLA-matched unrelated donor. Platelet function returned to normal, and the GT phenotype completely disappeared. Our experience suggests that BMT is a curative therapeutic strategy for GT. Furthermore, we believe this study is the first to demonstrate that engraftment after BMT for AML can be determined by monitoring the congenital genetic defect of GT.
Collapse
Affiliation(s)
- Tetsuro-Takahiro Fujimoto
- Department of Hematology and Oncology, Division of Clinical Pharmacotherapeutics, Program for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Coppola A, Tufano A, Cimino E, Agangi A, Maruotti GM, Martinelli P, Di Minno G. Recombinant factor VIIa in a patient with Glanzmann's thrombasthenia undergoing gynecological surgery: open issues in light of successful treatment. Thromb Haemost 2004; 92:1450-2. [PMID: 15583755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
|
46
|
Abstract
Glanzmann's thrombasthenia is a rare autosomal recessive disease characterized by potentially major mucocutaneous complications and nose bleeds. It is considered hazardous for these surgical patients to conceive, with a high risk of urgent surgery. The treatment of bleeding or prevention of hemorrhage for surgery or invasive procedures is based on platelet transfusion. However, platelet transfusions may be responsible for the development of alloimmunization, with a high risk of future platelet refractoriness. We report a surgical case of Glanzmann's thrombasthenia complicated by nasopharyngeal bleeding and managed with platelet transfusions, recombinant activated factor VII, and postoperative airway management in the intensive care unit.
Collapse
Affiliation(s)
- Halil Ibrahim Uzunlar
- Department of Anesthesiology and Reanimation, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | | | | | | | | |
Collapse
|
47
|
Fernandes Gomes M, de Melo RM, Plens G, Pontes EM, Silva MM, da Rocha JC. Surgical and clinical management of a patient with Glanzmann thrombasthenia: a case report. Quintessence Int 2004; 35:617-20. [PMID: 15366524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
A 6-year-old girl with Glanzmann thrombasthenia presented with caries and periapical lesions in the primary mandibular second molars and moderate gingivitis of the maxillary and mandibular anterior teeth. Dental extraction was recommended, and before every surgical intervention, the patient underwent platelet-concentrate transfusion to prevent hemorrhage. Epsilon aminocaproic acid was administered 6 hours before, and 48 hours after every dental procedure to prevent bleeding. In this case, treatment was effective in the prevention of hemorrhagic complications, during the required dental procedures.
Collapse
Affiliation(s)
- Mônica Fernandes Gomes
- Department of Biosciences and Oral Diagnosis, São José dos Campos Dental School, São Paulo State University-UNESP, São Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
48
|
Poon MC, D'Oiron R, Von Depka M, Khair K, Négrier C, Karafoulidou A, Huth-Kuehne A, Morfini M. Prophylactic and therapeutic recombinant factor VIIa administration to patients with Glanzmann's thrombasthenia: results of an international survey. J Thromb Haemost 2004; 2:1096-103. [PMID: 15219192 DOI: 10.1111/j.1538-7836.2004.00767.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antibodies to glycoprotein (GP) IIb-IIIa and/or HLA may render platelet transfusions ineffective to stop bleeding or to cover surgery in patients with Glanzmann's thrombasthenia (GT). Anecdotal reports suggest recombinant factor (rF)VIIa might be a therapeutic alternative in these situations. OBJECTIVES An international survey was conducted to evaluate further the efficacy and safety of rFVIIa in GT patients. PATIENTS We analyzed the use of rFVIIa during 34 surgical/invasive procedures and 108 bleeding episodes in 59 GT patients including 29 with current or previous antiplatelet antibodies, and 23 with a history of refractoriness to platelet transfusion. RESULTS rFVIIa was effective in 29 of the 31 evaluable procedures, and in 77 of the 103 evaluable bleeding episodes of which eight had a recurrence. A significantly higher success rate was observed in severe bleeding episodes when an arbitrarily defined 'optimal regimen' derived from the Canadian pilot study results (> or = 80 micro g kg(-1) rFVIIa/injection, dosing interval < or = 2.5 h, three or more doses before failure declaration) was used compared with other regimens (77%; 24/31 vs. 48%, 19/40; chi(2), P = 0.010). Patients given maintenance doses had significantly fewer recurrences within 48 h of bleed cessation compared with those not given any (Fisher's exact test, P = 0.022). One thromboembolic event and one blood clot in the ureter occurring in surgical patients following prolonged continuous infusion of high-dose rFVIIa and antifibrinolytic drug use have been previously reported. CONCLUSION rFVIIa seems a potential alternative to platelet transfusion in GT patients, particularly in those with antiplatelet antibodies and/or platelet refractoriness.
Collapse
Affiliation(s)
- M-C Poon
- Centre d'Hémophiles, AP-HP Hôpital Bicêtre, Le Kremlin Bicêtre, France.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Mairos JS, Bernardo AC, Neves AR, Campos AP, Nunes FP, Saraiva JS, Trinidade MC, Pereira AH, Pereira AM, Falcão CB, Retto H. [Thrombasthenia of Glanzmann. Vaginal hysterectomy treated with recombinant factor VIIa]. ACTA MEDICA PORT 2004; 17:180-2. [PMID: 15921650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In the present article, regarding a clinical case of Thrombasthenia of Glanzmann with severe anaemia by menometrorrhagia, the authors propose the vaginal hysterectomy and the administration of the recombinant factor VIIa on the immediate pre and postoperative as effective therapeutical alternatives.
Collapse
Affiliation(s)
- João S Mairos
- Serviço de Ginecologia, Hospital Garcia de Orta, Almada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Horton MA, Massey HM, Rosenberg N, Nicholls B, Seligsohn U, Flanagan AM. Upregulation of osteoclast alpha2beta1 integrin compensates for lack of alphavbeta3 vitronectin receptor in Iraqi-Jewish-type Glanzmann thrombasthenia. Br J Haematol 2003; 122:950-7. [PMID: 12956766 DOI: 10.1046/j.1365-2141.2003.04530.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Osteoclasts utilize alphavbeta3 integrin adhesion to bone matrix during bone resorption. We have generated osteoclasts from the peripheral blood of Iraqi-Jewish patients with Glanzmann thrombasthenia (GT) who are completely deficient in beta3 integrin and exhibit a haemorrhagic diathesis resulting from the absence of platelet alphaIIbbeta3. We show that, in contrast to osteoclasts generated from normal subjects or patients with alphaIIb integrin deficiency, GT osteoclasts lack alphavbeta3. These osteoclasts exhibited a two- to fourfold increase in alpha2 and beta1 integrin expression, whereas other alphav integrins, including alphavbeta5, were not significantly affected. An accompanying decrease in bone resorption was observed, with 44% and 59% declines in pit number and depth, respectively, and resorption lacunae showed abnormal morphology on scanning electron microscopy. However, osteoclasts from GT developed in similar numbers to controls and exhibited an otherwise 'normal' phenotype. We conclude that the observed rise in alpha2beta1 expression compensates for the chronic genetic deficiency of alphavbeta3 in osteoclasts from patients with GT and is sufficient to enable bone resorption to proceed, albeit to a submaximal extent. This explains why Iraqi-Jewish patients with GT do not have osteopetrosis.
Collapse
Affiliation(s)
- Michael A Horton
- Departments of Medicine and Histopathology, University College London, London, UK.
| | | | | | | | | | | |
Collapse
|