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Aliotta A, Bertaggia Calderara D, Zermatten MG, Marchetti M, Alberio L. Thrombocytopathies: Not Just Aggregation Defects-The Clinical Relevance of Procoagulant Platelets. J Clin Med 2021; 10:jcm10050894. [PMID: 33668091 PMCID: PMC7956450 DOI: 10.3390/jcm10050894] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/31/2021] [Accepted: 02/12/2021] [Indexed: 01/08/2023] Open
Abstract
Platelets are active key players in haemostasis. Qualitative platelet dysfunctions result in thrombocytopathies variously characterized by defects of their adhesive and procoagulant activation endpoints. In this review, we summarize the traditional platelet defects in adhesion, secretion, and aggregation. In addition, we review the current knowledge about procoagulant platelets, focusing on their role in bleeding or thrombotic pathologies and their pharmaceutical modulation. Procoagulant activity is an important feature of platelet activation, which should be specifically evaluated during the investigation of a suspected thrombocytopathy.
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Affiliation(s)
- Alessandro Aliotta
- Hemostasis and Platelet Research Laboratory, Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1010 Lausanne, Switzerland; (A.A.); (D.B.C.); (M.G.Z.); (M.M.)
| | - Debora Bertaggia Calderara
- Hemostasis and Platelet Research Laboratory, Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1010 Lausanne, Switzerland; (A.A.); (D.B.C.); (M.G.Z.); (M.M.)
| | - Maxime G. Zermatten
- Hemostasis and Platelet Research Laboratory, Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1010 Lausanne, Switzerland; (A.A.); (D.B.C.); (M.G.Z.); (M.M.)
| | - Matteo Marchetti
- Hemostasis and Platelet Research Laboratory, Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1010 Lausanne, Switzerland; (A.A.); (D.B.C.); (M.G.Z.); (M.M.)
- Service de Médecine Interne, Hôpital de Nyon, CH-1260 Nyon, Switzerland
| | - Lorenzo Alberio
- Hemostasis and Platelet Research Laboratory, Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1010 Lausanne, Switzerland; (A.A.); (D.B.C.); (M.G.Z.); (M.M.)
- Correspondence:
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2
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Mohan G, Malayala SV, Mehta P, Balla M. A Comprehensive Review of Congenital Platelet Disorders, Thrombocytopenias and Thrombocytopathies. Cureus 2020; 12:e11275. [PMID: 33274150 PMCID: PMC7707908 DOI: 10.7759/cureus.11275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Platelets play an important role in hemostasis through platelet plug formation by a phenomenon of adhesion; activation; secretion and aggregation. Defects in platelet hemostatic mechanisms can be congenital or acquired. Congenital platelet disorders are rare and manifestations range from asymptomatic to sometimes severe bleeding. The disorders arise due to diverse mechanisms. Congenital platelet disorders include thrombocytopathies and thrombocytopenia (platelet count <150 x 109/L) or thrombocytosis (platelet count > 450 x 109/L). Congenital thrombocytopathies include disorders of adhesion like von Willebrand's disease or Bernard-Soulier syndrome. The disorders of aggregation include congenital afibrinogenemia and Glanzmann thrombasthenia. Disorders of storage granules are gray platelet syndrome and Quebec platelet disorder. Congenital thrombocythopathy and thrombocytopenia often occur in conjunction. In this article, we have a detailed literature review of these rare thrombocytopathies, their presentation and treatment.
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Affiliation(s)
- Gisha Mohan
- Medical Research, Physicians for American Healthcare Access, Philadelphia, USA
| | | | - Parth Mehta
- Internal Medicine, Unity Point Health Methodist Hospital, Peoria, USA
| | - Mamtha Balla
- Internal Medicine, ProMedica Toledo Hospital, Toledo, USA
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3
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Cattaneo M. Inherited Disorders of Platelet Function. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Megakaryocyte Contribution to Bone Marrow Fibrosis: many Arrows in the Quiver. Mediterr J Hematol Infect Dis 2018; 10:e2018068. [PMID: 30416700 PMCID: PMC6223581 DOI: 10.4084/mjhid.2018.068] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/23/2018] [Indexed: 01/14/2023] Open
Abstract
In Primary Myelofibrosis (PMF), megakaryocyte dysplasia/hyperplasia determines the release of inflammatory cytokines that, in turn, stimulate stromal cells and induce bone marrow fibrosis. The pathogenic mechanism and the cells responsible for progression to bone marrow fibrosis in PMF are not completely understood. This review article aims to provide an overview of the crucial role of megakaryocytes in myelofibrosis by discussing the role and the altered secretion of megakaryocyte-derived soluble factors, enzymes and extracellular matrices that are known to induce bone marrow fibrosis.
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Ghosh K, Bhattacharya M, Chowdhury R, Mishra K, Ghosh M. Inherited Macrothrombocytopenia: Correlating Morphology, Epidemiology, Molecular Pathology and Clinical Features. Indian J Hematol Blood Transfus 2018; 34:387-397. [PMID: 30127546 PMCID: PMC6081320 DOI: 10.1007/s12288-018-0950-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/14/2018] [Indexed: 01/19/2023] Open
Abstract
Inherited macrothrombocytopenia is increasingly being recognized as a relatively common condition. This descriptive review aims at focusing on the different areas of advancement that have taken place with this condition with particular reference to India. A pubmed search of articles between January 1990 and October 2017 with the key words-macrothrombocytopenia, asymptomatic macrothrombocytopenia, macrothrombocytopenia India, syndromic macrothrombocytopenia, molecular pathology, megakaryopoiesis and platelet formation were searched. The shortlisted articles were then read. Review articles provided additional references and the articles thus obtained were also read. Special interest and research conducted by the authors provided further sources of information. A total of 487 articles were found of which 68 articles were related to our subject of review. Review articles were read and additional articles from the reference quoted. Forty-four percent of nonsyndromic Inherited macrothrombocytopenia showed mutations of MYH9, GP1BB, GP1Ba, GPIX, ABCG5 and 8, ACTN, FLI, TUBB and RUNX1 frequently in heterozygous state. All types of inheritance pattern namely autosomal dominant, recessive and sex linked patterns have been described. Syndromic causes of this phenomenon are well known and have been described. Many asymptomatic patients do have mild or moderate bleeding history. Clinical algorithms to differentiate chronic ITP associated macrothrombocytopenia from inherited variety have been explored. Inherited macrothrombocytopenia is an emerging area of interest in platelet biology with its implication in diagnosis, prognosis, genetic counseling, management and in transfusion medicine.
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Affiliation(s)
- Kanjaksha Ghosh
- Surat Raktadan Kendra and Research Centre, Udhna Magdalla Road, Near Chosath Joganio Mataji Temple, Surat, 395002 India
| | - Maitreyee Bhattacharya
- Institute of Haematology and Transfusion Medicine, Medical College, Kolkata, 12 College Street, Kolkata, 700078 India
| | - Ranjini Chowdhury
- Institute of Haematology and Transfusion Medicine, Medical College, Kolkata, 12 College Street, Kolkata, 700078 India
| | - Kanchan Mishra
- Surat Raktadan Kendra and Research Centre, Udhna Magdalla Road, Near Chosath Joganio Mataji Temple, Surat, 395002 India
| | - Malay Ghosh
- P-78 Green View, Garia-P.O., Kolkata, 700084 India
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Cao L, Su J, Li J, Yu Z, Bai X, Wang Z, Xia L, Ruan C. A novel nonsense NBEAL2 gene mutation causing severe bleeding in a patient with gray platelet syndrome. Platelets 2017; 29:288-291. [PMID: 28504079 DOI: 10.1080/09537104.2017.1306041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lijuan Cao
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Jian Su
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Jiaming Li
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ziqiang Yu
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xia Bai
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Zhaoyue Wang
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Lijun Xia
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Changgeng Ruan
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
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Affiliation(s)
- John T. Reilly
- Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
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8
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Larocca LM, Heller PG, Podda G, Pujol-Moix N, Glembotsky AC, Pecci A, Alberelli MA, Balduini CL, Landolfi R, Cattaneo M, De Candia E. Megakaryocytic emperipolesis and platelet function abnormalities in five patients with gray platelet syndrome. Platelets 2015; 26:751-7. [PMID: 25806575 DOI: 10.3109/09537104.2014.994093] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The gray platelet syndrome (GPS) is a rare congenital platelet disorder characterized by mild to moderate bleeding diathesis, macrothrombocytopenia and lack of azurophilic α-granules in platelets. Some platelet and megakaryocyte (MK) abnormalities have been described, but confirmative studies of the defects in larger patient cohorts have not been undertaken. We studied platelet function and bone marrow (BM) features in five GPS patients with NBEAL2 autosomal recessive mutations from four unrelated families. In 3/3 patients, we observed a defect in platelet responses to protease-activated receptor (PAR)1-activating peptide as the most consistent finding, either isolated or combined to defective responses to other agonists. A reduction of PAR1 receptors with normal expression of major glycoproteins on the platelet surface was also found. Thrombin-induced fibrinogen binding to platelets was severely impaired in 2/2 patients. In 4/4 patients, the BM biopsy showed fibrosis (grade 2-3) and extensive emperipolesis, with many (36-65%) MKs containing 2-4 leukocytes engulfed within the cytoplasm. Reduced immunolabeling for platelet factor 4 together with normal immunolabeling for CD63 in MKs of two patients demonstrated that GPS MKs display an alpha granule-specific defect. Increased immunolabeling for P-selectin and decreased immunolabeling for PAR1, PAR4 and c-MPL were also observed in MKs of two patients. Marked emperipolesis, specific defect of MK alpha-granule content and defect of PAR1-mediated platelet responses are present in all GPS patients that we could study in detail. These results help to further characterize the disease.
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Affiliation(s)
- Luigi M Larocca
- a Department of Pathology , Policlinico A. Gemelli, Università Cattolica del Sacro Cuore , Rome , Italy
| | - Paula G Heller
- b Department of Hematology Research , Instituto de Investigaciones Médicas Alfredo Lanari, University of Buenos Aires, CONICET , Buenos Aires , Argentina
| | - Gianmarco Podda
- c Medicina III, Azienda Ospedaliera San Paolo, Dipartimento di Scienze della Salute , Università degli Studi di Milano , Milano , Italy
| | - Nuria Pujol-Moix
- d Hemostasis and Thrombosis Unit, Department of Medicine , Institut de Recerca Sant Pau, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Ana C Glembotsky
- b Department of Hematology Research , Instituto de Investigaciones Médicas Alfredo Lanari, University of Buenos Aires, CONICET , Buenos Aires , Argentina
| | - Alessandro Pecci
- e Department of Internal Medicine , IRCCS Policlinico San Matteo Foundation, University of Pavia , Pava , Italy , and
| | - Maria Adele Alberelli
- f Department of Internal Medicine , Policlinico A. Gemelli, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Carlo L Balduini
- e Department of Internal Medicine , IRCCS Policlinico San Matteo Foundation, University of Pavia , Pava , Italy , and
| | - Raffaele Landolfi
- f Department of Internal Medicine , Policlinico A. Gemelli, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Marco Cattaneo
- c Medicina III, Azienda Ospedaliera San Paolo, Dipartimento di Scienze della Salute , Università degli Studi di Milano , Milano , Italy
| | - Erica De Candia
- f Department of Internal Medicine , Policlinico A. Gemelli, Università Cattolica del Sacro Cuore , Roma , Italy
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9
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Carubbi C, Masselli E, Nouvenne A, Russo D, Galli D, Mirandola P, Gobbi G, Vitale M. Laboratory diagnostics of inherited platelet disorders. Clin Chem Lab Med 2015; 52:1091-106. [PMID: 24698825 DOI: 10.1515/cclm-2014-0131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/11/2014] [Indexed: 11/15/2022]
Abstract
Abstract Inherited platelet disorders (IPDs) are the general and common denomination of a broad number of different rare and congenital pathologies affecting platelets. Even if these disorders are characterized by widely heterogeneous clinical presentations, all of them are commonly present as defects in hemostasis. Platelet number and/or function are affected by a wide spectrum of severity. IPDs might be associated with defects in bone marrow megakaryocytopoiesis and, rarely, with somatic defects. Although in the last few years new insights in the genetic bases and pathophysiology of IPDs have greatly improved our knowledge of these disorders, much effort still needs to be made in the field of laboratory diagnosis. This review discusses the laboratory approach for the differential diagnosis of the most common IPDs, suggesting a common multistep flowchart model which starts from the simpler test (platelet count) ending with the more selective and sophisticated analyses.
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Frias SY, Johns GS, Van Siclen C. Hypogranular Platelets in a 78-Year-Old Man. Lab Med 2013. [DOI: 10.1309/lm1mo9jsnczfr3po] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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Deppermann C, Cherpokova D, Nurden P, Schulz JN, Thielmann I, Kraft P, Vögtle T, Kleinschnitz C, Dütting S, Krohne G, Eming SA, Nurden AT, Eckes B, Stoll G, Stegner D, Nieswandt B. Gray platelet syndrome and defective thrombo-inflammation in Nbeal2-deficient mice. J Clin Invest 2013; 123:69210. [PMID: 23863626 PMCID: PMC4011026 DOI: 10.1172/jci69210] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/10/2013] [Indexed: 12/21/2022] Open
Abstract
Platelets are anuclear organelle-rich cell fragments derived from bone marrow megakaryocytes (MKs) that safeguard vascular integrity. The major platelet organelles, α-granules, release proteins that participate in thrombus formation and hemostasis. Proteins stored in α-granules are also thought to play a role in inflammation and wound healing, but their functional significance in vivo is unknown. Mutations in NBEAL2 have been linked to gray platelet syndrome (GPS), a rare bleeding disorder characterized by macrothrombocytopenia, with platelets lacking α-granules. Here we show that Nbeal2-knockout mice display the characteristics of human GPS, with defective α-granule biogenesis in MKs and their absence from platelets. Nbeal2 deficiency did not affect MK differentiation and proplatelet formation in vitro or platelet life span in vivo. Nbeal2-deficient platelets displayed impaired adhesion, aggregation, and coagulant activity ex vivo that translated into defective arterial thrombus formation and protection from thrombo-inflammatory brain infarction following focal cerebral ischemia. In a model of excisional skin wound repair, Nbeal2-deficient mice exhibited impaired development of functional granulation tissue due to severely reduced differentiation of myofibroblasts in the absence of α-granule secretion. This study demonstrates that platelet α-granule constituents are critically required not only for hemostasis but also thrombosis, acute thrombo-inflammatory disease states, and tissue reconstitution after injury.
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Affiliation(s)
- Carsten Deppermann
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Deya Cherpokova
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Paquita Nurden
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Jan-Niklas Schulz
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Ina Thielmann
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Peter Kraft
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Timo Vögtle
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Christoph Kleinschnitz
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Sebastian Dütting
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Georg Krohne
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Sabine A. Eming
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Alan T. Nurden
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Beate Eckes
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Guido Stoll
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - David Stegner
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
| | - Bernhard Nieswandt
- Department of Experimental Biomedicine, University of Würzburg, University Hospital and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg, Germany.
Plateforme Technologique et d’Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Department of Dermatology, University of Cologne, Cologne, Germany.
Department of Neurology and
Biocenter, University of Würzburg, Würzburg, Germany.
Center for Molecular Medicine and
Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Cologne, Germany
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12
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Cattaneo M. Congenital Disorders of Platelet Function. Platelets 2013. [DOI: 10.1016/b978-0-12-387837-3.00050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
Understanding platelet biology has been aided by studies of mice with mutations in key megakaryocytic transcription factors. We have shown that point mutations in the GATA1 cofactor FOG1 that disrupt binding to the nucleosome remodeling and deacetylase (NuRD) complex have erythroid and megakaryocyte lineages defects. Mice that are homozygous for a FOG1 point mutation (ki/ki), which ablates FOG1-NuRD interactions, have platelets that display a gray platelet syndrome (GPS)-like macrothrombocytopenia. These platelets have few α-granules and an increased number of lysosomal-like vacuoles on electron microscopy, reminiscent of the platelet in patients with GATA1-related X-linked GPS. Here we further characterized the platelet defect in ki/ki mice. We found markedly deficient levels of P-selectin protein limited to megakaryocytes and platelets. Other α-granule proteins were expressed at normal levels and were appropriately localized to α-granule-like structures. Treatment of ki/ki platelets with thrombin failed to stimulate Akt phosphorylation, resulting in poor granule secretion and platelet aggregation. These studies show that disruption of the GATA1/FOG1/NuRD transcriptional system results in a complex, pleiotropic platelet defect beyond GPS-like macrothrombocytopenia and suggest that this transcriptional complex regulates not only megakaryopoiesis but also α-granule generation and signaling pathways required for granule secretion.
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15
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Agarwal N, Willmott FJ, Bowles L, Pasi KJ, Beski S. Case report of Grey Platelet Syndrome in pregnancy. Haemophilia 2011; 17:825-6. [PMID: 21492324 DOI: 10.1111/j.1365-2516.2011.02535.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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16
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Homozygosity mapping with SNP arrays confirms 3p21 as a recessive locus for gray platelet syndrome and narrows the interval significantly. Blood 2011; 117:3430-4. [PMID: 21263149 DOI: 10.1182/blood-2010-12-322990] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Gray platelet syndrome (GPS) is an inherited bleeding disorder characterized by thrombocytopenia and the absence of α-granules in platelets. Patients with GPS present with mild to moderate bleeding and many develop myelofibrosis. The genetic cause of GPS is unknown. We present 2 Native American families with a total of 5 affected persons and a single affected patient of Pakistani origin in which GPS appears to be inherited in an autosomal recessive manner. Homozygosity mapping using the Affymetrix 6.0 chips demonstrates that all 6 GPS-affected persons studied are homozygous for a 1.7-Mb region in 3p21. Linkage analysis confirmed the region with a logarithm of the odds score of 2.7. Data from our families enabled us to significantly decrease the size of the critical region for GPS from the previously reported 9.4-Mb region at 3p21.
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Sandrock K, Zieger B. Current Strategies in Diagnosis of Inherited Storage Pool Defects. ACTA ACUST UNITED AC 2010; 37:248-258. [PMID: 21113247 DOI: 10.1159/000320279] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 08/17/2010] [Indexed: 01/24/2023]
Abstract
Inherited platelet defects lead to bleeding symptoms of varying severity. Typically, easy bruising, petechiae, epistaxis, and mucocutaneous bleeding are observed in affected patients. The platelet defects are classified into disorders affecting either platelet surface receptors or intracellular organelles of platelets. The latter are represented by platelet storage pool diseases (SPD) which share a defect of platelet granules. Platelet α-granules, δ-granules, or both may be affected resulting in the clinical picture of α-SPD (e.g. Gray platelet syndrome, Quebec platelet disorder, arthrogryposis, renal dysfunction, and cholestasis syndrome), δ-SPD (e.g. Hermansky-Pudlak syndrome, Chediak-Higashi syndrome, Griscelli syndrome), or αδ-SPD (e.g. X-linked thrombocytopenia, Wiskott-Aldrich syndrome). Diagnosis of SPD is very extensive and requires platelet aggregation and flow cytometry analyses with interpretation from a specialist. Many of these disorders share common treatments, however, efficacy can vary between different patients. Therapy regiments with tranexamic acid, DDAVP, activated FVIIa, and platelet transfusions have been published. Stem cell or bone marrow transplantations are preserved for severe defects. Here, we describe the pathophysiology, clinical manifestations, and diagnosis of the major human SPDs.
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Affiliation(s)
- Kirstin Sandrock
- Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Germany
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18
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Gray platelet syndrome: natural history of a large patient cohort and locus assignment to chromosome 3p. Blood 2010; 116:4990-5001. [PMID: 20709904 DOI: 10.1182/blood-2010-05-286534] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Gray platelet syndrome (GPS) is an inherited bleeding disorder characterized by macrothrombocytopenia and absence of platelet α-granules resulting in typical gray platelets on peripheral smears. GPS is associated with a bleeding tendency, myelofibrosis, and splenomegaly. Reports on GPS are limited to case presentations. The causative gene and underlying pathophysiology are largely unknown. We present the results of molecular genetic analysis of 116 individuals including 25 GPS patients from 14 independent families as well as novel clinical data on the natural history of the disease. The mode of inheritance was autosomal recessive (AR) in 11 and indeterminate in 3 families. Using genome-wide linkage analysis, we mapped the AR-GPS gene to a 9.4-Mb interval on 3p21.1-3p22.1, containing 197 protein-coding genes. Sequencing of 1423 (69%) of the 2075 exons in the interval did not identify the GPS gene. Long-term follow-up data demonstrated the progressive nature of the thrombocytopenia and myelofibrosis of GPS resulting in fatal hemorrhages in some patients. We identified high serum vitamin B(12) as a consistent, novel finding in GPS. Chromosome 3p21.1-3p22.1 has not been previously linked to a platelet disorder; identification of the GPS gene will likely lead to the discovery of novel components of platelet organelle biogenesis. This study is registered at www.clinicaltrials.gov as NCT00069680 and NCT00369421.
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Chedani H, Dupuy E, Massé JM, Cramer EM. Neutrophil secretory defect in the gray platelet syndrome: A new case. Platelets 2009; 17:14-9. [PMID: 16308182 DOI: 10.1080/09537100500165601] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report the case of a 60-year-old woman who was newly diagnosed for the gray platelet syndrome (GPS). This patient had long-term thrombocytopenia which had been initially misdiagnosed as idiopathic thrombocytopenic purpura (ITP). Blood smear displayed characteristic gray platelets, allowing the diagnosis to be made, which was confirmed by electron microscopy (EM). Polymorphonuclear neutrophils (PMN) appeared poorly granulated on the May-Grunwald-Giemsa-stained blood smear. Flow cytometry analysis of PMN demonstrated increased expression of CD35, CD11b and CD18 at resting PMN surface, without any changes after fMLP stimulation. Ultrastructural study retrieved a decreased number of myeloperoxidase (MPO)-negative secondary granules in PMN. Immunolabeling confirmed the presence of membrane proteins and the absence of soluble content in platelet and megakaryocyte (MK) alpha-granules, and the decrease of secondary granules and secretory vesicles in PMN. This new observation demonstrates that the impairment of the secretory compartment of PMN is definitely a hallmark of GPS, and that the detection of these subtle abnormalities should be searched with adequate and up-to-date technical approaches.
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20
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Abstract
Platelet alpha-granules are the storage site for the internal membrane glycoprotein P-selectin and for a variety of megakaryocyte-synthesized and plasma-derived soluble proteins. Quantitative and/or qualitative abnormalities in alpha-granules are found in a number of inherited bleeding disorders, including gray platelet syndrome, alphadelta-storage pool deficiency, the Quebec platelet disorder, and in some patients with dysmegakaryopoietic thrombocytopenia. In addition, single alpha-granular protein deficiencies are seen in other bleeding disorders,including factor V deficiency, afibrinogenemia, Glanzmann's thrombasthenia, von Willebrand disease, and plasminogen-activator inhibitor-1 deficiency. The excessive bleeding that occurs in patients with inherited abnormalities of platelet alpha-granules indicates that the proteins stored within this compartment are important for normal hemostasis. The clinical and laboratory features of these different, inherited platelet storage pool disorders suggest unique molecular and biochemical defects are responsible for these conditions. However, the genetic causes of these disorders are largely unknown. This paper reviews our current knowledge of the inherited disorders of platelet alpha-granules.
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Affiliation(s)
- C P Hayward
- Department of Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
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21
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Abstract
Congenital platelet disorders represent a rare group of diseases classified by either a qualitative or quantitative platelet defect. This article outlines the historical, clinical, laboratory, and genetic features of various inherited platelet disorders with attention given to updated information on disease classification, diagnosis, and genotypes. A separate discussion regarding management addresses the difficulty in treatment strategies, particularly in patients who develop alloimmunization to platelets.
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Affiliation(s)
- Cindy E Neunert
- The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA.
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22
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De Candia E, Pecci A, Ciabattoni G, De Cristofaro R, Rutella S, Yao-Wu Z, Lazzareschi I, Landolfi R, Coughlin S, Balduini CL. Defective platelet responsiveness to thrombin and protease-activated receptors agonists in a novel case of gray platelet syndrome: correlation between the platelet defect and the alpha-granule content in the patient and four relatives. J Thromb Haemost 2007; 5:551-9. [PMID: 17137471 DOI: 10.1111/j.1538-7836.2007.02329.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We report a novel case of gray platelet syndrome (GPS). A 14-year-old boy had bleeding diathesis, mild thrombocytopenia, giant platelets with severe defect of alpha-granule secretory proteins, myelofibrosis and splenomegaly. METHODS AND RESULTS Platelet function studies showed a marked reduction of aggregation and Ca(2+) mobilization by thrombin, protease-activated receptor 1 (PAR1)-activating peptide (AP) and PAR4-AP, PAR1 expression at 55% of normal levels, and a more than two hundred fold reduction of in vitro whole-blood thromboxane B(2) (TXB(2)) production. Sequencing of coding regions of the PAR1 gene failed to show abnormalities. This patient was initially classified as a sporadic case of GPS, as electron microscopy failed to identify giant platelets and/or alpha-granule deficiency in his relatives. However, further studies on the father and three other relatives showed a relative lack of platelet alpha-granule proteins by immunofluorescence microscopy, a defective platelet response to PAR4-AP, and severely reduced in vitro whole-blood TXB(2) production. On this basis, we suggest that in this family, GPS was transmitted in a dominant fashion with highly variable penetrance. CONCLUSIONS Our study suggests that current diagnostic criteria fail to identify some patients with a mild GPS phenotype and that such patients might be identified by the methods cited above. It also better characterizes the pathogenesis of defective platelet responses to thrombin, and raises interesting questions on the correlation between abnormal PAR function and the lack of alpha-granule content in GPS.
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Affiliation(s)
- E De Candia
- Department of Internal Medicine, Haemostasis Research Centre, Agostino Gemelli Hospital, Catholic University School of Medicine, Rome, Italy
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23
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Abstract
The gray platelet syndrome (GPS) is a rare inherited disorder of the megakaryocyte (MK) lineage. Thrombocytopenia and enlarged platelets are associated with a specific absence of alpha-granules and their contents. GPS patients exhibit much heterogeneity both in bleeding severity and in their response to platelet function testing. A unique feature is that proteins endogenously synthesised by megakaryocytes (MK) or endocytosed by MK or platelets fail to enter into the secretable storage pools that characterise alpha-granules of normal platelets. Although the molecular basis of the disease is unknown, evidence suggests that alpha-granules simply fail to mature during MK differentiation. One result is a continued leakage of growth factors and cytokines into the marrow causing myelofibrosis. While for some patients platelet function may be only moderately affected, for others thrombin and/or collagen-induced platelet aggregation is markedly modified and an acquired lack of the GPVI collagen receptor has been reported. In this review, we document the clinical and molecular heterogeneity in GPS, a unique disease of the biogenesis of platelet alpha-granules and of the storage of growth factors and secretable proteins.
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Affiliation(s)
- Alan T Nurden
- IFRN 4/CRPP, Laboratoire d'Hématologie, Hôpital Cardiologique, 33604 Pessac, France.
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24
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25
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Bolton-Maggs PHB, Chalmers EA, Collins PW, Harrison P, Kitchen S, Liesner RJ, Minford A, Mumford AD, Parapia LA, Perry DJ, Watson SP, Wilde JT, Williams MD. A review of inherited platelet disorders with guidelines for their management on behalf of the UKHCDO. Br J Haematol 2006; 135:603-33. [PMID: 17107346 DOI: 10.1111/j.1365-2141.2006.06343.x] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The inherited platelet disorders are an uncommon cause of symptomatic bleeding. They may be difficult to diagnose (and are likely to be under-diagnosed) and pose problems in management. This review discusses the inherited platelet disorders summarising the current state of the art with respect to investigation and diagnosis and suggests how to manage bleeding manifestations with particular attention to surgical interventions and the management of pregnancy.
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27
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Balduini CL, Drachman JG. Role of splenectomy in inherited thrombocytopenias. Blood 2004; 104:1227; author reply 1227-8. [PMID: 15294857 DOI: 10.1182/blood-2004-03-0875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Nurden P, Jandrot-Perrus M, Combrié R, Winckler J, Arocas V, Lecut C, Pasquet JM, Kunicki TJ, Nurden AT. Severe deficiency of glycoprotein VI in a patient with gray platelet syndrome. Blood 2004; 104:107-14. [PMID: 15010364 DOI: 10.1182/blood-2003-11-3842] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a novel case of gray platelet syndrome (GPS) where a severe deficiency of the platelet collagen receptor, glycoprotein (GP) VI, accompanies classical symptoms of a low platelet count and platelets lacking alpha-granules. Dense granules were normally present. Platelet aggregation with collagen was severely decreased, as was the response to convulxin (Cvx), a GPVI agonist. Quantitative analysis of GPVI using fluorescein isothiocyanate (FITC)-Cvx in flow cytometry showed its virtual absence on the patient's platelets. The GPVI deficiency was confirmed using monoclonal antibodies in Western blotting and in immunogold labeling on frozen thin sections where internal pools of GPVI were confirmed for normal platelets. The Fc receptor gamma-chain, constitutively associated with GPVI in normal platelets, was present in subnormal amounts, and the phospholipase C gamma 2-dependent activation pathway appeared to function normally. No autoantibodies to GPVI were found in the patient's serum using monoclonal antibody immobilization of platelet antigen (MAIPA). Sequencing of coding regions of the GPVI gene failed to show abnormalities, and mRNA for GPVI was present in the patient's platelets, pointing to a probable acquired defect in GPVI expression. Our results may provide a molecular explanation for the subgroup of patients with severely deficient collagen-induced platelet aggregation as previously described for GPS in the literature.
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Affiliation(s)
- Paquita Nurden
- Institut Federatif de Recherche No. 4, Laboratoire d'Hematologie, Hopital Cardiologique, Pessac, France.
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29
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Hyman T, Huizing M, Blumberg PM, Falik-Zaccai TC, Anikster Y, Gahl WA. Use of a cDNA microarray to determine molecular mechanisms involved in grey platelet syndrome. Br J Haematol 2003; 122:142-9. [PMID: 12823356 DOI: 10.1046/j.1365-2141.2003.04410.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The grey platelet syndrome (GPS) is a bleeding disorder of unknown aetiology with phenotypic and genetic heterogeneity. Affected patients exhibit macrothrombocytopenia, decreased alpha-granule content and, sometimes, myelofibrosis. We used microarray technology to investigate changes in gene expression that might reveal mechanisms involved in GPS. The expression of 4900 unique genes and expressed sequence tags was evaluated in fibroblasts from a GPS patient; normal fibroblasts provided the reference standard. Genes that were differentially regulated in the GPS cells were categorized into gene clusters based upon similarity/differences of expression differences. The results showed that genes with functional similarities clustered together. This analysis revealed significant upregulation of selected biological processes involving the production of cytoskeleton proteins, including fibronectin 1, thrombospondins 1 and 2, and collagen VI alpha. These genes appear to play a role in the pathogenesis of GPS. Indeed, Northern blot analyses confirmed that fibronectin, thrombospondin and matrix metalloprotease-2 were overexpressed in GPS fibroblasts compared with normal fibroblasts. Moreover, immunohistochemistry studies revealed robust fibronectin staining in GPS fibroblasts compared with normal ones. Our findings support the feasibility of using cDNA microarray techniques to detect distinctive and informative differences in gene expression patterns relevant to GPS, and suggest that the molecular basis for myelofibrosis in GPS involves upregulation of cytoskeleton proteins.
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Affiliation(s)
- Tehila Hyman
- Laboratory of Cellular Carcinogenesis and Tumor Promotion, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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30
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Abstract
Inherited platelet-based bleeding disorders include abnormalities of platelet number and function, and are generally classified based on the abnormal functions or responses. However, a clear distinction is problematic, and in this review, the classification has been based on abnormalities of platelet components that share common characteristics. Inherited thrombocytopenias are rare, but probably underdiagnosed. They are usually classified according to both platelet size and the presence or absence of clinical features other than those deriving from the platelet defect. Hereditary disorders of platelet function can be classified as resulting from: (i) abnormalities of the platelet receptors for adhesive proteins; (ii) abnormalities of the platelet receptors for soluble agonists; (iii) abnormalities of the platelet granules; (iv) abnormalities of the signal-transduction pathways; (v) abnormalities of the membrane phospholipids; and (vi) miscellaneous abnormalities of platelet function. The literature on these disorders is reviewed, and the underlying defects discussed.
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Affiliation(s)
- M Cattaneo
- Unit of Hematology and Thrombosis, Ospedale San Paolo, Department of Medicine, Surgery and Dentistry, University of Milan, Milan, Italy.
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31
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32
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Abstract
Platelet granule exocytosis plays a critical role in thrombosis and wound healing. Platelets have three major types of secretory granules that are defined by their unique molecular contents, kinetics of exocytosis and morphologies. Although the ontogeny of platelet granules is poorly understood, a convergence of new insights into megakaryocyte development, the molecular mechanisms of vesicle trafficking and the genetic basis of platelet granule defects, is beginning to define the cellular and molecular pathways responsible for platelet granule ontogeny.
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Affiliation(s)
- Sarah M King
- Cardiovascular Biology Laboratory, Harvard School of Public Health, Bldg. II-127, 677 Huntington Ave., Boston, MA 02115, USA
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33
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Abstract
Automated systems are currently in widespread use for the assessment of patients' complete blood counts. The evaluation of the peripheral blood smear, however, still constitutes a pivotal tool in the evaluation of patients with hematologic disorders. This article focuses on disorders affecting the number or morphology of platelets as assessed by evaluation of a peripheral blood smear and also outlines some of their important clinical findings.
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Affiliation(s)
- Alvaro Moreno
- Division of Hematology Oncology and Internal Medicine, Mayo Medical School, Jacksonville, Florida, USA.
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34
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Falik-Zaccai TC, Anikster Y, Rivera CE, Horne MK, Schliamser L, Phornphutkul C, Attias D, Hyman T, White JG, Gahl WA. A new genetic isolate of gray platelet syndrome (GPS): clinical, cellular, and hematologic characteristics. Mol Genet Metab 2001; 74:303-13. [PMID: 11708859 DOI: 10.1006/mgme.2001.3247] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Gray platelet syndrome (GPS) is a disorder characterized by thrombocytopenia and large platelets that lack alpha granules and their contents. We describe two siblings with GPS who are members of a Moslem Bedouin genetic isolate. The children, an 8-year-old girl and a 5-year-old boy, had characteristic pale blue platelets lacking alpha granules on electron microscopy. Platelet aggregation studies were normal. The girl underwent a bone marrow aspiration and biopsy which showed mild myelofibrosis and extensive emperipolesis, i.e., the passage of other hematopoietic cells through megakaryocytes. Both children lacked high-molecular-weight multimers of von Willebrand factor (vWF) and had reduced activity and antigens of vWf. Platelet activation was approximately normal when ADP was employed as agonist, but significantly impaired using the thrombin receptor-activating peptide (TRAP). These findings are explained in light of the mechanism of action of each agonist. In addition, we propose that the emperipolesis was caused by increased P-selectin in megakaryocytes, and resulted in release of fibroblastic growth factors, explaining the myelofibrosis. The detailed description of these cases provides a basis for future differentiation of the various types of GPS, and for our current attempts to isolate the gene causing GPS in this genetic isolate.
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Affiliation(s)
- T C Falik-Zaccai
- Division of Medical Genetics, Rappaport Faculty of Medicine, Hospital of Western Galillee-Naharia, Technion, Haifa, Israel
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35
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Mhawech P, Saleem A. Inherited giant platelet disorders. Classification and literature review. Am J Clin Pathol 2000; 113:176-90. [PMID: 10664620 DOI: 10.1309/fc4h-lm5v-vcw8-dnju] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inherited giant platelet disorders are extremely rare. The aim of this article is to review the clinical and laboratory features of this heterogeneous group and to arrive at a working classification. We conducted our literature search using the National Library of Medicine database. A total of 12 clinical entities were described. We classified them into 4 groups depending on the clinical and structural abnormalities. The pathophysiology of these disorders is largely unknown, and more research is needed, particularly in the light of recent advances in laboratory medicine. This review may provide a valuable reference for clinicians and may form a basis for future classification and research.
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Affiliation(s)
- P Mhawech
- Department of Pathology at Baylor College of Medicine, Houston, TX 77030, USA
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36
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Reilly JT. Pathogenesis and management of idiopathic myelofibrosis. BAILLIERE'S CLINICAL HAEMATOLOGY 1998; 11:751-67. [PMID: 10640215 DOI: 10.1016/s0950-3536(98)80037-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Idiopathic myelofibrosis is the least common and carries the worst prognosis of the chronic myeloproliferative disorders. The primary disease process is a clonal haematopoietic stem cell disorder which results in a chronic myeloproliferation and an atypical megakaryocyte hyperplasia. In contrast, the characteristic stromal proliferation is a reactive phenomenon, resulting from the inappropriate release of megakaryocyte/platelet-derived growth factors, including PDGF, TGF-beta bFGF and calmodulin. The median survival is approximately 4 years, although individual survival varies greatly. A variety of prognostic schema have been developed which enable the identification of high-risk patients, for whom bone marrow transplantation should be considered. Management for the majority of patients, however, is directed towards the alleviation of symptoms and improvement in quality of life. This review summarizes the recent advances in our understanding of the disease's pathogenesis and discusses the limited therapeutic options available to clinicians.
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Affiliation(s)
- J T Reilly
- Royal Hallamshire Hospital, Sheffield, UK
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37
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Lages B, Sussman II, Levine SP, Coletti D, Weiss HJ. Platelet alpha granule deficiency associated with decreased P-selectin and selective impairment of thrombin-induced activation in a new patient with gray platelet syndrome (alpha-storage pool deficiency). THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 1997; 129:364-75. [PMID: 9042822 DOI: 10.1016/s0022-2143(97)90185-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report studies on a new patient with gray platelet syndrome (GPS, alpha-storage pool deficiency). Her lifelong bleeding history is associated with platelet abnormalities characteristic of GPS including mild to moderate thrombocytopenia, a population of abnormally large platelets, and specific deficiencies of alpha-granule constituents and morphologically typical alpha-granules. Platelet function studies showed normal aggregation responses to adenosine diphosphate, epinephrine, collagen, arachidonate, and ristocetin but impaired activation responses to thrombin and a thrombin receptor-activating peptide (T1 peptide). These impaired responses included T1 peptide-induced aggregation, thrombin-induced adenine nucleotide secretion, and thrombin-induced (Ca2+)i increases. The impairment of the thrombin-induced (Ca2+)i increase was observed as a substantially slower initial rise in (Ca2+)i levels and a smaller maximum (Ca2+)i increase compared with the responses obtained in normal platelets and are thus similar to those reported previously in another patients with GPS. Flow cytometric measurements of the binding of two distinct monoclonal antibodies against the functional thrombin receptor indicated the presence of a normal number of receptors and normal receptor cleavage by thrombin in the GPS platelets, providing additional support for the hypothesis presented in previous studies that the thrombin activation defect in GPS platelets occurs subsequent to the interaction of thrombin with its receptor. The alpha-granule deficiency in this patient was associated with an approximately 50% decrease in the content and surface expression of the alpha-granule membrane-specific protein P-selectin in contrast to a previous report of normal amounts of P-selectin in the platelets of two related patients with GPS. This finding raises the possibility that the alpha-granule deficiency in GPS may be expressed in different phenotypes characterized by differences in the amount or constitution of residual alpha-granule membranes present in GPS platelets.
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Affiliation(s)
- B Lages
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10019, USA
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38
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Smith MP, Cramer EM, Savidge GF. Megakaryocytes and platelets in alpha-granule disorders. BAILLIERE'S CLINICAL HAEMATOLOGY 1997; 10:125-48. [PMID: 9154319 DOI: 10.1016/s0950-3536(97)80054-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This chapter summarizes research data contributing to current understanding of disorders affecting alpha-granules of megakaryocytes and platelets. Diagnostic features of the gray platelet syndrome are well defined. Combined evidence suggests a defect, specific to the megakaryocyte cell lineage, causing a cytoskeletal abnormality and defective targeting of endogenously synthesized proteins to the alpha-granule. The abnormalities linked by signal transduction pathways. von Willebrand disease and afibrinogenaemia are disorders which highlight the functional importance of platelet storage pools of von Willebrand factor and fibrinogen, essential ligands in the process of adhesion and aggregation. The abnormality in the factor V Quebec disorder leads to a degradation of most proteins contained within the alpha-granule. The familial platelet disorder Paris-Trousseau thrombocytopenia is the only alpha-granule disorder associated with a cytogenetic abnormality, and it presents a useful model for exploring the genetic influence on regulation of thrombopoiesis. Study of these syndromes has elucidated aspects of the physiology of normal megakaryocyte maturation and platelet formation, including storage organelle biosynthesis.
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Affiliation(s)
- M P Smith
- Haemophilia Centre, St Thomas' Hospital, London, UK
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39
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Abstract
Inherited thrombocytopenias may be divided into two groups. In the first group, there is no marked thrombocytopathy. Although numerous in the bone marrow, megakaryocytes often are abnormal cytologically. A dysmegakaryocytopoiesis with defective platelet production is suggested but remains to be evidenced. In the second group, thrombocytopenias are accompanied with variable thrombocytopathy. The functional and biochemical platelet abnormalities responsible for these different thrombocytopathies often are well elucidated. The study of the relations with the occurrence of thrombocytopenia constitutes an interesting field of investigation.
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Affiliation(s)
- S Bellucci
- Laboratory of Hematology, Hôpital Lariboisière, Paris, France
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Fabris F, Cordiano I, Salvan F, Ramon R, Valente M, Luzzatto G, Girolami A. Chronic isolated macrothrombocytopenia with autosomal dominant transmission: a morphological and qualitative platelet disorder. Eur J Haematol 1997; 58:40-5. [PMID: 9020372 DOI: 10.1111/j.1600-0609.1997.tb01408.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We studied 47 subjects belonging to 13 unrelated families with a history of mild haemorrhagic diathesis and chronic thrombocytopenia. 36 patients presented some degree of thrombocytopenia: 7/36 (19%) had slight thrombocytopenia (100-150 x 10(9)/L); 26/36 (72%) had mild thrombocytopenia (50-100 x 10(9)/L) and 3/36 (8%) had severe thrombocytopenia (< 50 x 10(9)/L). No correlation was observed between platelet count and the degree of haemorrhagic diathesis, which was mild in the majority of patients. Transmission was autosomal dominant. Platelet anisocytosis, increased percentage of large platelets and absence of leukocyte inclusions were observed in 26/30 (87%) of the examined blood smears. The ultrastructural appearance of platelets was normal. Megakaryocytes appeared normal in number in 10/10 patients, but showed asynchronous nuclear-cytoplasm maturation and mainly nonlobulated nuclei. Platelet aggregation was studied in 26 patients and either increased or decreased curves were variably observed in response to different aggregating agents. Platelet-associated IgG (PAIgG) was increased in 18/31 (58%) patients, while serum autoantibodies against platelet glycoproteins Ib/IX or IIb/IIIa were demonstrable in only 1 case. An increased expression of platelet surface glycoproteins Ib and IIb/IIIa, as studied by murine monoclonal antibodies binding in 17 cases, was observed. Platelet survival performed by 111Inoxine-labelled autologous platelets was normal in the 3 studied patients. Congenital macrothrombocytopenia confirms to be a distinct clinical disorder for which the name of "chronic isolated hereditary macrothrombocytopenia" is proposed.
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Affiliation(s)
- F Fabris
- Institute of Medical Semiotics, Chairs of Semeiotics and Internal Medicine, Padua, Italy
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Abstract
Giant platelet disorders (GPD) refer to rare, usually inherited states characterized by abnormally large platelets, thrombocytopenia and bleeding tendency of variable severity. This review summarizes major clinical and laboratory features of three GPDs (Bernard-Soulier syndrome, May-Hegglin anomaly and gray platelet syndrome). Differential diagnosis between immunological thrombocytopenia and GPDs is important. Although rare, giant platelet disorders should be borne in mind, since bleeding tendency in some individuals may be severe and knowledge of bleeding diathesis is of importance before delivery or surgical procedures also in less symptomatic individuals.
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Affiliation(s)
- E Jantunen
- Department of Medicine, Kuopio University Hospital, Finland
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