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Barghouthi DI, Abu-Hilal LH, Njoum Y, Hasan AD, Alshawwa K, Hourani F. Gray Platelet Syndrome-Unusual Presentation with Spontaneous Splenic Rupture: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2023; 11:23247096231196697. [PMID: 37649376 PMCID: PMC10472819 DOI: 10.1177/23247096231196697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023] Open
Abstract
Gray platelet syndrome (GPS) is a rare hereditary hemorrhagic disorder characterized by macrothrombocytopenia and the absence of alpha-granules in platelets. Clinically, mild-to-moderate bleeding is the main manifestation, often accompanied by thrombocytopenia, splenomegaly, and myelofibrosis. Here, we present a case of a 15-year-old male patient with a history of hepatosplenomegaly, and thrombocytopenia for 8 years, who presented with sudden generalized abdominal pain. Despite initial suspicion of gastroenteritis, diagnostic imaging revealed an extensive hemoperitoneum. Subsequent genetic testing confirmed the diagnosis of GPS, which had not been previously identified. This case highlights the importance of considering inherited platelet disorders should be considered in adolescents with long-standing thrombocytopenia, and emphasizes the need for thorough evaluation in patients with suggestive symptoms.
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Affiliation(s)
| | | | - Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Abeer Dar Hasan
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
| | - Khaled Alshawwa
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
| | - Fadi Hourani
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
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Didelot M, Docq C, Wahl D, Lacolley P, Regnault V, Lagrange J. Platelet aggregation impacts thrombin generation assessed by calibrated automated thrombography. Platelets 2017; 29:156-161. [PMID: 29022492 DOI: 10.1080/09537104.2017.1356452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A calibrated automated thrombogram (CAT) is performed usually with human platelet-free plasma (PFP) but may be more relevant with platelet-rich plasma (PRP). In this case, platelets are not stimulated by subendothelial molecules like collagen. Our aim was to assess the consequence of strong (collagen) or weak (ADP) induction of platelet release and aggregation on thrombin generation. Platelet aggregation in PRP was triggered with 10 µg/mL collagen or 10 µM ADP using a lumi-aggregometer. Thrombin generation curves were monitored by CAT in different conditions: PRP, PRP with activated platelets (actPRP), aggregated PRP (agPRP), aggregated platelets resuspended in autologous PFP (resPRP), PFP and PFP obtained after aggregation (agPFP). We found a 3-fold shortening of the lag time and time to peak and a marked increase in velocity and thrombin peak without changes in endogenous thrombin potential (ETP) in agPRP with both agonists compared with PRP. The same holds true in agPFP but with a marked increase in ETP compared with PFP. Similar changes in the kinetics of thrombin generation were observed with actPRP-collagen and to a lesser extent in resPRP-collagen compared with PRP. By contrast, there were no modifications of the thrombin generation curves in actPRP-ADP. Alpha-2-macroglobin-thrombin complexes were unchanged in the different PRP conditions but were increased in PFP prepared from agPFP compared to control PFP. Platelet aggregation during activation by agonists other than thrombin did not increase thrombin generation but accelerated its kinetics mainly via platelet content release and platelet-derived extracellular vesicules formation. In diseases characterized by altered platelet granule content or release as well as altered platelet activation, a platelet aggregation step prior to CAT analysis may be clinically relevant to improve laboratory estimation of the bleeding/thrombotic balance.
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Affiliation(s)
- Mélusine Didelot
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France
| | - Clémence Docq
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France
| | - Denis Wahl
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France.,c CHRU Nancy , Vandœuvre-lès-Nancy , France
| | - Patrick Lacolley
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France.,c CHRU Nancy , Vandœuvre-lès-Nancy , France
| | - Véronique Regnault
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France.,c CHRU Nancy , Vandœuvre-lès-Nancy , France
| | - Jérémy Lagrange
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France.,d Center for Thrombosis and Hemostasis , University Medical Center Mainz , Mainz , Germany
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Grey-platelet-Syndrom: Pathophysiologie, Klinik, Diagnostik und Therapie. Hamostaseologie 1999. [DOI: 10.1007/978-3-662-07673-6_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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