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Prospective evaluation of variables affecting platelet function in patients with newly diagnosed chronic myeloid leukemia. Blood Coagul Fibrinolysis 2021; 31:562-568. [PMID: 33181760 DOI: 10.1097/mbc.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Platelet function in chronic myeloid leukemia (CML) could be affected by either hyperleucocytosis, clonal megakaryopoiesis, or tyrosine kinase inhibitors. However, these variables have never been prospectively evaluated. We conducted a prospective study over a period of 1.5 years in a tertiary care center of north India. Patients with CML in chronic phase, more than 18 years, and treated with imatinib were enrolled (n = 32). Age, and sex-matched controls were also included. Platelet function test was performed using two-channel Chrono-Log aggregometer 490 at four time-points: first, at diagnosis; second, after leucoreduction (total leucocyte count, <10 × 10/l) achieved with hydroxycarbamide; third, on-imatinib at BCR-ABL less than 1%; and fourth, in an independent cohort (off-imatinib) at deep molecular response (DMR) (BCR-ABL < 0.01%). Statistical analysis was performed using IBM SPSS statistics (version 22.0). Median age of patients was 42 years (15-65), and M : F ratio was 1 : 1. At diagnosis, platelet function correlated negatively with total leucocyte count, but not with platelet count. As compared with baseline, platelet aggregation with ADP (2.5 μl), and collagen (2.5 μl) improved significantly after leucoreduction (P = 0.05 and 0.009, respectively). Imatinib further caused significant impairment of aggregation with ADP (2.5 μl), collagen (2.5 μl), and collagen (1 μl) (P = 0.04, 0.008, and 0.02, respectively). Patients in DMR also demonstrated a significant impairment of platelet aggregation with all the agonists as compared with controls. While leucoreduction alone can improve the baseline platelet function derangement in CML, imatinib further impairs it. Residual CML stem cells, or effect of imatinib on normal common myeloid progenitors might account for platelet function derangement at DMR.
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Jain A, Prasad P, Chaudhry S, Gupta DK, Saluja S. Spontaneous Acute Subdural Hematoma as an Initial Presentation of Chronic Myeloid Leukemia. Indian J Hematol Blood Transfus 2019; 35:578-579. [PMID: 31388280 DOI: 10.1007/s12288-019-01115-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/11/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ankur Jain
- Department of Haematology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, 110029 India
| | - Pooja Prasad
- Department of Haematology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, 110029 India
| | - Sumita Chaudhry
- Department of Haematology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, 110029 India
| | - D K Gupta
- Department of Haematology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, 110029 India
| | - Sumita Saluja
- Department of Haematology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, 110029 India
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Nurden AT. Acquired Glanzmann thrombasthenia: From antibodies to anti-platelet drugs. Blood Rev 2019; 36:10-22. [PMID: 31010659 DOI: 10.1016/j.blre.2019.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 02/06/2023]
Abstract
In contrast to the inherited platelet disorder given by mutations in the ITGA2B and ITGB3 genes, mucocutaneous bleeding from a spontaneous inhibition of normally expressed αIIbβ3 characterizes acquired Glanzmann thrombasthenia (GT). Classically, it is associated with autoantibodies or paraproteins that block platelet aggregation without causing a fall in platelet count. However, inhibitory antibodies to αIIbβ3 are widely associated with primary immune thrombocytopenia (ITP), occur in secondary ITP associated with leukemia and related disorders, solid cancers and myeloma, other autoimmune diseases, following organ transplantation while cytoplasmic dysregulation of αIIbβ3 function features in myeloproliferative and myelodysplastic syndromes. Antibodies to αIIbβ3 occur during viral and bacterial infections, while drug-dependent antibodies reacting with αIIbβ3 are a special case. Direct induction of acquired GT is a feature of therapies that block platelets in coronary artery disease. This review looks at these conditions, emphasizing molecular mechanisms, therapy, patient management and future directions for research.
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Affiliation(s)
- Alan T Nurden
- Institut de Rhythmologie et de Modélisation Cardiaque, Plateforme Technologique d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
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Chauhan R, Sazawal S, Singh K, Ragesh R Nair R, Chhikara S, Deka R, Chaubey R, Veetil KK, Dange P, Mahapatra M, Saxena R. Reversal of Glanzmann thrombasthenia platelet phenotype after imatinib treatment in a pediatric chronic myeloid leukemia patient. Platelets 2017; 29:203-206. [PMID: 29185819 DOI: 10.1080/09537104.2017.1384539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic Myelogenous Leukemia (CML) is a myeloproliferative neoplasm characterized by proliferation of Philadelphia positive clonal pluripotent hematopoietic cells. Bleeding is a rare presentation of CML that can occur due to platelet dysfunction. Both pre-treatment and post-treatment platelet function abnormalities in CML have been described in the literature. We describe a rare case of childhood CML who presented with mucocutateous bleeding manifestations. On laboratory workup, a Glanzmann Thrombasthenia (GT) like platelet phenotype was demonstrated along with confirmation of diagnosis of CML in chronic phase. The acquired nature of platelet function defect was confirmed by demonstrating recovery of platelet antigens glycoprotein IIb/IIIa after achieving complete hematological response with Imatinib. Due to presenting complaint of bleeding diathesis and absence of hepatosplenomegaly, the case was undiagnosed for CML until the patient reported to us. Careful evaluation of complete blood counts, peripheral blood picture and detailed laboratory workup was the window to proper diagnosis and treatment in this case.
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Affiliation(s)
- Richa Chauhan
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Sudha Sazawal
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Kanwaljeet Singh
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - R Ragesh R Nair
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Sunita Chhikara
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Roopam Deka
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Rekha Chaubey
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Karthika Kundil Veetil
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Prasad Dange
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Manoranjan Mahapatra
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Renu Saxena
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
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Nagase Y, Ueda S, Matsunaga H, Yoshioka A, Okada Y, Machida T, Nakata K, Mima F, Takeda R, Hayashi D, Iio S, Okita K, Narahara H, Yasunaga Y, Inui Y, Kawata S. Acute compartment syndrome as the initial manifestation of chronic-phase chronic myeloid leukemia: a case report and review of the literature. J Med Case Rep 2016; 10:201. [PMID: 27443161 PMCID: PMC4957314 DOI: 10.1186/s13256-016-0985-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/24/2016] [Indexed: 12/28/2022] Open
Abstract
Background Acute compartment syndrome is an orthopedic emergency requiring urgent fasciotomy to prevent irreversible damage. In hematological malignancies, acute compartment syndrome caused by severe soft tissue bleeding is extremely rare. We present a patient with chronic-phase chronic myeloid leukemia who had acute compartment syndrome caused by severe soft tissue bleeding in her right forearm. Case presentation A 72-year-old Japanese woman was referred to our hospital with swelling and pain of her right forearm without a previous history of trauma. She was diagnosed with chronic-phase chronic myeloid leukemia. Extreme thrombocytosis was present, although no evidence of acquired von Willebrand disorder was found. Compartment syndrome caused by soft tissue bleeding was confirmed. An emergency fasciotomy for decompression was conducted. However, sustained postoperative bleeding occurred and required massive red cell concentrate transfusion. As her platelet count decreased by cytoreductive therapy, complete hemostasis was achieved. Conclusions Patients with an extremely high platelet count might be at high risk for severe bleeding complications even without acquired von Willebrand disease. For the control of severe bleeding complications in patients with myeloproliferative disorder, the importance of thrombocyte reduction should be recognized.
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Affiliation(s)
- Yoshikazu Nagase
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Shuji Ueda
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
| | - Hitomi Matsunaga
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Aya Yoshioka
- Department of Clinical Laboratory, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan
| | - Yoshiyuki Okada
- Department of Orthopaedic Surgery, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan
| | - Tomohisa Machida
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Keiichi Nakata
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Fuka Mima
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Risato Takeda
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Daisuke Hayashi
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Sadaharu Iio
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Kohei Okita
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Hiroyuki Narahara
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Yuichi Yasunaga
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Yoshiaki Inui
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Sumio Kawata
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
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Assessment of changes in membrane properties of platelets from patients with chronic myeloid leukaemia in different stages of the disease. Blood Coagul Fibrinolysis 2014; 25:142-50. [PMID: 24346354 DOI: 10.1097/mbc.0b013e328365776f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patients with chronic myeloproliferative leukemia (CML) have frequent haemorrhage and/or thrombosis in their medical history. The mechanisms of these major and life-threatening complications remain unclear. Membrane organization influences many of the unique cellular functions and is strongly correlated, among other factors, to the membrane lipid composition; it may be evaluated by following up the membrane fluidity and aggregation properties of the platelet. In this study, we evaluated the platelet aggregation, the expression of platelet surface receptors, the membrane fluidity (as evaluated by fluorescence anisotropy) and its correlation to reactive oxygen species (ROS) production, in patients with chronic myeloid leukaemia (CML). It was found that the patients in accelerated and blastic phase of CML present an altered platelet aggregation response to all reagents except for ristocetin as compared with chronic phase group, which shows only epinephrine-altered response. We also found that BCR/ABL transcript leads to higher levels of ROS in accelerated and blastic CML phases. Patients without molecular remission have lower platelet membrane fluidity. We obtained a positive correlation between ROS level and membrane fluorescence anisotropy changes. The CD41 expression was decreased in CML patients and P selectin expression was found to be higher in these patients than in healthy volunteers. Platelets of CML patients have altered aggregation parameters in accelerated and blastic phases, in which BCR/ABL transcript level is increased. The increased level of ROS in CML patients without molecular remission is associated with a decrease in fluidity of platelet membrane and expression of CD41/CD61 receptors. These findings may contribute to understanding the mechanism of the altered platelet response reported in CML patients.
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Permanent sensorineural deafness in a patient with chronic myelogenous leukemia secondary to intracranial hemorrhage. Case Rep Hematol 2013; 2013:894141. [PMID: 24367730 PMCID: PMC3866831 DOI: 10.1155/2013/894141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 10/31/2013] [Indexed: 11/17/2022] Open
Abstract
A 52-year-old male presented with tinnitus and fullness in left ear for one day. Workup revealed a white blood cell count of 685 × 10(3)/μL with marked increase in granulocyte series and myeloid precursors on peripheral smear. The initial impression was chronic myelogenous leukemia with hyperleukocytosis, and patient was started on hydration, hydroxyurea, and allopurinol. Patient tolerated bone marrow biopsy well but continued to bleed excessively from the biopsy site. Results confirmed Philadelphia chromosome positive chronic myelogenous leukemia (chronic phase). On day three of hospitalization, patient developed sudden slurred speech along with shaking movements involving extremities. Magnetic resonance imaging revealed multiple hemorrhages throughout the brain. Hydroxyurea was continued until insurance coverage for nilotinib was getting approved. On day nine of hospitalization, patient developed sudden bilateral sensorineural deafness. Repeat magnetic resonance imaging revealed multiple new hemorrhages throughout the brain. Computer tomography of the temporal bones showed inflammatory changes in right and left mastoid cells. Nilotinib was started on day eleven of hospitalization. Patient's white blood cell count continued to decrease, but there was no improvement in hearing. Four months later, patient was treated with bilateral transmastoid cochlear implants. This case highlights permanent deafness as a hemorrhagic complication secondary to chronic myelogenous leukemia.
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