Harris Platelet Syndrome in Patients of Non-Indian Origin

Prevalence of constitutional macrothrombocytopenia in the immigrants of Northern and Eastern states of India

Background

Thrombocytopenia is generally alarming to both clinicians and patients as the consequence can be disastrous. However, some of the conditions associated with thrombocytopenia can be innocuous. Unless this is recognized, detection of thrombocytopenia results in series of further investigations and management plan by clinicians. Hematological investigation in an apparently healthy/asymptomatic individual can throw up many surprises. One of them is thrombocytopenia and giant platelets on peripheral smear examination. Asymptomatic constitutional macrothrombocytopenia (also called as Harris platelet syndrome) is increasingly recognized in north and eastern parts of India. However, this condition is nearly unknown in southern part of our country. With Increased immigrants to south India from northern and eastern states, it becomes imperative for both clinicians and lab physicians to be aware of the magnitude of the condition and interpret appropriately. This can avoid unnecessary anxiety and investigations.

Materials and Methods

Blood samples from 300 north and northeastern immigrants (Cases) and equal number of healthy subjects from south India (Controls) were examined for hematological parameters. Peripheral smears were examined for the presence of giant platelets. Results: Constitutional macrothrombocytopenia was seen in 4.3% of the cases and in 0.66% of the controls. The difference was statistically significant with a Fischer exact P value of 0.0067. The prevalence of macrothrombocytopenia on subjective assessment of peripheral smear was 6.7% in the cases and 1% in the control group.

Conclusions

The prevalence of Harris platelet syndrome was found to be 4.3% in the immigrants from north and northeastern states.

Effect of plateletpheresis on total platelet count and mean platelet volume: A meta-analysis

OBJECTIVE

Currently, there are discrepancies in the reports on the extent of the reduction in platelet count after platelet donation by apheresis, and its impact on mean platelet volume (MPV). This study was conducted to meta-analyze the effect of plateletpheresis on platelet count and on mean platelet volume, based on studies published between 1980 and 2018.

METHODS

Medline-Pubmed, Scielo, ScienceDirect, and Scopus databases were searched from inception to December 31 2019. The PRISMA guidelines, reproducibility, and evaluation of the methodological quality were guaranteed. Heterogeneity was evaluated with DerSimonian-Laird's, publication bias with a Begg's test. Sensitivity analysis and cumulative meta-analysis were also conducted, as well as a forest plot.

RESULTS

Twenty-five studies with 3769 donors were systematized to analyze platelet count, and seven studies with 1176 donors to observe MPV. Most studies were published in India and the United States. There was a postprocedure reduction in both variables. The reduction in platelet count was 14.3 × 10³ /μL (95% CI 11.4 to 17.1 × 10³ ⁄μL). The reduction in MPV was 1.43 fL (95% CI 0.3 to 2.5 fL). The analysis of subgroups showed that, in the case of platelet count, the reduction is not statistically significant two weeks after donation.

CONCLUSION

Platelet donation by apheresis reduces platelet count and MPV in donors, which is detrimental to the purposes of the procedure; although the decrease is not clinically significant for the donor or the recipient. This demonstrates the need for subsequent studies to evaluate variables, such as donation frequency and donation intervals, should be considered to evaluate if the reported decrease is easily compensated, without adverse consequences for donors, or if modifications in donor selection criteria are required.