1
|
Sapkota S, Kuehl S, Pulluri B. Do Not Ignore Those Raccoon Eyes; They May Indicate Lethal AL Amyloidosis. Case Rep Oncol 2022; 15:1039-1048. [PMID: 36636680 PMCID: PMC9830280 DOI: 10.1159/000527169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Light chain (AL) amyloidosis is a lethal form of systemic amyloidosis that arises from the clonal expansion of CD38+ plasma cells. Organ damage occurs when these plasma cells produce misfolded immunoglobulin light chains, which form amyloid fibrils and deposit in tissues. A minority of patients with AL amyloidosis show "raccoon eyes" caused by increased vascular fragility from accumulation of amyloid fibrils. Amyloidosis can be directly associated with bleeding diathesis due to factor X deficiency as factor X binds to amyloid fibrils primarily in the liver and spleen. A 65-year-old Caucasian male presented with random bruising in the upper chest and around the eyes for 1.5 years. Physical examination was unremarkable, except for neck bruising. Pertinent workup showed protein electrophoresis with a faint M spike, increased serum lambda light chains, a kappa to lambda ratio of 0.06, increased Bence-Jones proteins, reduced factor X activity, elevated NT-proBNP. The bone marrow biopsy was positive for Congo red stain for amyloid protein. Magnetic resonance imaging revealed diffuse enhancement of the right and left ventricle subendocardial late gadolinium, consistent with cardiac amyloidosis. The patient started systemic therapy with a regimen of daratumumab, cyclophosphamide, bortezomib, and dexamethasone. After one cycle of therapy, lambda light chains normalized with an improvement in bruising. Diagnostic delays for cardiac patients are concerning as the median survival rate among these patients, when not treated, is approximately 6 months after the onset of symptoms. Since timely treatment can prevent organ damage, clinicians should be aware of specific clinical signs such as raccoon eyes and the importance of systemic evaluation for a prompt diagnosis.
Collapse
Affiliation(s)
- Surendra Sapkota
- Department of Internal Medicine, Ascension Saint Agnes Hospital, Baltimore, Maryland, USA,*Surendra Sapkota,
| | - Sapna Kuehl
- Department of Internal Medicine, Ascension Saint Agnes Hospital, Baltimore, Maryland, USA
| | - Bhargavi Pulluri
- Ascension Saint Agnes Hospital, Cancer Institute, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Zhang Y, Chen F, Yang A, Wang X, Han Y, Wu D, Wu Y, Zhang J. The disulfide bond Cys2724-Cys2774 in the C-terminal cystine knot domain of von Willebrand factor is critical for its dimerization and secretion. Thromb J 2021; 19:94. [PMID: 34838051 PMCID: PMC8626975 DOI: 10.1186/s12959-021-00348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022] Open
Abstract
Background Type 3 von Willebrand disease (VWD) exhibits severe hemorrhagic tendency with complicated pathogenesis. The C-terminal cystine knot (CTCK) domain plays an important role in the dimerization and secretion of von Willebrand factor (VWF). The CTCK domain has four intrachain disulfide bonds including Cys2724-Cys2774, Cys2739-Cys2788, Cys2750-Cys2804 and Cys2754-Cys2806, and the single cysteine mutation in Cys2739-Cys2788, Cys2750-Cys2804 and Cys2754-Cys2806 result in type 3 VWD, demonstrating the crucial role of these three disulfide bonds in VWF biosynthesis, however, the role of the remaining disulfide bond Cys2724-Cys2774 remains unclear. Method and results In this study, by the next-generation sequencing we found a missense mutation a c.8171G>A (C2724Y) in the CTCK domain of VWF allele in a patient family with type 3 VWD. In vitro, VWF C2724Y protein was expressed normally in HEK-293T cells but did not form a dimer or secrete into cell culture medium, suggesting that C2724 is critical for the VWF dimerization, and thus for VWF multimerization and secretion. Conclusions Our findings provide the first genetic evidence for the important role of Cys2724-Cys2774 in VWF biosynthesis and secretion. Therefore, all of the four intrachain disulfide bonds in CTCK monomer contribute to VWF dimerization and secretion.
Collapse
Affiliation(s)
- Yuxin Zhang
- Department of Hematology, Key Laboratory of Hematology of Hebei Province, The Second Hospital of Hebei Medical University, 050000, Shijiazhuang, China.,National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Cyrus Tang Medical Institute, Soochow University, 215123, Suzhou, China
| | - Fengwu Chen
- National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Cyrus Tang Medical Institute, Soochow University, 215123, Suzhou, China
| | - Aizhen Yang
- National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Cyrus Tang Medical Institute, Soochow University, 215123, Suzhou, China
| | - Xiaoying Wang
- Department of Hematology, Key Laboratory of Hematology of Hebei Province, The Second Hospital of Hebei Medical University, 050000, Shijiazhuang, China
| | - Yue Han
- National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Cyrus Tang Medical Institute, Soochow University, 215123, Suzhou, China
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Cyrus Tang Medical Institute, Soochow University, 215123, Suzhou, China
| | - Yi Wu
- Department of Hematology, Key Laboratory of Hematology of Hebei Province, The Second Hospital of Hebei Medical University, 050000, Shijiazhuang, China. .,National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Cyrus Tang Medical Institute, Soochow University, 215123, Suzhou, China.
| | - Jingyu Zhang
- Department of Hematology, Key Laboratory of Hematology of Hebei Province, The Second Hospital of Hebei Medical University, 050000, Shijiazhuang, China.
| |
Collapse
|
3
|
Kim HJ, Shim YJ, Lee JM, Lim YT, Yang EJ, Park KM, Chueh HW, Park ES, Kim HS, Park JK, Choi EJ, Kong SG, Kim JY, Park SK. A Multicenter Study on von Willebrand Disease Realities in Yeungnam Region. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2019. [DOI: 10.15264/cpho.2019.26.1.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Hyun Ju Kim
- Department of Pediatrics, School of Medicine, University of Ulsan, Ulsan, Korea
| | - Ye Jee Shim
- Department of Pediatrics, Keimyung University College of Medicine, Daegu, Korea
| | - Jae Min Lee
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
| | - Young Tak Lim
- Department of Pediatrics, Pusan National University College of Medicine, Yangsan, Korea
| | - Eu Jeen Yang
- Department of Pediatrics, Pusan National University College of Medicine, Yangsan, Korea
| | - Kyung Mi Park
- Department of Pediatrics, Pusan National University College of Medicine, Yangsan, Korea
| | - Hee Won Chueh
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea
| | - Eun Sil Park
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyo Sun Kim
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Ji Kyoung Park
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, Korea
| | - Eun Jin Choi
- Department of Pediatrics, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Seom Gim Kong
- Department of Pediatrics, Kosin University College of Medicine, Busan, Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Kyu Park
- Department of Pediatrics, School of Medicine, University of Ulsan, Ulsan, Korea
| |
Collapse
|
4
|
Lubnin AY, Konovalov AN, Lasunin NV, Abramov TA, Bulanov AY, Galstyan GM, Polevodova OA, Moshkin AV, Gadzhieva OA, Manushkova AA. [Severe postoperative intracranial hemorrhagic complications in a neurosurgical patient with von Willebrand disease not diagnosed before surgery (a case report and literature review)]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2018; 82:56-65. [PMID: 29927426 DOI: 10.17116/neiro201882356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The article describes a rare clinical case of a patient with previously undiagnosed von Willebrand disease and basal meningioma; an intracranial neurosurgical intervention was complicated by delayed intracranial hematomas, both at the resected tumor site and distantly. The diagnosis of von Willebrand disease was established only after special hematology tests and only after surgery. Despite the use of specific therapy, the patient died due to intracranial hemorrhagic complications in the postoperative period. The paper discusses the problem of preoperative diagnosis of asymptomatic hemostasis disorders in neurosurgical patients and potential ways of its solution.
Collapse
Affiliation(s)
- A Yu Lubnin
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A N Konovalov
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - N V Lasunin
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - T A Abramov
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A Yu Bulanov
- City Clinical Hospital #52, Pekhotnaya Str., 53, Moscow, Russia, 123182
| | - G M Galstyan
- National Hematology Research Center, Novy Zykovskiy Proezd, 4, Moscow, Russia, 125167
| | - O A Polevodova
- National Hematology Research Center, Novy Zykovskiy Proezd, 4, Moscow, Russia, 125167
| | - A V Moshkin
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - O A Gadzhieva
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A A Manushkova
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| |
Collapse
|
5
|
Mazzeffi MA, Lee K, Taylor B, Tanaka KA. Perioperative management and monitoring of antiplatelet agents: a focused review on aspirin and P2Y 12 inhibitors. Korean J Anesthesiol 2017; 70:379-389. [PMID: 28794832 PMCID: PMC5548939 DOI: 10.4097/kjae.2017.70.4.379] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 01/02/2023] Open
Abstract
Platelets play pivotal roles in hemostasis as well as pathological arterial thrombosis. The combination of aspirin and a P2Y12 inhibitor has become the mainstay therapy in the ageing population with cardiovascular conditions, particularly during and after percutaneous coronary intervention. A number of novel P2Y12 inhibitors has become available in the recent years, and they markedly vary in pharmacokinetic and pharmacodynamic properties. Perioperative physicians today face a challenge of preventing hemorrhage due to platelet inhibitors, while minimizing thrombotic risks. There are several point-of-care platelet function tests available in the peri-procedural assessment of residual platelet aggregation. However, these platelet function tests are not standardized in terms of sample processing, agonist type and potency as well as methods of detecting platelet activity. Understanding the differences in pharmacological properties of antiplatelet agents, principles of platelet function tests, and pertinent hemostatic strategies may be useful to anesthesiologists and intensivists who manage perioperative issues associated with antiplatelet agents. The objectives of this review are: 1) to discuss clinical data on aspirin and P2Y12 inhibitors relating to perioperative bleeding, 2) to outline different features of point-of-care platelet function tests, and 3) to discuss therapeutic options for the prevention and treatment of bleeding associated with antiplatelet agents.
Collapse
Affiliation(s)
- Michael A Mazzeffi
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Khang Lee
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bradley Taylor
- Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kenichi A Tanaka
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Periayah MH, Halim AS, Saad AZM, Yaacob NS, Karim FA. Report on von Willebrand Disease in Malaysia. Open Access Maced J Med Sci 2016; 4:112-7. [PMID: 27275342 PMCID: PMC4884229 DOI: 10.3889/oamjms.2016.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 01/23/2016] [Accepted: 01/24/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Von Willebrand disease (vWD) is an inherited hemostatic disorder that affects the hemostasis pathway. The worldwide prevalence of vWD is estimated to be 1% of the general population but only 0.002% in Malaysia. AIM Our present paper has been written to disclose the statistical counts on the number of vWD cases reported from 2011 to 2013. MATERIAL AND METHODS This article is based on sociodemographic data, diagnoses and laboratory findings of vWD in Malaysia. A total of 92 patients were reported to have vWD in Malaysia from 2011 to 2013. RESULTS Sociodemographic-analysis revealed that 60% were females, 63% were of the Malay ethnicity, 41.3% were in the 19-44 year old age group and 15.2% were from Sabah, with the East region having the highest registered number of vWD cases. In Malaysia, most patients are predominately affected by vWD type 1 (77.2%). Factor 8, von Willebrand factor: Antigen and vWF: Collagen-Binding was the strongest determinants in the laboratory profiles of vWD. CONCLUSION This report has been done with great interest to provide an immense contribution from Malaysia, by revealing the statistical counts on vWD from 2011-2013.
Collapse
Affiliation(s)
- Mercy Halleluyah Periayah
- Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Ahmad Sukari Halim
- Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Arman Zaharil Mat Saad
- Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nik Soriani Yaacob
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Faraizah Abdul Karim
- Hemophilia Clinic, National Blood Centre (Pusat Darah Negara), Jalan Tun Razak, 50400, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| |
Collapse
|
7
|
Chagas AC, McPhie P, San H, Narum D, Reiter K, Tokomasu F, Brayner FA, Alves LC, Ribeiro JMC, Calvo E. Simplagrin, a platelet aggregation inhibitor from Simulium nigrimanum salivary glands specifically binds to the Von Willebrand factor receptor in collagen and inhibits carotid thrombus formation in vivo. PLoS Negl Trop Dis 2014; 8:e2947. [PMID: 24921659 PMCID: PMC4055580 DOI: 10.1371/journal.pntd.0002947] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/01/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Among the several challenges faced by bloodsucking arthropods, the vertebrate hemostatic response against blood loss represents an important barrier to efficient blood feeding. Here we report the first inhibitor of collagen-induced platelet aggregation derived from the salivary glands of a black fly (Simulium nigrimanum), named Simplagrin. METHODS AND FINDINGS Simplagrin was expressed in mammalian cells and purified by affinity-and size-exclusion chromatography. Light-scattering studies showed that Simplagrin has an elongated monomeric form with a hydrodynamic radius of 5.6 nm. Simplagrin binds to collagen (type I-VI) with high affinity (2-15 nM), and this interaction does not involve any significant conformational change as determined by circular dichroism spectroscopy. Simplagrin-collagen interaction is both entropically and enthalpically driven with a large negative ΔG, indicating that this interaction is favorable and occurs spontaneously. Simplagrin specifically inhibits von Willebrand factor interaction with collagen type III and completely blocks platelet adhesion to collagen under flow conditions at high shear rates; however, Simplagrin failed to block glycoprotein VI and Iα2β1 interaction to collagen. Simplagrin binds to RGQOGVMGF peptide with an affinity (K(D) 11 nM) similar to that of Simplagrin for collagen. Furthermore, Simplagrin prevents laser-induced carotid thrombus formation in vivo without significant bleeding in mice and could be useful as an antithrombotic agent in thrombosis related disease. CONCLUSION Our results support the orthology of the Aegyptin clade in bloodsucking Nematocera and the hypothesis of a faster evolutionary rate of salivary function of proteins from blood feeding arthropods.
Collapse
Affiliation(s)
- Andrezza C. Chagas
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland, United States of America
| | - Peter McPhie
- Physical and Biochemistry Section, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States of America
| | - Hong San
- Animal Surgery and Resources Core, National Heart Lung and Blood Institute, NIH, Bethesda, Maryland, United States of America
| | - David Narum
- Laboratory of Malaria Immunology and Vaccinology, NIAID, NIH, Bethesda, Maryland, United States of America
| | - Karine Reiter
- Laboratory of Malaria Immunology and Vaccinology, NIAID, NIH, Bethesda, Maryland, United States of America
| | - Fuyuki Tokomasu
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland, United States of America
| | - Fabio A. Brayner
- Centro de Pesquisas Aggeu Magalhães (CPqAM/FIOCRUZ) and Laboratório de Imunopatologia Keizo Asami. Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Luiz C. Alves
- Centro de Pesquisas Aggeu Magalhães (CPqAM/FIOCRUZ) and Laboratório de Imunopatologia Keizo Asami. Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - José M. C. Ribeiro
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland, United States of America
| | - Eric Calvo
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland, United States of America
- * E-mail:
| |
Collapse
|
8
|
Branchford BR, Di Paola J. Making a diagnosis of VWD. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2012; 2012:161-7. [PMID: 23233576 PMCID: PMC5873588 DOI: 10.1182/asheducation-2012.1.161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A clear understanding of the molecular basis of VWD can guide the choice and interpretation of appropriate diagnostic tests. This review briefly describes the lifecycle and molecular interactions of VWF and how they lead to the current clinical classification. It also includes a brief discussion of the differential diagnosis and general workup of mucocutaneous bleeding, a review of the various VWD subtypes, and pertinent laboratory assays for each, including genetic tests. Finally, common testing pitfalls and diagnostic dilemmas are covered, including the challenge created by the overlap of borderline low VWF levels and mild bleeding.
Collapse
Affiliation(s)
- Brian R. Branchford
- Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Aurora, CO
- Children’s Hospital Colorado, Aurora, CO
- University of Colorado Hemophilia and Thrombosis Center, Aurora, CO
| | - Jorge Di Paola
- Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Aurora, CO
- Children’s Hospital Colorado, Aurora, CO
- University of Colorado Hemophilia and Thrombosis Center, Aurora, CO
| |
Collapse
|