The Glanzmann's Thrombasthenia in Tunisia: A Cohort Study

Hemorrhage of Upper Digestive and Respiratory Tracts in a Child with Glanzmann Thrombasthenia

Glanzmann thrombasthenia (GT) is an autosomal recessive platelet disorder that could cause mild to severe bleeding episodes. The incidence is approximately 1 per 1,000,000 births. Patients with GT frequently have mucocutaneous bleeding with absent platelet aggregation in response to all physiologic stimuli, but a normal platelet count and morphology. Specifically, the glycoprotein IIb/IIIa (GP IIb/IIIa) complex is either inadequate or dysfunctional. This case reports a 3.5-year-old boy with Glanzmann thrombasthenia who had two episodes with uncontrolled hemorrhage from upper digestive and respiratory tracts, the first with the bleeding point found in the left tonsil and the second in the adenoids.

Glanzmann's thrombasthenia: a rare bleeding disorder in a Nigerian girl

INTRODUCTION

Glanzmann's Thrombasthenia (GT) is a rare autosomal recessive bleeding disorder due to defective platelet membrane glycoprotein GP IIb/IIIa (integrin αIIbβ3). The prevalence is estimated at 1:1,000,000 and it is commonly seen in areas where consanguinity is high.

CASE PRESENTATION

The authors report a 12 year old Nigerian girl of Igbo ethnic group, born of non-consanguineous parents, who presented with prolonged heavy menstrual bleeding which started at menarche 3 months earlier, weakness and dizziness. She had a past history of recurrent episodes of prolonged epistaxis, gastrointestinal bleeding and gum bleeding during early childhood. On examination, she was severely pale with a haemic murmur and vaginal bleeding. The initial diagnosis was menorrhagia secondary to bleeding diathesis possibly von Willebrand's Disease. She was on supportive treatment with fresh whole blood, fresh frozen plasma and platelets until diagnosis of GT was made in the USA. Currently, she is on 3 monthly intramuscular Depo-provera with remarkable improvement.

CONCLUSION

To the best of our knowledge, this is the first documented report of GT in our environment where consanguinity is rarely practised. Our health facilities require adequate diagnostic and treatment facilities for rare diseases like GT.

Glanzmann Thrombasthenia in Children: Experience From a Tertiary Care Center in Southern India

BACKGROUND

Glanzmann thrombasthenia (GT) is a globally rare inherited disorder of hemostasis.

OBJECTIVES

To describe the clinical profile of GT in a tertiary care center in Southern India.

METHODS

A retrospective chart review of all children with GT was performed between January 2005 and August 2017 in the Department of Paediatrics.

RESULTS

A total of 48 patients (representing 43 families) were included. Median age at diagnosis was 2.75 years (interquartile range: 1.5 to 6.75). Two thirds had an onset of bleeding within the first 2 years of life. Sixty-seven percent were born out of consanguineous marriage. The common symptoms were epistaxis, gingival bleeding, and ecchymoses. Neonatal onset of bleeding manifested as purpura, epistaxis, and intracranial hemorrhage. Postsurgical bleeding and menorrhagia were unique presentations in adolescence. About 25% had life-threatening hemorrhage while 50% had growth retardation due to chronic anemia.

CONCLUSIONS

GT is relatively more common in areas of Southern India due to the higher prevalence of consanguinity. Chronic anemia can contribute to growth stunting in these patients.