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Khalighi M, Wheeler AP, Adeyemi-Fowode OA, Kouides PA, Durazo-Arvizu RA, Haley K, Dersch CM, Weyand AC, Baldwin MK, Borzutzky C. Does a Bleeding Disorder Lessen the Efficacy of the 52-mg Levonorgestrel-Releasing Intrauterine System for Heavy Menstrual Bleeding in Adolescents? A Retrospective Multicenter Study. J Adolesc Health 2022; 71:204-209. [PMID: 35430143 PMCID: PMC9329177 DOI: 10.1016/j.jadohealth.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/29/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study is to compare the patient-reported bleeding outcomes and complication rates with the use of the 52-mg levonorgestrel-releasing intrauterine system (52-LNG-IUS) for treatment of heavy menstrual bleeding (HMB) among adolescents with and without a diagnosed inherited bleeding disorder (BD) within the first 12 months after insertion. METHODS Retrospective chart review was conducted of adolescents ages 14-21 years, with and without an inherited BD, who underwent 52-LNG-IUS insertion between September 2013 and February 2020 for the treatment of HMB. RESULTS One hundred forty-four 52-LNG-IUS insertions among 139 subjects were evaluated. Fifty-nine (41%) of these were among adolescents with a diagnosed inherited BD, and 85 (59%) were among those without a BD. Among subjects with follow-up, documentation of patient-reported bleeding outcome, and a retained IUS (92/144), both groups subjectively reported improvement in bleeding outcome, with 91.7% (33/36) of those with a BD and 94.6% (53/56) of those without a BD reporting that bleeding outcome was better than prior to IUS insertion (p = .675). There was no statistically significant difference in the rate of spontaneous expulsion (p = .233), with the rate of expulsion in the first 12 months after placement among those with a BD of 13.7% (7/51) and 6.8% for those without a BD (5/72). DISCUSSION Adolescents with HMB both with and without an inherited BD benefit from the 52-LNG-IUS for the treatment of HMB. Rates of spontaneous IUS expulsion are not statistically different regardless of the presence of a BD and are similar to rates found in other studies of intrauterine device use in adolescents.
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Affiliation(s)
- Misha Khalighi
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California.
| | - Allison P Wheeler
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Peter A Kouides
- Department of Hematology and Medical Oncology, Rochester General Hospital, University of Rochester School of Medicine and Mary M. Gooley Hemophilia Treatment Center, Rochester, New York
| | - Ramon A Durazo-Arvizu
- The Saban Research Institute Biostatistics Core, Children's Hospital Los Angeles, Los Angeles, California
| | - Kristina Haley
- Division of Hematology and Oncology, Oregon Health & Sciences University, Portland, Oregon
| | - Candice M Dersch
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine
| | - Angela C Weyand
- Division of Hematology and Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Maureen K Baldwin
- Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, Oregon
| | - Claudia Borzutzky
- Division of Adolescent and Young Adult Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
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Atiq F, Saes J, Punt M, van Galen K, Schutgens R, Meijer K, Cnossen M, Laros-Van Gorkom B, Peters M, Nieuwenhuizen L, Kruip M, de Meris J, van der Bom J, van der Meer F, Fijnvandraat K, Kruis I, van Heerde W, Eikenboom H, Leebeek FW, Schols S. Major differences in clinical presentation, diagnosis and management of men and women with autosomal inherited bleeding disorders. EClinicalMedicine 2021; 32:100726. [PMID: 33554093 PMCID: PMC7848767 DOI: 10.1016/j.eclinm.2021.100726] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/23/2020] [Accepted: 01/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In recent years, more awareness is raised about sex-specific dilemmas in inherited bleeding disorders. However, no large studies have been performed to assess differences in diagnosis, bleeding phenotype and management of men and women with bleeding disorders. Therefore, we investigated sex differences in a large cohort of well-defined patients with autosomal inherited bleeding disorders (von Willebrand disease (VWD), rare bleeding disorders (RBDs) and congenital platelet defects (CPDs)). METHODS We included patients from three nationwide cross-sectional studies on VWD, RBDs and CPDs in the Netherlands, respectively the WiN, RBiN and TiN study. In all studies a bleeding score (BS) was obtained, and patients filled in an extensive questionnaire on the management and burden of their disorder. FINDINGS We included 1092 patients (834 VWD; 196 RBD; 62 CPD), of whom 665 (60.9%) were women. Women were more often referred because of a bleeding diathesis than men (47.9% vs 36.6%, p = 0.002). Age of first bleeding was similar between men and women, respectively 8.9 ± 13.6 (mean ±sd) years and 10.6 ± 11.3 years (p = 0.075). However, the diagnostic delay, which was defined as time from first bleeding to diagnosis, was longer in women (11.6 ± 16.4 years) than men (7.7 ± 16.6 years, p = 0.002). Similar results were found when patients referred for bleeding were analyzed separately. Of women aging 12 years or older, 469 (77.1%) had received treatment because of sex-specific bleeding. INTERPRETATION Women with autosomal inherited bleeding disorders are more often referred for bleeding, have a longer diagnostic delay, and often require treatment because of sex-specific bleeding. FUNDING The WiN study was supported (in part) by research funding from the Dutch Hemophilia Foundation (Stichting Haemophilia), Shire (Takeda), and CSL Behring (unrestricted grant).
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Affiliation(s)
- F. Atiq
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J.L. Saes
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M.C. Punt
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
| | - K.P.M. van Galen
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
| | - R.E.G. Schutgens
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
| | - K. Meijer
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | - M.H. Cnossen
- Department of Pediatric Hematology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - B.A.P. Laros-Van Gorkom
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M. Peters
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric-Hematology, Amsterdam, the Netherlands
| | - L. Nieuwenhuizen
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Maxima Medical Center Eindhoven, Eindhoven, the Netherlands
| | - M.J.H.A. Kruip
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J. de Meris
- Netherlands Hemophilia Society, Leiden, the Netherlands
| | - J.G. van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin Research, Leiden, the Netherlands
| | - F.J.M. van der Meer
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - K. Fijnvandraat
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric-Hematology, Amsterdam, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
| | - I.C. Kruis
- Netherlands Hemophilia Society, Leiden, the Netherlands
| | - W.L. van Heerde
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Enzyre BV, Novio Tech Campus, Nijmegen, the Netherlands
| | - H.C.J. Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank W.G. Leebeek
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S.E.M. Schols
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - For the WiN, RBiN and TiN study groups
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pediatric Hematology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric-Hematology, Amsterdam, the Netherlands
- Department of Hematology, Maxima Medical Center Eindhoven, Eindhoven, the Netherlands
- Netherlands Hemophilia Society, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin Research, Leiden, the Netherlands
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
- Enzyre BV, Novio Tech Campus, Nijmegen, the Netherlands
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Lafon T, Vallejo C, Hadj M, Laroche ML, Geniaux H. [Misuse and adverse effects of new direct oral anticoagulants: A prospective observational study in patients admitted to an emergency unit of a French university hospital]. Therapie 2017; 73:209-215. [PMID: 28822583 DOI: 10.1016/j.therap.2017.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/12/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The use of direct oral anticoagulants (NOAC) is complex: indications, dosage adjustments and precautions. Emergency departments (ED) are increasingly faced with patients receiving NOAC. The aim of this study was to evaluate the misuse and the adverse effects (AE) of NOAC. METHODS All subjects with NOAC admitted to the Limoges University Hospital ED from 1/8/2013 to 1/4/2014 were included in a prospective observational study. Misuse was identified from the NOAC summary of product characteristics and from the 2014 ANSM guideline (indication, dose, co-medications, age, hepatic and renal function); adverse effects were recorded. RESULTS A total of 198 subjects were included receiving rivaroxaban (68.7 %), dabigatran (30.8 %) or apixaban (0.5 %). Main indications were embolic prevention in patients with non-valvular atrial fibrillation (78.7 %) and curative treatment of venous thromboembolism (17.2 %). In 16.2 % of the cases, the treatment was not in according to the guidelines: 78 % for prescribing errors (incorrect dosage according to age, renal function, co-medications) and 22 % for wrong initial indication. AE related to NOAC were encountered in 25.8 % patients. Hemorrhagic events were diagnosed in 36 patients with no according to the guidelines in 11.1 % of them. Hemorrhagic events resulted in 3 deaths (8.3 %). Thrombotic events occurred in 15 patients, all these patients were issued with appropriate guidelines. CONCLUSION Through the view of an ED, this study confirms a part of misuse and highlights the risk of spontaneous bleeding of NOAC despite appropriate use.
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Affiliation(s)
- Thomas Lafon
- Département des urgences, service des urgences, SAMU, CHU de Limoges, 87042 Limoges cedex, France; Inserm CIC 1435, 87042 Limoges, France.
| | - Christine Vallejo
- Département des urgences, service des urgences, SAMU, CHU de Limoges, 87042 Limoges cedex, France; Inserm CIC 1435, 87042 Limoges, France
| | - Mathilde Hadj
- Département des urgences, service des urgences, SAMU, CHU de Limoges, 87042 Limoges cedex, France
| | - Marie-Laure Laroche
- Centre régional de pharmacovigilance, de pharmaco-épidémiologie et d'information sur les médicaments, CHU de Limoges, 87042 Limoges cedex, France; Service de pharmacologie, toxicologie et pharmacovigilance, CHU de Limoges, 87042 Limoges cedex, France; Faculté de médecine, université de Limoges, 87042 Limoges, France
| | - Hélène Geniaux
- Centre régional de pharmacovigilance, de pharmaco-épidémiologie et d'information sur les médicaments, CHU de Limoges, 87042 Limoges cedex, France; Service de pharmacologie, toxicologie et pharmacovigilance, CHU de Limoges, 87042 Limoges cedex, France
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Jones GM, Erdman MJ, Smetana KS, Mohrien KM, Vandigo JE, Elijovich L. 3-Factor Versus 4-Factor Prothrombin Complex Concentrate for Warfarin Reversal in Severe Bleeding: A Multicenter, Retrospective, Propensity-Matched Pilot Study. J Thromb Thrombolysis 2017; 42:19-26. [PMID: 26721625 DOI: 10.1007/s11239-015-1330-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Current guidelines recommend 4-factor prothrombin complex concentrate (4PCC) for emergent reversal of bleeding secondary to warfarin. While current research has demonstrated superiority of 4PCC over plasma, direct comparisons with 3-factor PCC (3PCC) are lacking. The purpose of this study is to compare the efficacy and safety of 3PCC and 4PCC. We conducted a retrospective analysis of patients who received PCC at one of four medical centers. All patients in the 3PCC group were treated at one center that utilizes a fixed, weight-based dosing protocol. After evaluation of all patients meeting inclusion criteria, propensity-score matching was used to adjust for differences in treatment characteristics. There was no difference in the primary outcome of INR ≤ 1.4 between 3PCC and 4PCC in both the unmatched (85.7 vs. 90.6 %; p = 0.37) and matched (84.2 vs. 92.1 %; p = 0.48) analyses. There was a significant difference in goal INR achieved favoring 4PCC (56.3 vs 90.0 %; p < 0.02) when baseline INR > 4.0. A total of three thrombotic events were documented, all in the 4PCC group. We found no difference in the rate of INR reversal in those treated with 3PCC and 4PCC. However, those with a baseline INR > 4.0 may experience more successful INR reversal with 4PCC.
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Affiliation(s)
- G Morgan Jones
- Department of Pharmacy, Methodist University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA. .,Department of Clinical Pharmacy, University of Tennessee Health Sciences Center (UTHSC), 920 Court Ave, Memphis, TN, 38163, USA. .,Department of Neurology and Neurosurgery, UTHSC, 920 Court Ave, Memphis, TN, 38163, USA.
| | - Michael J Erdman
- Department of Pharmacy, University of Florida Health, 655 West 8th Street, Jacksonville, FL, 32209, USA
| | - Keaton S Smetana
- Department of Pharmacy, University of Kentucky HealthCare, 800 Rose St, Lexington, KY, 40536, USA
| | - Kerry M Mohrien
- Department of Pharmacy, Temple University Hospital, 3509 N Broad St, Philadelphia, PA, 19140, USA
| | - Joseph E Vandigo
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 620 W Lexington St, Baltimore, MD, 21201, USA
| | - Lucas Elijovich
- Department of Neurology and Neurosurgery, UTHSC, 920 Court Ave, Memphis, TN, 38163, USA.,Semmes-Murphey Neurologic and Spine Institute, 6325 Humphreys Blvd, Memphis, TN, 38120, USA
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Fujimoto DE, Koifman S. Clinical and laboratory characteristics of patients with dengue hemorrhagic fever manifestations and their transfusion profile. Rev Bras Hematol Hemoter 2014; 36:115-20. [PMID: 24790536 PMCID: PMC4005509 DOI: 10.5581/1516-8484.20140027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 12/18/2013] [Indexed: 11/27/2022] Open
Abstract
Background Dengue is an infectious disease with a recurring incidence, especially in developing countries. Despite recent economic growth, success in disease control has not been achieved, and dengue has evolved from cyclic epidemic outbreaks to a lack of seasonality. The lack of scientific basis for the proper management of cases with hemorrhagic manifestations, especially regarding transfusion procedures, might contribute to the high death rate in potentially avoidable cases. Objective The aim of the study was to identify the clinical and laboratory manifestations in hemorrhagic dengue fever treated at the emergency services in Rio Branco, AC, Brazil, as well as to describe transfusion characteristics of patients and identify possible prognostic factors. Methods A retrospective descriptive study was performed to analyze the distribution of relative frequencies of clinical and laboratory variables. The study was carried out in Rio Branco with confirmed dengue fever cases. Secondary data were obtained by Acre Epidemiological Surveillance teams of cases with bleeding or platelet counts under 100.0 × 109/L. The patients' clinical, laboratory and transfusion data were obtained from hospital records. Results A total of 90,553 dengue cases were reported of which 7,447 had serologic confirmation; 267 cases had hemorrhagic manifestations and 193 patients were located. Nearly half of the patients had anemia and the mean of the lowest platelet count of these patients was 26.4 × 109/L. Platelet concentrate was transfused in 22.3% of cases with a mean of 7.5 IU/patient, fresh frozen plasma in 21.2% with a mean of 5.2 IU/patient and just 2.6% of patients received concentrated red blood cells with a mean of 3.2 IU/patient. Bleeding led to transfusions. Signs of plasma leakage and cardiopulmonary dysfunction were correlated to unfavorable outcomes. Conclusion The pattern of clinical and laboratory criteria observed in this investigation does not differ from the literature. Transfusions were used as part of the treatment of dengue hemorrhagic fever manifestations. Some of the clinical manifestations may be related to unfavorable outcomes. © 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. All rights reserved.
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Affiliation(s)
- Denys Eiti Fujimoto
- Universidade Federal do Acre , Rio Branco, AC, Brazil, Universidade Federal do Acre (UFAC), Rio Branco, AC, Brazil
| | - Sergio Koifman
- Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
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Abstract
The diagnostic workup to differentiate hemorrhage caused by vascular injury from a systemic hemostatic imbalance typically involves a combination of broad screening tests and specific assays. The characterization of 3 overlapping phases of primary hemostasis, secondary hemostasis, and fibrinolysis provides a simple diagnostic framework for evaluating patients with clinical signs of hemorrhage. New techniques such as flow cytometry, thrombin-generation assays, thrombelastography, and anticoagulant drug monitoring are under investigation for veterinary patients; however, their ability to improve diagnosis or treatment requires further study in clinical trials.
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Matus V, Valenzuela G, Sáez CG, Hidalgo P, Lagos M, Aranda E, Panes O, Pereira J, Pillois X, Nurden AT, Mezzano D. An adenine insertion in exon 6 of human GP6 generates a truncated protein associated with a bleeding disorder in four Chilean families. J Thromb Haemost 2013; 11:1751-9. [PMID: 23815599 DOI: 10.1111/jth.12334] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 06/19/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Glycoprotein VI (GPVI), 60-65 kDa, is a major collagen receptor on platelet membranes involved in adhesive and signaling responses. Mice lacking GPVI have impaired platelet response to collagen and defective primary adhesion and subsequent thrombus formation. Complete or partial deficiency of GPVI in humans is a rare condition presenting as a mild bleeding disorder. The defect in most of the reported patients is acquired and associated with other diseases. To date, only two patients have been characterized at the molecular level who carry different compound heterozygous mutations in the GP6 gene. OBJECTIVE To report four unrelated patients from non-consanguineous families who presented with mucocutaneous bleeding. They had absent platelet aggregation and (14) C-5-HT secretion with collagen, convulxin and collagen-related peptide. RESULTS Flow cytometry and immunofluorescence-confocal microscopy showed an absence of GPVI in non-permeabilized platelets. All the patients had an adenine insertion in exon 6 (c.711_712insA), changing the reading frame and generating a premature 'stop codon' in site 242 of the protein. The mutation predicts the synthesis of the truncated protein before the trans-membrane domain, corresponding to a band of ≈49 kDa observed in western blots and in permeabilized platelets by immunofluorescence. Platelet mRNA from all the patients was sequenced and contained the corresponding adenine insertion. Heterozygous relatives had no pathological bleeding, normal response to collagen and convulxin and intermediate membrane expression of GPVI. CONCLUSIONS The identification of four unrelated homozygous patients with an identical defect suggests that inherited GPVI deficiency is more frequent than previously suspected, at least in Chile.
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Affiliation(s)
- V Matus
- Departments of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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