Glanzmann's thrombasthenia

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Glanzmann's thrombasthenia
Classification and external resources
Specialty Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value).
ICD-10 D69.1
ICD-9-CM 287.1
OMIM 187800 273800
DiseasesDB 5224
MedlinePlus 001305
eMedicine med/872
Patient UK Glanzmann's thrombasthenia
MeSH D013915
[[[d:Lua error in Module:Wikidata at line 863: attempt to index field 'wikibase' (a nil value).|edit on Wikidata]]]

Glanzmann's thrombasthenia is an abnormality of the platelets.[1] It is an extremely rare coagulopathy (bleeding disorder due to a blood abnormality), in which the platelets contain defective or low levels of glycoprotein IIb/IIIa (GpIIb/IIIa), which is a receptor for fibrinogen. As a result, no fibrinogen bridging of platelets to other platelets can occur, and the bleeding time is significantly prolonged.

Signs and symptoms

Characteristically, there is increased mucosal bleeding:[2]

The bleeding tendency is variable but may be severe. Hemarthrosis, particularly spontaneous, is very rare, in contrast to the hemophilias.

Platelet numbers and morphology are normal. Platelet aggregation is normal with ristocetin, but impaired with other agonists such as ADP, thrombin, collagen or epinephrine.

Template:Bleeding worksheet

Cause

Glanzmann's thrombasthenia can be inherited in an autosomal recessive manner[2][3] or acquired as an autoimmune disorder.[2][4]

The bleeding tendency in Glanzmann's thrombasthenia is variable,[2] some individuals having minimal bruising, while others have frequent, severe, potentially fatal hemorrhages. Moreover, platelet αIIbβ3 levels correlate poorly with hemorrhagic severity, as virtually undetectable αIIbβ3 levels can correlate with negligible bleeding symptoms, and 10%–15% levels can correlate with severe hemorrhage.[5] Unidentified factors other than the platelet defect itself may have important roles.[2]

Pathophysiology

Glanzmann's thrombasthenia is associated with abnormal glycoprotein IIb/IIIa (GpIIb/IIIa), also known as αIIbβ3, which is an integrin aggregation receptor on platelets. This receptor is activated when the platelet is stimulated by ADP, epinephrine, collagen, or thrombin. GpIIb/IIIa is essential to blood coagulation since the activated receptor has the ability to bind fibrinogen (as well as von Willebrand factor, fibronectin, and vitronectin), which is required for fibrinogen-dependent platelet-platelet interaction (aggregation).

In contrast, glycoprotein Ib receptors are normal with Glanzmann's thrombasthenia. The role of GpIb is to enable platelet activation by contact with the von Willebrand factor-collagen complex that is exposed when the endothelial blood vessel lining is damaged.

Understanding of the role of GpIIb/IIIa in Glanzmann's thrombasthenia led to the development of GpIIb/IIIa inhibitors, a class of powerful antiplatelet agents.[3]

Treatment

Therapy involves both preventive measures and treatment of specific bleeding episodes.[2]

Eponym

It is named after Eduard Glanzmann (1887-1959), the Swiss pediatrician who originally described it.[7][8][9]

See also

References

  1. "Glanzmann thrombasthenia" at Dorland's Medical Dictionary
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Kaushansky K, Lichtman M, Beutler E, Kipps T, Prchal J, Seligsohn U. (2010; edition 8: pages 1933-1941) Williams Hematology. McGraw-Hill.ISBN 978-0071621519
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External links

  • Internet database of mutations giving rise to Glanzmann's thrombasthenia: [1]