BACKGROUND: Acquired Glanzmann's thrombasthenia (aGT) is a rare hemorrhagic disorder caused by autoantibodies, alloantibodies, or paraproteins directed against platelet GPIIb/IIIa. Its diagnosis requires several laboratory assays and mixing tests, which are complex and time consuming. We describe here a new case of aGT and compare different tests for the detection of GPIIb/IIIa-blocking autoantibodies. METHODS: A previously healthy 27-year-old male developed severe mucocutaneous bleeding, despite a normal platelet count, associated with non Hodgkin lymphoma. RESULTS: Blood clotting tests were normal. Bleeding time and PFA-100 were unmeasurable. Platelet aggregation was absent in response to all agonists except ristocetin. Platelet adhesion to collagen at high shear was impaired. Platelet granular content and release was normal. Flow cytometry showed normal binding of some anti-GPIIb/IIIa antibodies (SZ21 and SAP), and decreased binding of others (P2, SZ22, A2A 9/6). Binding of PAC-1, against activated GPIIb/IIIa, and of fibrinogen, was absent. In mixing tests, patient's serum inhibited aggregation, adhesion, and PAC-1 and A2A9/6 binding to control platelets. The patient's antibody, purified by affinity chromatography, recognized purified GPIIb by western blotting. Isolated patient's IgG inhibited platelet aggregation and A2A 9/6 binding by flow cytometry. CONCLUSIONS: Flow cytometry is especially useful for the diagnosis of aGT, being the only test able to characterize both the functional effect and the molecular target of the patient's autoantibody. (c) 2008 Clinical Cytometry Society
BACKGROUND: Acquired Glanzmann's thrombasthenia (aGT) is a rare hemorrhagic disorder caused by autoantibodies, alloantibodies, or paraproteins directed against platelet GPIIb/IIIa. Its diagnosis requires several laboratory assays and mixing tests, which are complex and time consuming. We describe here a new case of aGT and compare different tests for the detection of GPIIb/IIIa-blocking autoantibodies. METHODS: A previously healthy 27-year-old male developed severe mucocutaneous bleeding, despite a normal platelet count, associated with non Hodgkin lymphoma. RESULTS: Blood clotting tests were normal. Bleeding time and PFA-100 were unmeasurable. Platelet aggregation was absent in response to all agonists except ristocetin. Platelet adhesion to collagen at high shear was impaired. Platelet granular content and release was normal. Flow cytometry showed normal binding of some anti-GPIIb/IIIa antibodies (SZ21 and SAP), and decreased binding of others (P2, SZ22, A2A 9/6). Binding of PAC-1, against activated GPIIb/IIIa, and of fibrinogen, was absent. In mixing tests, patient's serum inhibited aggregation, adhesion, and PAC-1 and A2A9/6 binding to control platelets. The patient's antibody, purified by affinity chromatography, recognized purified GPIIb by western blotting. Isolated patient's IgG inhibited platelet aggregation and A2A 9/6 binding by flow cytometry. CONCLUSIONS: Flow cytometry is especially useful for the diagnosis of aGT, being the only test able to characterize both the functional effect and the molecular target of the patient's autoantibody. (c) 2008 Clinical Cytometry Society
Authors: Alex F Sandes; Mihoko Yamamoto; Sergio Matarraz; Maria de Lourdes L F Chauffaille; Sandra Quijano; Antonio López; Tsutomu Oguro; Eliza Y S Kimura; Alberto Orfao Journal: Haematologica Date: 2012-01-22 Impact factor: 9.941
Authors: Paolo Gresele; Emanuela Falcinelli; Silvia Giannini; Pio D'Adamo; Angela D'Eustacchio; Teresa Corazzi; Anna Maria Mezzasoma; Filomena Di Bari; Giuseppe Guglielmini; Luca Cecchetti; Patrizia Noris; Carlo L Balduini; Anna Savoia Journal: Haematologica Date: 2009-03-31 Impact factor: 9.941