Glanzmann's thrombasthenia laboratory findings: Difference between revisions

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==Overview==
==Overview==


Glanzmann's thrombasthenia is commonly mistaken with other acquired platelet disorders , while they have similar clinical and laboratory presentations, such as epistaxis, easily bruising or heavy menstruation or severe bleeding after minor trauma ,hence the diagnosis of GT begins with the aforementioned symptoms, family history of consanguineous marriage  and the clinical presentation (petechia, purpura, ecchymoses,...).
Initial evaluation of a patient for a suspected functional [[platelet]] disorder should include a [[complete blood count]] and examination of the [[peripheral blood smear]]. The [[red blood cell]] count is usually normal. Some patients with [[Glanzmann's thrombasthenia]] may have reduced count of [[red blood cell]], because of coexisting [[iron deficiency]] or [[bleeding]]. The platelet count in [[Glanzmann's thrombasthenia]] is mostly on the lower end of normal. The [[Partial thromboplastin time|activated partial thromboplastin time]] (PTT) and [[prothrombin time]] (PT) are in this disease commonly normal. [[Platelet aggregation]] [[assays]] which is panel of [[assays]] measuring [[platelet aggregation]] and activation in vitro using like [[ADP]], [[arachidonic acid]], [[collagen]], [[epinephrine]], [[thrombin]], and [[ristocetin]]. There are several newer technologies in current clinical use measuring various aspects of [[platelet]] function. The most widely tested is the [[PFA-100]] device. It is used to distinguish between an [[aspirin]]-induced defect and more severe [[platelet]] dysfunction. [[Platelet aggregation]] failure in LTA with all [[agonists]] except [[ristocetin]] is diagnostic of [[Glanzmann's thrombasthenia]].  Laboratory findings consistent with the diagnosis of [[Glanzmann's thrombasthenia]] include prolonged [[bleeding time]] (BT) and failure of [[platelets]] plugging to the collagen-based filter in the [[PFA-100]] test.
 
Routine laboratory tests after these symptoms are not generally diagnostic , since the complete blood count (CBC) can be completely normal. The platelet count in Glanzmann's thrombasthenia is usually normal (mostly on the lower end of normal), as in GT the quality of the platelet is disordered,not the quantity. The red blood cell count may be normal or reveal anemia due to bleeding.
 
The prolonged bleeding time warns the potential of GT, however the activated partial thromboplastin (PTT) and prothrombin time (PT) are in this disease usually normal.
 
Flow cytometry is also useful .In flow cytometry various monoclonal antibodies are used for measuring different platelet receptor densities. Since the glycoprotein receptor in Glanzmann's thrombasthenia is dysfunctional or deficient. 
 
Among the patients with GT in flow cytometric analysis the αIIbβ3 is nonfunctional or deficient, CD41 and CD61 markers are absent or reduced, but the levels of CD42 is normal.
 
Other beneficial test for Glanzmann's thrombasthenia diagnosis is platelet function analyzer (PFA-100) study. This test is highly sensitive and it is prolonged in patients with GT.
 
In PFA-100 study a destructed vessel endothelium is simulated by using cartridges of collagen + implanted epinephrine and collagen + ADP . When the citrated whole blood moves along these cartridges with high shear stress rate ,the platelets adhere and a platelet plug is manufactured.
 
The most accurate method of GT diagnose is Genomic DNA analysis. in which the mutation in sequence of the 45 exons containing the αIIbβ3 unit is investigated, accompanied by the splice spots of the ITGA2B and ITGB3 gene. Moreover second DNA sample analysis is mandatory for the the confirmation of diagnosis.
 
Light transmission aggregometry (LTA) is highly specific for diagnosis of Glanzmann's thrombasthenia . In this test a platelet agonist is added to the centrifuged platelet-rich plasma samples and they are observed before and after the addition of the agonist.
 
The agonists include : ADP, ristocetin, arachidonic acid, collagen, thromboxane A2 mimetic, thrombin receptor activating peptide and epinephrine.
 
This test assesses mainly the platelet aggregation, specifically the percent of aggregation, the slope of aggregation, deaggregation, shape changes and the lag phase are investigated . Through LTA  platelet aggregation is disturbed with any agonist, other than ristocetin, in which the reaction is preserved.
 
LTA is greatly acknowledged as the gold standard diagnostic method for platelet function assessment. Although it is a very accurate test but it is personnel dependent and requires a lot of time consuming, moreover experienced laboratories are needed.
 
Another inconvenience of LTA assessment is among pediatric patients and thrombocytopenic patients, as obtaining platelet-rich plasma is difficult in them.
 
All in all the diagnosis of Glanzmann's thrombasthenia is through the prolonged bleeding time, normal platelet count and prolonged PFA time in blood tests. Platelets aggregation failure in LTA with all agonists except ristocetin is diagnostic of GT. <ref name="pmid22781097">{{cite journal| author=Fiore M, Nurden AT, Nurden P, Seligsohn U| title=Clinical utility gene card for: Glanzmann thrombasthenia. | journal=Eur J Hum Genet | year= 2012 | volume= 20 | issue= 10 | pages= | pmid=22781097 | doi=10.1038/ejhg.2012.151 | pmc=3449071 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22781097  }}</ref>


==Laboratory Findings==
==Laboratory Findings==
==='''CBC and peripheral smear examination'''===
==='''CBC and peripheral smear examination'''===
Initial evaluation of a patient for a suspected functional platelet disorder should include a complete blood count and examination of the peripheral blood smear. The red blood cell count (CBC) is usually normal. Some patients with Glanzmann's thrombasthenia may have reduced count of red blood cell, because of coexisting iron deficiency or bleeding. The platelet count in Glanzmann's thrombasthenia is mostly on the lower end of normal.<ref name="pmid20709904">{{cite journal |vauthors=Gunay-Aygun M, Zivony-Elboum Y, Gumruk F, Geiger D, Cetin M, Khayat M, Kleta R, Kfir N, Anikster Y, Chezar J, Arcos-Burgos M, Shalata A, Stanescu H, Manaster J, Arat M, Edwards H, Freiberg AS, Hart PS, Riney LC, Patzel K, Tanpaiboon P, Markello T, Huizing M, Maric I, Horne M, Kehrel BE, Jurk K, Hansen NF, Cherukuri PF, Jones M, Cruz P, Mullikin JC, Nurden A, White JG, Gahl WA, Falik-Zaccai T |title=Gray platelet syndrome: natural history of a large patient cohort and locus assignment to chromosome 3p |journal=Blood |volume=116 |issue=23 |pages=4990–5001 |date=December 2010 |pmid=20709904 |pmc=3012593 |doi=10.1182/blood-2010-05-286534 |url=}}</ref><ref name="pmid11520786">{{cite journal |vauthors=Drouin A, Favier R, Massé JM, Debili N, Schmitt A, Elbim C, Guichard J, Adam M, Gougerot-Pocidalo MA, Cramer EM |title=Newly recognized cellular abnormalities in the gray platelet syndrome |journal=Blood |volume=98 |issue=5 |pages=1382–91 |date=September 2001 |pmid=11520786 |doi= |url=}}</ref>
Initial evaluation of a patient for a suspected functional [[platelet]] disorder should include a [[complete blood count]] and examination of the [[peripheral blood smear]]. The [[red blood cell]] count is usually normal. Some patients with [[Glanzmann's thrombasthenia]] may have reduced count of [[red blood cell]], because of coexisting [[iron deficiency]] or [[bleeding]]. The platelet count in [[Glanzmann's thrombasthenia]] is mostly on the lower end of normal.<ref name="pmid20709904">{{cite journal |vauthors=Gunay-Aygun M, Zivony-Elboum Y, Gumruk F, Geiger D, Cetin M, Khayat M, Kleta R, Kfir N, Anikster Y, Chezar J, Arcos-Burgos M, Shalata A, Stanescu H, Manaster J, Arat M, Edwards H, Freiberg AS, Hart PS, Riney LC, Patzel K, Tanpaiboon P, Markello T, Huizing M, Maric I, Horne M, Kehrel BE, Jurk K, Hansen NF, Cherukuri PF, Jones M, Cruz P, Mullikin JC, Nurden A, White JG, Gahl WA, Falik-Zaccai T |title=Gray platelet syndrome: natural history of a large patient cohort and locus assignment to chromosome 3p |journal=Blood |volume=116 |issue=23 |pages=4990–5001 |date=December 2010 |pmid=20709904 |pmc=3012593 |doi=10.1182/blood-2010-05-286534 |url=}}</ref><ref name="pmid11520786">{{cite journal |vauthors=Drouin A, Favier R, Massé JM, Debili N, Schmitt A, Elbim C, Guichard J, Adam M, Gougerot-Pocidalo MA, Cramer EM |title=Newly recognized cellular abnormalities in the gray platelet syndrome |journal=Blood |volume=98 |issue=5 |pages=1382–91 |date=September 2001 |pmid=11520786 |doi= |url=}}</ref>


=== Thromboplastin (PTT) and Prothrombin time (PT) ===
=== Thromboplastin (PTT) and Prothrombin time (PT) ===
The activated partial thromboplastin (PTT) and prothrombin time (PT) are in this disease commonly normal.<ref name="pmid16722529">{{cite journal |vauthors=Nurden AT |title=Glanzmann thrombasthenia |journal=Orphanet J Rare Dis |volume=1 |issue= |pages=10 |date=April 2006 |pmid=16722529 |pmc=1475837 |doi=10.1186/1750-1172-1-10 |url=}}</ref><ref name="pmid26185478">{{cite journal |vauthors=Solh T, Botsford A, Solh M |title=Glanzmann's thrombasthenia: pathogenesis, diagnosis, and current and emerging treatment options |journal=J Blood Med |volume=6 |issue= |pages=219–27 |date=2015 |pmid=26185478 |pmc=4501245 |doi=10.2147/JBM.S71319 |url=}}</ref>
The [[Partial thromboplastin time|activated partial thromboplastin time]] (PTT) and [[prothrombin time]] (PT) are in this disease commonly normal.<ref name="pmid16722529">{{cite journal |vauthors=Nurden AT |title=Glanzmann thrombasthenia |journal=Orphanet J Rare Dis |volume=1 |issue= |pages=10 |date=April 2006 |pmid=16722529 |pmc=1475837 |doi=10.1186/1750-1172-1-10 |url=}}</ref><ref name="pmid26185478">{{cite journal |vauthors=Solh T, Botsford A, Solh M |title=Glanzmann's thrombasthenia: pathogenesis, diagnosis, and current and emerging treatment options |journal=J Blood Med |volume=6 |issue= |pages=219–27 |date=2015 |pmid=26185478 |pmc=4501245 |doi=10.2147/JBM.S71319 |url=}}</ref>


=== Platelet aggregation assays ===
=== Platelet aggregation assays ===
Platelet aggregation [[assays]] which is panel of [[assays]] measuring platelet aggregation and activation in vitro. using like [[ADP]], [[arachidonic acid]], [[collagen]], [[epinephrine]], [[thrombin]], and [[ristocetin]]. <ref name="pmid19775303">{{cite journal |vauthors=Quiroga T, Goycoolea M, Matus V, Zúñiga P, Martínez C, Garrido M, Aranda E, Leighton F, Panes O, Pereira J, Mezzano D |title=Diagnosis of mild platelet function disorders. Reliability and usefulness of light transmission platelet aggregation and serotonin secretion assays |journal=Br. J. Haematol. |volume=147 |issue=5 |pages=729–36 |date=December 2009 |pmid=19775303 |doi=10.1111/j.1365-2141.2009.07890.x |url=}}</ref><ref name="pmid18663056">{{cite journal |vauthors=Jennings I, Woods TA, Kitchen S, Walker ID |title=Platelet function testing: practice among UK National External Quality Assessment Scheme for Blood Coagulation participants, 2006 |journal=J. Clin. Pathol. |volume=61 |issue=8 |pages=950–4 |date=August 2008 |pmid=18663056 |doi=10.1136/jcp.2008.057174 |url=}}</ref>
[[Platelet aggregation]] [[assays]] which is panel of [[assays]] measuring [[platelet aggregation]] and activation in vitro using like [[ADP]], [[arachidonic acid]], [[collagen]], [[epinephrine]], [[thrombin]], and [[ristocetin]] <ref name="pmid19775303">{{cite journal |vauthors=Quiroga T, Goycoolea M, Matus V, Zúñiga P, Martínez C, Garrido M, Aranda E, Leighton F, Panes O, Pereira J, Mezzano D |title=Diagnosis of mild platelet function disorders. Reliability and usefulness of light transmission platelet aggregation and serotonin secretion assays |journal=Br. J. Haematol. |volume=147 |issue=5 |pages=729–36 |date=December 2009 |pmid=19775303 |doi=10.1111/j.1365-2141.2009.07890.x |url=}}</ref><ref name="pmid18663056">{{cite journal |vauthors=Jennings I, Woods TA, Kitchen S, Walker ID |title=Platelet function testing: practice among UK National External Quality Assessment Scheme for Blood Coagulation participants, 2006 |journal=J. Clin. Pathol. |volume=61 |issue=8 |pages=950–4 |date=August 2008 |pmid=18663056 |doi=10.1136/jcp.2008.057174 |url=}}</ref>
=== '''Automated platelet function screening tests''' ===
=== '''Automated platelet function screening tests''' ===
There are several newer technologies in current clinical use measuring various aspects of platelet function.<ref name="pmid10588464">{{cite journal |vauthors=Cattaneo M, Lecchi A, Agati B, Lombardi R, Zighetti ML |title=Evaluation of platelet function with the PFA-100 system in patients with congenital defects of platelet secretion |journal=Thromb. Res. |volume=96 |issue=3 |pages=213–7 |date=November 1999 |pmid=10588464 |doi= |url=}}</ref><ref name="pmid9579642">{{cite journal |vauthors=Mammen EF, Comp PC, Gosselin R, Greenberg C, Hoots WK, Kessler CM, Larkin EC, Liles D, Nugent DJ |title=PFA-100 system: a new method for assessment of platelet dysfunction |journal=Semin. Thromb. Hemost. |volume=24 |issue=2 |pages=195–202 |date=1998 |pmid=9579642 |doi=10.1055/s-2007-995840 |url=}}</ref><ref name="pmid11528368">{{cite journal |vauthors=Jilma B |title=Platelet function analyzer (PFA-100): a tool to quantify congenital or acquired platelet dysfunction |journal=J. Lab. Clin. Med. |volume=138 |issue=3 |pages=152–63 |date=September 2001 |pmid=11528368 |doi=10.1067/mlc.2001.117406 |url=}}</ref><ref name="pmid11260277">{{cite journal |vauthors=Favaloro EJ |title=Utility of the PFA-100 for assessing bleeding disorders and monitoring therapy: a review of analytical variables, benefits and limitations |journal=Haemophilia |volume=7 |issue=2 |pages=170–9 |date=March 2001 |pmid=11260277 |doi= |url=}}</ref><ref name="pmid11122132">{{cite journal |vauthors=Harrison P |title=Progress in the assessment of platelet function |journal=Br. J. Haematol. |volume=111 |issue=3 |pages=733–44 |date=December 2000 |pmid=11122132 |doi= |url=}}</ref>
There are several newer technologies in current clinical use measuring various aspects of [[platelet]] function <ref name="pmid10588464">{{cite journal |vauthors=Cattaneo M, Lecchi A, Agati B, Lombardi R, Zighetti ML |title=Evaluation of platelet function with the PFA-100 system in patients with congenital defects of platelet secretion |journal=Thromb. Res. |volume=96 |issue=3 |pages=213–7 |date=November 1999 |pmid=10588464 |doi= |url=}}</ref><ref name="pmid9579642">{{cite journal |vauthors=Mammen EF, Comp PC, Gosselin R, Greenberg C, Hoots WK, Kessler CM, Larkin EC, Liles D, Nugent DJ |title=PFA-100 system: a new method for assessment of platelet dysfunction |journal=Semin. Thromb. Hemost. |volume=24 |issue=2 |pages=195–202 |date=1998 |pmid=9579642 |doi=10.1055/s-2007-995840 |url=}}</ref><ref name="pmid11528368">{{cite journal |vauthors=Jilma B |title=Platelet function analyzer (PFA-100): a tool to quantify congenital or acquired platelet dysfunction |journal=J. Lab. Clin. Med. |volume=138 |issue=3 |pages=152–63 |date=September 2001 |pmid=11528368 |doi=10.1067/mlc.2001.117406 |url=}}</ref><ref name="pmid11260277">{{cite journal |vauthors=Favaloro EJ |title=Utility of the PFA-100 for assessing bleeding disorders and monitoring therapy: a review of analytical variables, benefits and limitations |journal=Haemophilia |volume=7 |issue=2 |pages=170–9 |date=March 2001 |pmid=11260277 |doi= |url=}}</ref><ref name="pmid11122132">{{cite journal |vauthors=Harrison P |title=Progress in the assessment of platelet function |journal=Br. J. Haematol. |volume=111 |issue=3 |pages=733–44 |date=December 2000 |pmid=11122132 |doi= |url=}}</ref>


=== '''Platelet Function Analyzer (PFA-100)''' ===
=== '''Platelet Function Analyzer (PFA-100)''' ===
The most widely tested is the PFA-100 device. It is used to distinguish between an aspirin-induced defect and more severe platelet dysfunction <ref name="pmid10588464">{{cite journal |vauthors=Cattaneo M, Lecchi A, Agati B, Lombardi R, Zighetti ML |title=Evaluation of platelet function with the PFA-100 system in patients with congenital defects of platelet secretion |journal=Thromb. Res. |volume=96 |issue=3 |pages=213–7 |date=November 1999 |pmid=10588464 |doi= |url=}}</ref><ref name="pmid9579642">{{cite journal |vauthors=Mammen EF, Comp PC, Gosselin R, Greenberg C, Hoots WK, Kessler CM, Larkin EC, Liles D, Nugent DJ |title=PFA-100 system: a new method for assessment of platelet dysfunction |journal=Semin. Thromb. Hemost. |volume=24 |issue=2 |pages=195–202 |date=1998 |pmid=9579642 |doi=10.1055/s-2007-995840 |url=}}</ref><ref name="pmid11528368">{{cite journal |vauthors=Jilma B |title=Platelet function analyzer (PFA-100): a tool to quantify congenital or acquired platelet dysfunction |journal=J. Lab. Clin. Med. |volume=138 |issue=3 |pages=152–63 |date=September 2001 |pmid=11528368 |doi=10.1067/mlc.2001.117406 |url=}}</ref><ref name="pmid11260277">{{cite journal |vauthors=Favaloro EJ |title=Utility of the PFA-100 for assessing bleeding disorders and monitoring therapy: a review of analytical variables, benefits and limitations |journal=Haemophilia |volume=7 |issue=2 |pages=170–9 |date=March 2001 |pmid=11260277 |doi= |url=}}</ref><ref name="pmid11122132">{{cite journal |vauthors=Harrison P |title=Progress in the assessment of platelet function |journal=Br. J. Haematol. |volume=111 |issue=3 |pages=733–44 <nowiki><ref name="pmid19422455"></nowiki>{{cite journal |vauthors=Cattaneo M, Hayward CP, Moffat KA, Pugliano MT, Liu Y, Michelson AD |title=Results of a worldwide survey on the assessment of platelet function by light transmission aggregometry: a report from the platelet physiology subcommittee of the SSC of the ISTH |journal=J. Thromb. Haemost. |volume=7 |issue=6 |pages=1029 |date=June 2009 |pmid=19422455 |doi=10.1111/j.1538-7836.2009.03458.x |url=}}</ref><ref name="pmid19143930">{{cite journal |vauthors=Hayward CP, Pai M, Liu Y, Moffat KA, Seecharan J, Webert KE, Cook RJ, Heddle NM |title=Diagnostic utility of light transmission platelet aggregometry: results from a prospective study of individuals referred for bleeding disorder assessments |journal=J. Thromb. Haemost. |volume=7 |issue=4 |pages=676–84 |date=April 2009 |pmid=19143930 |doi=10.1111/j.1538-7836.2009.03273.x |url=}}</ref><ref name="pmid13871375">{{cite journal |vauthors=BORN GV |title=Aggregation of blood platelets by adenosine diphosphate and its reversal |journal=Nature |volume=194 |issue= |pages=927–9 |date=June 1962 |pmid=13871375 |doi= |url=}}</ref>. Platelets aggregation failure in LTA with all agonists except ristocetin is diagnostic of Glanzmann's thrombasthenia.  Laboratory findings consistent with the diagnosis of Glanzmann's thrombasthenia include prolonged bleeding time (BT) and failure of platelets plugging to the collagen-based filter in the PFA-100 test.  The diagnosis of Glanzmann thrombasthenia is confirmed through monoclonal antibody testing and Flow cytometry.  The coagulation tests and platelet count are usually normal among patients with Glanzmann's thrombasthenia.  The platelet morphology on peripheral blood smears is normal in patients with Glanzmann's thrombasthenia. <ref name="pmid26185478">{{cite journal| author=Solh T, Botsford A, Solh M| title=Glanzmann's thrombasthenia: pathogenesis, diagnosis, and current and emerging treatment options. | journal=J Blood Med | year= 2015 | volume= 6 | issue=  | pages= 219-27 | pmid=26185478 | doi=10.2147/JBM.S71319 | pmc=4501245 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26185478  }}</ref> <ref name="pmid16722529">{{cite journal| author=Nurden AT| title=Glanzmann thrombasthenia. | journal=Orphanet J Rare Dis | year= 2006 | volume= 1 | issue=  | pages= 10 | pmid=16722529 | doi=10.1186/1750-1172-1-10 | pmc=1475837 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16722529  }}</ref>
The most widely tested is the [[PFA-100]] device. It is used to distinguish between an [[aspirin]]-induced defect and more severe [[platelet]] dysfunction <ref name="pmid10588464">{{cite journal |vauthors=Cattaneo M, Lecchi A, Agati B, Lombardi R, Zighetti ML |title=Evaluation of platelet function with the PFA-100 system in patients with congenital defects of platelet secretion |journal=Thromb. Res. |volume=96 |issue=3 |pages=213–7 |date=November 1999 |pmid=10588464 |doi= |url=}}</ref><ref name="pmid9579642">{{cite journal |vauthors=Mammen EF, Comp PC, Gosselin R, Greenberg C, Hoots WK, Kessler CM, Larkin EC, Liles D, Nugent DJ |title=PFA-100 system: a new method for assessment of platelet dysfunction |journal=Semin. Thromb. Hemost. |volume=24 |issue=2 |pages=195–202 |date=1998 |pmid=9579642 |doi=10.1055/s-2007-995840 |url=}}</ref><ref name="pmid11528368">{{cite journal |vauthors=Jilma B |title=Platelet function analyzer (PFA-100): a tool to quantify congenital or acquired platelet dysfunction |journal=J. Lab. Clin. Med. |volume=138 |issue=3 |pages=152–63 |date=September 2001 |pmid=11528368 |doi=10.1067/mlc.2001.117406 |url=}}</ref><ref name="pmid11260277">{{cite journal |vauthors=Favaloro EJ |title=Utility of the PFA-100 for assessing bleeding disorders and monitoring therapy: a review of analytical variables, benefits and limitations |journal=Haemophilia |volume=7 |issue=2 |pages=170–9 |date=March 2001 |pmid=11260277 |doi= |url=}}</ref><ref name="pmid11122132"><nowiki>{{cite journal |vauthors=Harrison P |title=Progress in the assessment of platelet function |journal=Br. J. Haematol. |volume=111 |issue=3 |pages=733–44 </nowiki><nowiki><ref name="pmid19422455"></nowiki>{{cite journal |vauthors=Cattaneo M, Hayward CP, Moffat KA, Pugliano MT, Liu Y, Michelson AD |title=Results of a worldwide survey on the assessment of platelet function by light transmission aggregometry: a report from the platelet physiology subcommittee of the SSC of the ISTH |journal=J. Thromb. Haemost. |volume=7 |issue=6 |pages=1029 |date=June 2009 |pmid=19422455 |doi=10.1111/j.1538-7836.2009.03458.x |url=}}</ref><ref name="pmid19143930">{{cite journal |vauthors=Hayward CP, Pai M, Liu Y, Moffat KA, Seecharan J, Webert KE, Cook RJ, Heddle NM |title=Diagnostic utility of light transmission platelet aggregometry: results from a prospective study of individuals referred for bleeding disorder assessments |journal=J. Thromb. Haemost. |volume=7 |issue=4 |pages=676–84 |date=April 2009 |pmid=19143930 |doi=10.1111/j.1538-7836.2009.03273.x |url=}}</ref><ref name="pmid13871375">{{cite journal |vauthors=BORN GV |title=Aggregation of blood platelets by adenosine diphosphate and its reversal |journal=Nature |volume=194 |issue= |pages=927–9 |date=June 1962 |pmid=13871375 |doi= |url=}}</ref>. [[Platelet aggregation]] failure in LTA with all [[agonists]] except [[ristocetin]] is diagnostic of [[Glanzmann's thrombasthenia]].  Laboratory findings consistent with the diagnosis of [[Glanzmann's thrombasthenia]] include prolonged [[bleeding time]] (BT) and failure of [[platelets]] plugging to the collagen-based filter in the [[PFA-100]] test.   


'''Other devices''' — The Ultegra is an automated whole blood assay that can be used at the bedside [21]. It measures platelet aggregation based on the binding of activated platelets to fibrinogen. It is marketed to specifically measure the effects of the integrin α<sub>IIb</sub>β<sub>3</sub> antagonists abciximab, tirofiban, and eptifibatide. It is insensitive to aspirin, clopidogrel, and ticlopidine and is not useful in screening for VWD.'''Bleeding time''' — A screening test for platelet function [7,22]
The diagnosis of [[Glanzmann's thrombasthenia|Glanzmann thrombasthenia]] is confirmed through monoclonal antibody testing and [[flow cytometry]]. The [[coagulation]] tests and [[platelet count]] are usually normal among [[patients]] with [[Glanzmann's thrombasthenia]]. The [[platelet]] morphology on [[peripheral blood smear]] is normal in patients with [[Glanzmann's thrombasthenia]] <ref name="pmid26185478">{{cite journal| author=Solh T, Botsford A, Solh M| title=Glanzmann's thrombasthenia: pathogenesis, diagnosis, and current and emerging treatment options. | journal=J Blood Med | year= 2015 | volume= 6 | issue=  | pages= 219-27 | pmid=26185478 | doi=10.2147/JBM.S71319 | pmc=4501245 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26185478  }}</ref> <ref name="pmid16722529">{{cite journal| author=Nurden AT| title=Glanzmann thrombasthenia. | journal=Orphanet J Rare Dis | year= 2006 | volume= 1 | issue=  | pages= 10 | pmid=16722529 | doi=10.1186/1750-1172-1-10 | pmc=1475837 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16722529  }}</ref>




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[[Category:Disease]]
[[Category:Disease]]
[[Category:Hematology]]
[[Category:Hematology]]
[[Category:Primary care]]

Latest revision as of 21:52, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2]

Overview

Initial evaluation of a patient for a suspected functional platelet disorder should include a complete blood count and examination of the peripheral blood smear. The red blood cell count is usually normal. Some patients with Glanzmann's thrombasthenia may have reduced count of red blood cell, because of coexisting iron deficiency or bleeding. The platelet count in Glanzmann's thrombasthenia is mostly on the lower end of normal. The activated partial thromboplastin time (PTT) and prothrombin time (PT) are in this disease commonly normal. Platelet aggregation assays which is panel of assays measuring platelet aggregation and activation in vitro using like ADP, arachidonic acid, collagen, epinephrine, thrombin, and ristocetin. There are several newer technologies in current clinical use measuring various aspects of platelet function. The most widely tested is the PFA-100 device. It is used to distinguish between an aspirin-induced defect and more severe platelet dysfunction. Platelet aggregation failure in LTA with all agonists except ristocetin is diagnostic of Glanzmann's thrombasthenia. Laboratory findings consistent with the diagnosis of Glanzmann's thrombasthenia include prolonged bleeding time (BT) and failure of platelets plugging to the collagen-based filter in the PFA-100 test.

Laboratory Findings

CBC and peripheral smear examination

Initial evaluation of a patient for a suspected functional platelet disorder should include a complete blood count and examination of the peripheral blood smear. The red blood cell count is usually normal. Some patients with Glanzmann's thrombasthenia may have reduced count of red blood cell, because of coexisting iron deficiency or bleeding. The platelet count in Glanzmann's thrombasthenia is mostly on the lower end of normal.[1][2]

Thromboplastin (PTT) and Prothrombin time (PT)

The activated partial thromboplastin time (PTT) and prothrombin time (PT) are in this disease commonly normal.[3][4]

Platelet aggregation assays

Platelet aggregation assays which is panel of assays measuring platelet aggregation and activation in vitro using like ADP, arachidonic acid, collagen, epinephrine, thrombin, and ristocetin [5][6]

Automated platelet function screening tests

There are several newer technologies in current clinical use measuring various aspects of platelet function [7][8][9][10][11]

Platelet Function Analyzer (PFA-100)

The most widely tested is the PFA-100 device. It is used to distinguish between an aspirin-induced defect and more severe platelet dysfunction [7][8][9][10][11][12][13]. Platelet aggregation failure in LTA with all agonists except ristocetin is diagnostic of Glanzmann's thrombasthenia. Laboratory findings consistent with the diagnosis of Glanzmann's thrombasthenia include prolonged bleeding time (BT) and failure of platelets plugging to the collagen-based filter in the PFA-100 test.

The diagnosis of Glanzmann thrombasthenia is confirmed through monoclonal antibody testing and flow cytometry. The coagulation tests and platelet count are usually normal among patients with Glanzmann's thrombasthenia. The platelet morphology on peripheral blood smear is normal in patients with Glanzmann's thrombasthenia [4] [3]


References

  1. ↑ Gunay-Aygun M, Zivony-Elboum Y, Gumruk F, Geiger D, Cetin M, Khayat M, Kleta R, Kfir N, Anikster Y, Chezar J, Arcos-Burgos M, Shalata A, Stanescu H, Manaster J, Arat M, Edwards H, Freiberg AS, Hart PS, Riney LC, Patzel K, Tanpaiboon P, Markello T, Huizing M, Maric I, Horne M, Kehrel BE, Jurk K, Hansen NF, Cherukuri PF, Jones M, Cruz P, Mullikin JC, Nurden A, White JG, Gahl WA, Falik-Zaccai T (December 2010). "Gray platelet syndrome: natural history of a large patient cohort and locus assignment to chromosome 3p". Blood. 116 (23): 4990–5001. doi:10.1182/blood-2010-05-286534. PMC 3012593. PMID 20709904.
  2. ↑ Drouin A, Favier R, Massé JM, Debili N, Schmitt A, Elbim C, Guichard J, Adam M, Gougerot-Pocidalo MA, Cramer EM (September 2001). "Newly recognized cellular abnormalities in the gray platelet syndrome". Blood. 98 (5): 1382–91. PMID 11520786.
  3. ↑ 3.0 3.1 Nurden AT (April 2006). "Glanzmann thrombasthenia". Orphanet J Rare Dis. 1: 10. doi:10.1186/1750-1172-1-10. PMC 1475837. PMID 16722529.
  4. ↑ 4.0 4.1 Solh T, Botsford A, Solh M (2015). "Glanzmann's thrombasthenia: pathogenesis, diagnosis, and current and emerging treatment options". J Blood Med. 6: 219–27. doi:10.2147/JBM.S71319. PMC 4501245. PMID 26185478.
  5. ↑ Quiroga T, Goycoolea M, Matus V, Zúñiga P, Martínez C, Garrido M, Aranda E, Leighton F, Panes O, Pereira J, Mezzano D (December 2009). "Diagnosis of mild platelet function disorders. Reliability and usefulness of light transmission platelet aggregation and serotonin secretion assays". Br. J. Haematol. 147 (5): 729–36. doi:10.1111/j.1365-2141.2009.07890.x. PMID 19775303.
  6. ↑ Jennings I, Woods TA, Kitchen S, Walker ID (August 2008). "Platelet function testing: practice among UK National External Quality Assessment Scheme for Blood Coagulation participants, 2006". J. Clin. Pathol. 61 (8): 950–4. doi:10.1136/jcp.2008.057174. PMID 18663056.
  7. ↑ 7.0 7.1 Cattaneo M, Lecchi A, Agati B, Lombardi R, Zighetti ML (November 1999). "Evaluation of platelet function with the PFA-100 system in patients with congenital defects of platelet secretion". Thromb. Res. 96 (3): 213–7. PMID 10588464.
  8. ↑ 8.0 8.1 Mammen EF, Comp PC, Gosselin R, Greenberg C, Hoots WK, Kessler CM, Larkin EC, Liles D, Nugent DJ (1998). "PFA-100 system: a new method for assessment of platelet dysfunction". Semin. Thromb. Hemost. 24 (2): 195–202. doi:10.1055/s-2007-995840. PMID 9579642.
  9. ↑ 9.0 9.1 Jilma B (September 2001). "Platelet function analyzer (PFA-100): a tool to quantify congenital or acquired platelet dysfunction". J. Lab. Clin. Med. 138 (3): 152–63. doi:10.1067/mlc.2001.117406. PMID 11528368.
  10. ↑ 10.0 10.1 Favaloro EJ (March 2001). "Utility of the PFA-100 for assessing bleeding disorders and monitoring therapy: a review of analytical variables, benefits and limitations". Haemophilia. 7 (2): 170–9. PMID 11260277.
  11. ↑ 11.0 11.1 Harrison P (December 2000). "Progress in the assessment of platelet function". Br. J. Haematol. 111 (3): 733–44. PMID 11122132.
  12. ↑ Hayward CP, Pai M, Liu Y, Moffat KA, Seecharan J, Webert KE, Cook RJ, Heddle NM (April 2009). "Diagnostic utility of light transmission platelet aggregometry: results from a prospective study of individuals referred for bleeding disorder assessments". J. Thromb. Haemost. 7 (4): 676–84. doi:10.1111/j.1538-7836.2009.03273.x. PMID 19143930.
  13. ↑ BORN GV (June 1962). "Aggregation of blood platelets by adenosine diphosphate and its reversal". Nature. 194: 927–9. PMID 13871375.
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