Thrombasthenia D69.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 21.06.2022

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Synonym(s)

familial hemorrhagic thrombasthenia; Glanzmann-Naegeli Syndrome; Glanzmann thrombasthenia; hereditary thrombasthenia; Hereditary thrombasthenia; thrombasthenia; Thrombasthenia familial hemorrhagic

History
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Glanzmann, 1918; Naegeli, 1931

Definition
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Hereditary disease with disturbed platelet aggregation at normal platelet count.

Etiopathogenesis
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Autosomal recessive mutations of the integrin alpha-2b gene (ITGA2B gene; gene locus: 17q21.32) and the integrin beta-3 gene (ITGB3 gene; gene locus: 17q21.32) with consecutive deficiency of platelet membrane glycoproteins IIb and IIIa and severe coagulation disorders.

Manifestation
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Occurring already in early childhood.

Clinical features
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Bleeding and haemorrhaging in various organs is a regular occurrence. Hemorrhages of the skin and mucous membranes, petechiae, sometimes extensive purpura, bleeding from the mouth or nasopharynx, bleeding from the nose and/or gums, melaena or hematuria are particularly common. S.a.u. purpura, idiopathic thrombocytopenic.

Laboratory
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Normal platelet count as well as prolonged bleeding time and pathological platelet aggregation. Clotting time is normal. Decreased to suspended retraction.

Differential diagnosis
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thrombocytopathies as well as diseases with a lack of coagulation factors, e.g. Willebrand v. Jürgens disease; immunodeficiency diseases, e.g. Wiskott-Aldrich syndrome.

Complication(s)
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Iron deficiency anemiamay occur due to chronic blood loss. In case of menorrhagia, estrogen-containing anticonceptives are required. In case of bleeding, rapid hemostasis must be initiated. If necessary, prophylactic, platelet count-adapted applications (e.g. before operations) of platelet concentrates are required.

Therapy
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Treatment by haematologists. Careful hemostasis in case of injury or surgery, if necessary platelet concentrates. Supportive therapy. Since the risk of bleeding cannot be foreseen, prophylactic measures are not indicated. Hepatitis vaccination.

Literature
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  1. Breddin HK (1985) Congenital thrombocytopathies. Haemostaseology 5: 17-31
  2. Caglar K et al (2003) Use of recombinant factor VIIa for bleeding in children with Glanzmann thrombasthenia. Pediatric Hematol Oncol 20: 435-438
  3. Glanzmann E (1918) Hereditary hamorrhagic thrombasthenia:
  4. A contribution to platelet pathology. J Childrenkr 88: 113-141
  5. Kannan M et al (2003) Type I Glanzmann thrombasthenia: most common subtypes in North Indians. At J Hematol 74: 139-141
  6. Naegeli D (1931) Blood diseases and blood diagnostics. SpringerVerlag, Berlin, Volume 1
  7. Nair S et al (2002) Glanzmann's thrombasthenia: updated. Platelets 13: 387-393
  8. Scharf RE (2003) Congenital and acquired platelet function disorders. Hamostaseology 23: 170-180

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Last updated on: 21.06.2022