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{{Glanzmann's thrombasthenia}}
{{Glanzmann's thrombasthenia}}


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{{CMG}} {{AE}} {{OK}}, [[User:Niush.D|Niyousha Danesh, MD-MPH]]


==Overview==
==Overview==
Glycoprotein (GP)IIb-IIIa(aIIb,P3) is a Ca2+- G dependent heterodimer complex that belongs to the integrin family receptors involved in cell-cell and cell matrix adhesion. Normal platelets contain approximately 50,000 molecules of GPIIb-IIIa, which comprise 1% to 2% of the total platelet protein.<ref name="pmid1455408">{{cite journal| author=Kato A, Yamamoto K, Aoki N| title=Classification of Glanzmann's thrombasthenia based on the intracellular transport pathway of GPIIb-IIIa. | journal=Thromb Haemost | year= 1992 | volume= 68 | issue= 5 | pages= 615-6 | pmid=1455408 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1455408  }}</ref> The two genes, encoding for GPIIb (ITGA2B) and GPIIIa (ITGB3) are closely associated at chromosome 17q21.<ref name="pmid24829739">{{cite journal| author=Manne RK, Natarajan K, Patil R, Prathi VS, Beeraka SS, Kolaparthi VS| title=Glanzmann thrombasthenia associated with human immunodeficiency virus-positive patient. | journal=Int J Prev Med | year= 2014 | volume= 5 | issue= 4 | pages= 500-4 | pmid=24829739 | doi= | pmc=4018600 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24829739  }}</ref>
[[Glanzmann's thrombasthenia]] is mainly divided into hereditary GT, variant GT, and acquired GT. [[Glanzmann's thrombasthenia|Glanzmann thrombasthenia]] (GT) is an [[autosomal recessive]] inherited qualitative [[platelet disorder]] characterized by absence or reduction of [[platelet]] [[glycoprotein]] [[Glycoprotein IIb/IIIa|GPIIb]] or GPIIIa or [[CD61]]. [[Hereditary]] [[Glanzmann's thrombasthenia|Glanzmann thrombasthenia]] is classified into three types  The subtypes vary based on ethnicity. For example, Type I is more common in Arabs and Iraqi-Jews living in Israel, whilst type II is relatively frequent in the Japanese population. Variant type includes patients with [[Platelet|platelets]] expression of αIIbβ3 more than 20% in which mainly the [[platelets]] are able to aggregate but they present the clinical [[phenotype]] of GT. The reason being that the stimulated [[platelets]] can not bind to soluble Fg or [[antibodies]] recognizing activation-dependent determinants on [[αIIbβ3]]. It is due to a single amino acid substitution. Acquired GT is defined by [[inhibition]] of [[platelet]] αIIbβ3 actual function due to the attack of [[autoantibodies]]. These [[antibodies]] can be produced in numerous disorders such as [[hematologic]] [[malignancy]], [[transfusion]], [[drugs]] and [[autoimmune diseases]][[autoimmune diseases.|.]]


==Classification ==
==Classification ==
Inherent GT
[[Glanzmann's thrombasthenia]] is mainly divided into the following types:<ref name="pmid14508803">{{cite journal| author=Kannan M, Ahmed RP, Jain P, Kumar R, Choudhry VP, Saxena R| title=Type I Glanzmann thrombasthenia: most common subtypes in North Indians. | journal=Am J Hematol | year= 2003 | volume= 74 | issue= 2 | pages= 139-41 | pmid=14508803 | doi=10.1002/ajh.10395 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14508803  }}</ref><ref name="pmid23929305">{{cite journal| author=Nurden AT, Pillois X, Wilcox DA| title=Glanzmann thrombasthenia: state of the art and future directions. | journal=Semin Thromb Hemost | year= 2013 | volume= 39 | issue= 6 | pages= 642-55 | pmid=23929305 | doi=10.1055/s-0033-1353393 | pmc=4011384 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23929305  }}</ref><ref name="pmid1990;75:1383–952">{{cite journal| author=Arimura H| title=Correlation between molecular size and interferon- inducing activity of poly I:C. | journal=Acta Virol | year= 1975 | volume= 19 | issue= 6 | pages= 457-66 | pmid=1990;75:1383–95 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1990  }}</ref>


Glanzmann thrombasthenia (GT) is an autosomal recessive inherited qualitative platelet disorder characterized by absence or reduction of platelet glycoprotein GPIIb or GPIIIa. On the basic of levels of GPIIb/ IIIa as detected by CD61, GT has been subclassified into three groups based on the platelet fibrinogen content and clot retraction into types I, II, and III. Patients with less than 5% of normal GPIIb/IIIa are classified as type I and patients with 5% to 20% normal GPIIb/IIIa are type II. Type III variants usually have dysfunctional receptors with near-normal GPIIb/ IIIa levels.<ref name="pmid1990;75:1383–95">{{cite journal| author=Arimura H| title=Correlation between molecular size and interferon- inducing activity of poly I:C. | journal=Acta Virol | year= 1975 | volume= 19 | issue= 6 | pages= 457-66 | pmid=1990;75:1383–95 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1990  }}</ref> Variability exists in the subtypes found in various ethnic groups. Type I GT is relatively frequent in Iraqi-Jews and Arabs residing in Israel, whereas type II GT is more often found in the Japanese population.<ref name="pmid14508803">{{cite journal| author=Kannan M, Ahmed RP, Jain P, Kumar R, Choudhry VP, Saxena R| title=Type I Glanzmann thrombasthenia: most common subtypes in North Indians. | journal=Am J Hematol | year= 2003 | volume= 74 | issue= 2 | pages= 139-41 | pmid=14508803 | doi=10.1002/ajh.10395 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14508803  }}</ref>
===Hereditary GT===


Variant GTs are defined as patients with the clinical phenotype of GT but whose platelets express αIIbβ3 (>20%) in amounts that would normally support platelet aggregation. variants are characterized by the inability of stimulated platelets to bind soluble Fg or antibodies recognizing activation-dependent determinants on αIIbβ3. They are mostly given by single amino acid substitutions with the nature and position of the affected residue defining the residual functional response. As for the alloantigen systems carried by αIIbβ3, most variant forms concern ''ITGB3''.
[[Glanzmann's thrombasthenia|Glanzmann thrombasthenia]] (GT) is an [[autosomal recessive]] inherited qualitative [[platelet disorder]] characterized by absence or reduction of [[platelet]] [[glycoprotein]] [[Glycoprotein IIb/IIIa|GPIIb]] or GPIIIa or [[CD61]]. Glanzmann thrombasthenia is classified into three types 
* Patients with less than 5% of normal [[Glycoprotein IIb/IIIa|GPIIb/IIIa]] are classified as type I
* Type II variants have 5% to 20% normal [[Glycoprotein IIb/IIIa|GPIIb/IIIa]]
* ype III possess near-normal GPIIb/ IIIa levels but dysfunctional receptors
The subtypes vary based on ethnicity. For example, Type I is more common in Arabs and Iraqi-Jews living in Israel, whilst type II is relatively frequent in the Japanese population.<ref name="pmid14508803">{{cite journal| author=Kannan M, Ahmed RP, Jain P, Kumar R, Choudhry VP, Saxena R| title=Type I Glanzmann thrombasthenia: most common subtypes in North Indians. | journal=Am J Hematol | year= 2003 | volume= 74 | issue= 2 | pages= 139-41 | pmid=14508803 | doi=10.1002/ajh.10395 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14508803  }}</ref>


== Acquired GT ==
=== Variant GT ===
Acquired GT is commonly the result of an autoantibody attack on platelet αIIbβ3, or iso antibodies inhibiting proper function. The production of autoantibodies has been associated with platelet transfusions, as well as numerous hematologic conditions, including immune thrombocytopenic purpura, non-Hodgkin’s lymphoma, multiple myeloma, myelodysplastic syndrome, hairy cell leukemia, and acute lymphoblastic leukemia. In a case report done by Blickstein et al, a patient with systemic lupus erythematosus presented in adulthood with degrees of mucocutaneous bleeding secondary to antibody production against GPIIb/IIIa.5 Also, some anti-thrombotic therapies use αIIbβ3 antagonists, such as abciximab, eptifibatide, and tirofiban, for treatment of acute coronary events, which can trigger a transient GT-like state.<ref name="pmid1990;75:1383–952">{{cite journal| author=Arimura H| title=Correlation between molecular size and interferon- inducing activity of poly I:C. | journal=Acta Virol | year= 1975 | volume= 19 | issue= 6 | pages= 457-66 | pmid=1990;75:1383–95 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1990  }}</ref>
This subset includes patients with [[Platelet|platelets]] expression of αIIbβ3 more than 20% in which mainly the [[platelets]] are able to aggregate but they present the clinical [[phenotype]] of GT. The reason being that the stimulated [[platelets]] can not bind to soluble Fg or [[antibodies]] recognizing activation-dependent determinants on [[αIIbβ3]]. It is due to a single amino acid substitution. <ref name="pmid23929305">{{cite journal| author=Nurden AT, Pillois X, Wilcox DA| title=Glanzmann thrombasthenia: state of the art and future directions. | journal=Semin Thromb Hemost | year= 2013 | volume= 39 | issue= 6 | pages= 642-55 | pmid=23929305 | doi=10.1055/s-0033-1353393 | pmc=4011384 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23929305  }}</ref>
 
=== Acquired GT ===
Acquired GT is defined by inhibition of [[platelet]] αIIbβ3 actual function due to the attack of [[autoantibodies]]. These [[antibodies]] can be produced in numerous disorders such as [[hematologic]] [[malignancy]], [[transfusion]], [[drugs]] and [[autoimmune diseases]][[autoimmune diseases.|.]]<ref name="pmid1990;75:1383–952">{{cite journal| author=Arimura H| title=Correlation between molecular size and interferon- inducing activity of poly I:C. | journal=Acta Virol | year= 1975 | volume= 19 | issue= 6 | pages= 457-66 | pmid=1990;75:1383–95 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1990  }}</ref>


==References==
==References==
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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], Niyousha Danesh, MD-MPH

Overview

Glanzmann's thrombasthenia is mainly divided into hereditary GT, variant GT, and acquired GT. Glanzmann thrombasthenia (GT) is an autosomal recessive inherited qualitative platelet disorder characterized by absence or reduction of platelet glycoprotein GPIIb or GPIIIa or CD61. Hereditary Glanzmann thrombasthenia is classified into three types The subtypes vary based on ethnicity. For example, Type I is more common in Arabs and Iraqi-Jews living in Israel, whilst type II is relatively frequent in the Japanese population. Variant type includes patients with platelets expression of αIIbβ3 more than 20% in which mainly the platelets are able to aggregate but they present the clinical phenotype of GT. The reason being that the stimulated platelets can not bind to soluble Fg or antibodies recognizing activation-dependent determinants on αIIbβ3. It is due to a single amino acid substitution. Acquired GT is defined by inhibition of platelet αIIbβ3 actual function due to the attack of autoantibodies. These antibodies can be produced in numerous disorders such as hematologic malignancy, transfusion, drugs and autoimmune diseases.

Classification

Glanzmann's thrombasthenia is mainly divided into the following types:[1][2][3]

Hereditary GT

Glanzmann thrombasthenia (GT) is an autosomal recessive inherited qualitative platelet disorder characterized by absence or reduction of platelet glycoprotein GPIIb or GPIIIa or CD61. Glanzmann thrombasthenia is classified into three types

  • Patients with less than 5% of normal GPIIb/IIIa are classified as type I
  • Type II variants have 5% to 20% normal GPIIb/IIIa
  • ype III possess near-normal GPIIb/ IIIa levels but dysfunctional receptors

The subtypes vary based on ethnicity. For example, Type I is more common in Arabs and Iraqi-Jews living in Israel, whilst type II is relatively frequent in the Japanese population.[1]

Variant GT

This subset includes patients with platelets expression of αIIbβ3 more than 20% in which mainly the platelets are able to aggregate but they present the clinical phenotype of GT. The reason being that the stimulated platelets can not bind to soluble Fg or antibodies recognizing activation-dependent determinants on αIIbβ3. It is due to a single amino acid substitution. [2]

Acquired GT

Acquired GT is defined by inhibition of platelet αIIbβ3 actual function due to the attack of autoantibodies. These antibodies can be produced in numerous disorders such as hematologic malignancy, transfusion, drugs and autoimmune diseases.[3]

References

  1. 1.0 1.1 Kannan M, Ahmed RP, Jain P, Kumar R, Choudhry VP, Saxena R (2003). "Type I Glanzmann thrombasthenia: most common subtypes in North Indians". Am J Hematol. 74 (2): 139–41. doi:10.1002/ajh.10395. PMID 14508803.
  2. 2.0 2.1 Nurden AT, Pillois X, Wilcox DA (2013). "Glanzmann thrombasthenia: state of the art and future directions". Semin Thromb Hemost. 39 (6): 642–55. doi:10.1055/s-0033-1353393. PMC 4011384. PMID 23929305.
  3. 3.0 3.1 Arimura H (1975). "Correlation between molecular size and interferon- inducing activity of poly I:C". Acta Virol. 19 (6): 457–66. PMID 1990;75:1383–95 Check |pmid= value (help).