A novel approach using ancillary tests to guide treatment of Glanzmann thrombasthenia patients undergoing surgical procedures.
BACKGROUND
Glanzmann thrombasthenia (GT) is a disorder of platelet function. Standard therapy includes platelet transfusions, which may be hampered by antiplatelet antibodies.


AIMS
To assess potential correlation between bleeding and number of active platelets in GT patients undergoing surgery. Clinical peri- operative patients' hemostasis was compared with flow cytometry analysis (FC), and whole blood clot formation.


METHODS
GT patients undergoing surgery were included. Blood counts, platelet activation studies, FC and rotational thromboelastography (ROTEM) were performed as ancillary tests to estimate the effectiveness of treatment.


RESULTS
A total of 4 GT patients undergoing 5 surgeries were included. Consecutive FC analysis following platelet transfusions showed gradual decrease of donor platelets with a nadir of 3280 platelets in patients who experienced no post procedural bleeding following minor procedures. After major surgery, bleeding occurred when donor platelets decreased to 2600-4280. Decline in donor platelets was associated with reduced clot firmness as noted by ROTEM.


CONCLUSION
Results suggest that very low number of active donor platelets may suffice to achieve proper hemostasis in certain procedures. Our study points to the potential role of consecutive FC examinations to demonstrate the number of donor platelets as an ancillary tool for decision making in GT patients undergoing surgery.
['Barg|Assaf Arie|AA|', 'Hauschner|Hagit|H|', 'Misgav|Mudi|M|', 'Lubetsky|Aaron|A|', 'Levy-Mendelowitz|Sarina|S|', 'Livnat|Tami|T|', 'Avishai|Einat|E|', 'Rosenberg|Nurit|N|', 'Kenet|Gili|G|']
D001782:Blood Donors D003657:Decision Making D005260:Female D005434:Flow Cytometry D006487:Hemostasis D006801:Humans D008297:Male D019990:Perioperative Care D010976:Platelet Count D017713:Platelet Transfusion D013915:Thrombasthenia
Glanzmann thrombasthenia Platelet transfusion Surgery Flow cytometry