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Chapter 130 Acquired Disorders of Platelet Function 1943

antibody mediated because IgG purified from the plasma or eluted eosinophilia and platelet dysfunction returned to normal after anti-
from the platelets of these patients inhibited the aggregation of helmintic therapy, which suggests a parasitic infection.
normal platelets.
Platelet antibodies may affect several aspects of platelet function.
The most frequently observed abnormality is absence of platelet SUGGESTED READINGS
aggregation in response to low concentrations of collagen and absence
of the second wave of aggregation in response to ADP or epinephrine. Ashrani AA, Tefferi A, Pruthi RK, et al: Acquired factor V deficiency in
This pattern is identical to the abnormalities caused by aspirin, myeloproliferative neoplasms: a Mayo Clinic series of 33 patients. Br J
described earlier. In ITP and SLE, the abnormal aggregation may be Haematol 171:875, 2015.
related to a reduction in the contents of dense and α-granules, or to Bartoli CR, Restle DJ, Zhang DM, et al: Pathologic von Willebrand factor
an activation defect manifested by diminished synthesis of TXA 2. degradation with a left ventricular assist device occurs via two distinct
Autoantibodies or alloantibodies usually impair the function of mechanisms: mechanical demolition and enzymatic cleavage. J Thorac
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syndrome similar to Glanzmann thrombasthenia. 276–280 These bleeding and clotting in high-risk patients. Hematology Am Soc Hematol
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It is not surprising that many of the antiplatelet antibodies target Fu R, Meng Y, Wang Y, et al: The dysfunction of platelets in paroxysmal
α IIb β 3 because this is the most abundant receptor on the platelet nocturnal hemoglobinuria. Thromb Res 148:50, 2016.
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surface and required for all aggregation responses. Antibodies that Hanley GE, Smolina K, Mintzes B, et al: Postpartum Hemorrhage and Use
target GPIb have also been described, in one case producing a syn- of Serotonin Reuptake Inhibitor Antidepressants in Pregnancy. Obstet
drome of severe refractory thrombocytopenia and a functional defect Gynecol 127:553, 2016.
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resembling that observed in Bernard-Soulier syndrome. An inter- Kaur H, Corscadden K, Lott C, et al: Bromelain has paradoxical effects on
esting aspect of antibodies against GPIb is their association with more blood coagulability: a study using thromboelastography. Blood Coagul
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against other antigens. This finding is consistent with the observa- King S, Short M, Harmon C: Glycoprotein IIb/IIIa inhibitors: the resurgence
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tions that anti-GPIb antibodies inhibit megakaryopoiesis and of tirofiban. Vascul Pharmacol 78:10, 2016.
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proplatelet formation in vitro. Autoantibodies have been described Kostos L, Burbury K, Srivastava G, et al: Gastrointestinal bleeding in a
288
that target GPIa (integrin α 2 ), 287,288 GPIV, and GPVI. 289–291 chronic myeloid leukaemia patient precipitated by dasatinib-induced
Platelet-activating antibodies have been described. Of particular platelet dysfunction: case report. Platelets 26:809, 2015.
interest is the report of a patient who presented with immune throm- Lukito P, Wong A, Jing J, et al: Mechanical circulatory support is associated
bocytopenia and an antibody against CD9 (a member of the tet- with loss of platelet receptors glycoprotein Ibalpha and glycoprotein VI.
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292
platelets. After recovery of the platelet count, the patient relapsed, Noordam R, Aarts N, Leening MJ, et al: Use of antidepressants and the
this time with an antibody described against the platelet Fc receptor, risk of myocardial infarction in middle-aged and older adults: a matched
FcγRIIA. The latter antibody blocked the capacity of the first anti- case-control study. Eur J Clin Pharmacol 72:211, 2016.
body to activate platelets, confirming that activation involved stimu- Oudemans-van Straaten HM: Hemostasis and thrombosis in continuous
lation of the Fc receptor. renal replacement treatment. Semin Thromb Hemost 41:91, 2015.
Platelets that have been activated and induced to secrete but have Reuken PA, Kussmann A, Kiehntopf M, et al: Imbalance of von Willebrand
not been incorporated into aggregates are likely to be refractory to factor and its cleaving protease ADAMTS13 during systemic inflamma-
platelet agonists and deficient in secretory granule contents, essen- tion superimposed on advanced cirrhosis. Liver Int 35:37, 2015.
tially leading to an acquired storage pool deficiency, which has also Roose SP, Rutherford BR: Selective serotonin reuptake inhibitors and
been described in association with autoantibodies. 293 operative bleeding risk: a review of the literature. J Clin Psychopharmacol
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Sajan F, Conte JV, Tamargo RJ, et al: Association of Selective Serotonin
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Vitamin C deficiency results in defective collagen synthesis and Tripodi A: Hemostasis abnormalities in cirrhosis. Curr Opin Hematol 22:406,
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platelet aggregation defects can be seen in patients with scurvy, which Tuffigo M, Lazaro E, James C, et al: Successful use of recombinant factor
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ACQUIRED PLATELET DYSFUNCTION Van Poucke S, Stevens K, Wetzels R, et al: Early platelet recovery following
cardiac surgery with cardiopulmonary bypass. Platelets 1:2016.
WITH EOSINOPHILIA Yadav DD, Nayar PS, Manchanda RV: Acquired Platelet Dysfunction with
Eosinophilia (APDE) syndrome: a case report. Indian J Hematol Blood
Acquired platelet dysfunction with eosinophilia is a self-limited dis- Transfus 32:235, 2016.
order characterized by mucocutaneous bleeding and hyper-
eosinophilia. 295,296 The platelet count is usually normal; however, the
platelets are pale by light microscopy (as in gray platelet syndrome), REFERENCES
and aggregation studies show an acquired storage pool defect. All
reported cases have been from South-East Asia. In some cases For the complete list of references, log on to www.expertconsult.com.