Platelet hemostatic disorders: how to reach a diagnosis?
https://doi.org/10.35754/0234-5730-2026-71-2-258-270
Abstract
Introduction. Thrombocytopenia can be primary or secondary and warrants differential diagnosis of hereditary functional platelet defects.
Aim: to present the difficulties of verifying the diagnosis in disorders of the platelet component of hemostasis.
Main findings. A clinical case of a 28-year old female patient is presented. The patient presented with a mild mucocutaneous hemorrhagic syndrome and moderate thrombocytopenia of a familial nature. All available routine and alternative methods for investigating platelet disorders were performed. Whole genome sequencing proved to be a crucial diagnostic method. This genetic analysis, in comparison with morphological and functional studies, is a promising tool for the differential diagnosis of heterogeneous platelet disorders.
About the Authors
E. V. YakovlevaRussian Federation
Elena V. Yakovleva, Cand. Sci. (Med.), Hematologist, Clinical and Diagnostic Department of Hematology and Hemostasis Disorders
125167, Moscow
D. V. Pavlenko
Russian Federation
Diana V. Pavlenko, Clinical Laboratory Diagnostic Doctor of the Centralized Clinical Diagnostic Laboratory
125167, Moscow
V. N. Dvirnyk
Russian Federation
Valentina N. Dvirnyk, Cand. Sci. (Med.), Head of the Laboratory, Clinical Laboratory Diagnostics Physician at the Centralized Clinical and Diagnostic Laboratory
125167, Moscow
Zh. V. Tratevskaya
Russian Federation
Zhanna V. Tratsevskaya, Cand. Sci. (Med.), Pathologist, Pathological Anatomy Department
125167, Moscow
A. M. Kovrigina
Russian Federation
Alla M. Kovrigina, Dr. Sci. (Biol.), Head of the Pathology Department
125167, Moscow
O. S. Pshenichnikova
Russian Federation
Olesya S. Pshenichnikova, Cand. Sci. (Biol.), Head of Laboratory of Genetic Engineering
125167, Moscow
V. L. Surin
Russian Federation
Vadim L. Surin, Senior Researcher, Laboratory of Genetic Engineering
125167, Moscow
J. M. Poznyakova
Russian Federation
Yulia M. Poznyakova, Leading Specialist, Genetic Diagnostics Support Team
125167, Moscow
E. V. Yushkova
Russian Federation
Eugenia V. Yushkova, Laboratory Assistant Researcher, the Laboratory of Cellular Hemostasis and Thrombosis; Postgraduate Student
117198, Moscow
109029, Moscow
N. A. Podoplelova
Russian Federation
Nadezhda A. Podoplelova, Cand. Sci. (Biol.), Leading researcher, the Laboratory of Cellular Hemostasis and Thrombosis; Head of Collective Use Center “Modern methods of experimental biophysics”
117198, Moscow
109029, Moscow
N. I. Zozulya
Russian Federation
Nadezhda I. Zozulya, Dr. Sci. (Med.), Hematologist, Head of Clinical and Diagnostic Department of Hematology and Hemostasis Disorders
125167, Moscow
References
1. Greenberg E.M., Kaled E.S. Thrombocytopenia. Crit Care Nurs Clin North Am. 2013;25(4):427–34. DOI: 10.1016/j.ccell.2013.08.003.
2. Puyo C.A. Thrombocytopenia. Int Anesthesiol Clin. 2001;39(1):17–34. DOI: 10.1097/00004311-200101000-00004.
3. Veneri D., Franchini M., Randon F., et al. Thrombocytopenias: a clinical point of view. Blood Transfus. 2009;7(2):75–85. DOI: 10.2450/2008.0012-08.
4. Palma-Barqueros V., Revilla N., Sanchez A., et al. Inherited Platelet Disorders: An Updated Overview. Int J Mol Sci. 2021;26;22(9):4521. DOI: 10.3390/ijms22094521.
5. Nurden P., Stritt S., Favier R., Nurden A.T. Inherited platelet diseases with normal platelet count: phenotypes, genotypes and diagnostic strategy. Haematologica. 2021;106(2):337–50. DOI: 10.3324/haematol.2020.248153.
6. Shim Y.J. Genetic classification and confirmation of inherited platelet disorders: current status in Korea. Clin Exp Pediatr. 2020;63(3):79–87. DOI: 10.3345/kjp.2019.00052.
7. Zaninetti C., Wolff M., Greinacher A. Diagnosing Inherited Platelet Disorders: Modalities and Consequences. Hamostaseologie. 2021;41(6):475–88. DOI: 10.1055/a-1515-0813.
8. Yushkova E.V., Podoplelova N.A., Fedorova D.V., et al. A single-center experience of using immunofl uorescence staining of blood smears for the diagnosis of hereditary thrombocytopathies. Voprosy Gematologii/Onkologii I Immunopatologii v Pediatrii. 2023;22(3):43–7 (In Russian). DOI: 10.24287/1726-1708-2023-22-3-43-47.
9. Fouassier M., Babuty A., Debord C., Bene M.C. Platelet immunophenotyping in health and inherited bleeding disorders, a review and practical hints. Cytometry B Clin Cytom. 2020;98(6):464–75. DOI: 10.1002/cyto.b.21892.
10. Frelinger A.L., Spurgeon B.E.J. Clinical Cytometry for Platelets and Platelet Disorders. Clin Lab Med. 2023 ;43(3):445–54. DOI: 10.1016/j.cll.2023.04.008.
11. Bourguignon A., Tasneem S., Hayward C.P. Screening and diagnosis of inherited platelet disorders. Crit Rev Clin Lab Sci. 2022;59(6):405–44. DOI: 10.1080/10408363.2022.2049199.
12. Richards S., Aziz N., Bale S., et al. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med. 2015;17(5):405–24. DOI: 10.1038/gim.2015.30.
13. Durkie M., Cassidy E.-J., Berry I., et al. ACGS (2024) Best Practice Guidelines for Variant Classification in Rare Disease. Association for Clinical Genomic Science. https://www.genomicseducation.hee.nhs.uk/wp-content/uploads/2024/08/ACGS-2024_UK-practice-guidelines-for-variant-classification.pdf
14. Althaus K., Greinacher A. MYH9-related platelet disorders. Semin Thromb Hemost. 2009;35(2):189–203. DOI: 10.1055/s-0029-1220327.
15. Zaninetti C. Greinacher A. Diagnosis of Inherited Platelet Disorders on a Blood Smear. J Clin Med. 2020;17;9(2):539. DOI: 10.3390/jcm9020539.
16. Arber D.A, Orazi A., Hasserjian R., et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127(20):2391–405. DOI: 10.1182/blood-2016-06-721662.
17. Andres O., Konig E.M., Althaus K., et al. Use of targeted high-throughput sequencing for genetic classification of patients with bleeding diathesis and suspected platelet disorder. TH Open 2018;2(4):e445–54. DOI: 10.1055/s-0038-1676813.
18. Liu Y.C, Eldomery M.K, Maciaszek J.L, Klco J.M. Inherited Predispositions to Myeloid Neoplasms: Pathogenesis and Clinical Implications. Annu Rev Pathol. 2025;20(1):87–114. DOI: 10.1146/annurev-pathmchdis-111523-023420.
19. Dowton S.B., Beardsley D., Jamison D., et al. Studies of a familial platelet disorder. Blood. 1985;65(3):557–63.
20. Song W.J., Sullivan M.G., Legare R.D., et al. Haploinsufficiency of CBFA2 causes familial thrombocytopenia with propensity to develop acute myelogenous leukaemia. Nat Genet. 1999;23(2):166–75. DOI: 10.1038/13793.
21. Brown A.L., Arts P., Carmichael C.L., Babic M., et al. RUNX1-mutated families show phenotype heterogeneity and a somatic mutation profile unique to germline predisposed AML. Blood Adv. 2020;4(6):1131–44. DOI: 10.1182/bloodadvances.2019000901.
22. Patel N., Calvo K.R. How I diagnose myeloid neoplasms with germline predisposition. Am J Clin Pathol. 2023;3;160(4):352–64. DOI: 10.1093/ajcp/aqad075.
23. Burley K., Westbury S.K., Mumford A.D. TUBB1 variants and human platelet traits. Platelets. 2018;29(2):209–11. DOI: 10.1080/09537104.2017.1411587.
24. Cuenca-Zamora E.J., Ferrer-Marin F., Rivera J., Teruel-Montoya R. Tubulin in Platelets: When the Shape Matters. Int J Mol Sci. 2019;20(14):3484. DOI: 10.3390/ijms20143484.
25. Schwer H.D., Lecine P., Tiwari S., et al. A lineage-restricted and divergent beta-tubulin isoform is essential for the biogenesis, structure and function of blood platelets. Curr Biol. 2001;11(8):579–86. DOI: 10.1016/s0960-9822(01)00153-1.
26. Cerecedo D. Platelet cytoskeleton and its hemostatic role. Blood Coagul Fibrinolysis. 2013;24(8):798–808. DOI: 10.1097/MBC.0b013e328364c379.
27. Tablin F., Castro M., Leven R.M. Blood platelet formation in vitro. The role of the cytoskeleton in megakaryocyte fragmentation. J Cell Sci. 1990;97(Pt 1):59–70. DOI: 10.1242/jcs.97.1.59.
28. Palma-Barqueros V., Bury L., Kunishima S., et al. Expanding the genetic spectrum of TUBB1-related thrombocytopenia. Blood Adv. 2021;28;5(24):5453–67. DOI: 10.1182/bloodadvances.2020004057.
29. Navarro-Nunez, L., Lozano M.L., Rivera J., et al. The association of the beta1-tubulin Q43P polymorphism with intracerebral hemorrhage in men. Haematologica. 2007;92:513–8.
30. Navarro-Nunez L., Roldan, V., Lozano M.L., et al. TUBB1 Q43P polymorphism does not protect against acute coronary syndrome and premature myocardial infarction. Thromb. Haemost. 2008;100:1211–3.
31. Matsumura T., Nakamura-Ishizu A., Takaoka K., et al. TUBB1 dysfunction in inherited thrombocytopenia causes genome instability. Br J Haematol. 2019;185(5):888–902. DOI: 10.1111/bjh.15835.
32. Palma-Barqueros V., Bury L., Kunishima S., et al. Expanding the genetic spectrum of TUBB1-related thrombocytopenia. Blood Adv. 2021;5(24):5453–67. DOI: 10.1182/bloodadvances.2020004057.
33. Stoupa A., Adam F., Kariyawasam D., et al. TUBB1 mutations cause thyroid dysgenesis associated with abnormal platelet physiology. EMBO Mol Med. 2018;10(12):e9569. DOI: 10.15252/emmm.201809569.
34. Raadsen M., Du Toit J., Langerak T., et al. Thrombocytopenia in Virus Infections. J Clin Med. 2021;10(4):877. DOI: 10.3390/jcm10040877.
35. Seyoum M., Enawgaw B., Melku M. Human blood platelets and viruses: defense mechanism and role in the removal of viral pathogens. Thromb J. 2018;16:16. DOI: 10.1186/s12959-018-0170-8.
36. Schrottmaier W.C., Schmuckenschlager A., Pirabe A., Assinger A. Platelets in Viral Infections — Brave Soldiers or Trojan Horses. Front Immunol. 2022;13:856713. DOI: 10.3389/fimmu.2022.856713.
37. Bandini P., Borras N., Berrueco R., et al. Gaining Insights into Inherited Bleeding Disorders of Complex Etiology in Pediatric Patients: Whole-Exome Sequencing as First-Line Investigation Tool. Thromb Haemost. 2024;124(7):628–40. DOI: 10.1055/s-0043-1778070.
38. Almazni I., Stapley R.J., Khan A.O., Morgan N.V. A comprehensive bioinformatic analysis of 126 patients with an inherited platelet disorder to identify both sequence and copy number genetic variants. Hum Mutat. 2020;41(11):1848–65. DOI: 10.1002/humu.24114.
39. Freson K, Turro E. High-throughput sequencing approaches for diagnosing hereditary bleeding and platelet disorders. J Thromb Haemost. 2017;15(7):1262–72. DOI: 10.1111/jth.13681.
40. Bastida J.M, Lozano M.L., Benito R., et al. Introducing high-throughput sequencing into mainstream genetic diagnosis practice in inherited platelet disorders. Haematologica. 2018;103(1):148–62. DOI: 10.3324/haematol.2017.171132.
Review
For citations:
Yakovleva E.V., Pavlenko D.V., Dvirnyk V.N., Tratevskaya Zh.V., Kovrigina A.M., Pshenichnikova O.S., Surin V.L., Poznyakova J.M., Yushkova E.V., Podoplelova N.A., Zozulya N.I. Platelet hemostatic disorders: how to reach a diagnosis? Russian journal of hematology and transfusiology. 2026;71(2):258-270. (In Russ.) https://doi.org/10.35754/0234-5730-2026-71-2-258-270
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