Inherited thrombocytopenias

Summary

The chapter of inherited thrombocytopenias has expanded greatly over the last decade and many “new” forms deriving from mutations in “new” genes have been identified. Nevertheless, nearly half of patients remain without a definite diagnosis because their illnesses have not yet been described. The diagnostic approach to these diseases can still take advantage of the algorithm proposed by the Italian Platelet Study Group in 2003, although an update is required to include the recently described disorders. So far, transfusions of platelet concentrates have represented the main tool for preventing or treating bleedings, while haematopoietic stem cell transplantation has been reserved for patients with very severe forms. However, recent disclosure that an oral thrombopoietin mimetic is effective in increasing platelet count in patients with MYH9-related thrombocytopenia opened new therapeutic perspectives.

This review summarizes the general aspects of inherited thrombocytopenias and describes in more detail MYH9-related diseases (encompassing four thrombocytopenias previously recognized as separate diseases) and the recently described ANKRD26-related thrombocytopenia, which are among the most frequent forms of inherited thrombocytopenia.

Zusammenfassung

Das Kapitel zu erblich bedingten Thrombozytopenien ist im vergangenen Jahrzehnt sehr umfangreich geworden, zahlreiche “neue” Formen, abgeleitet von Mutationen in “neuen” Genen, wurden identifiziert. Trotzdem bleibt fast die Hälfte der Patienten ohne korrekte Diagnose, weil ihre Erkrankungen nicht beschrieben sind. Das diagnostische Vorgehen kann zwar von dem Algorithmus profitieren, der 2003 von italienischen Thrombozyten-Forschern vorgeschlagen wurde, jedoch ist dieser unter Berücksichtigung der jüngst beschriebenen Störungen zu aktualisieren. Bisher waren Transfusionen mit Thrombozytenkonzentraten am wichtigsten zur Vorbeugung oder Behandlung von Blutungen, die Transplantation hämatopoetischer Stammzellen blieb Patienten mit sehr schweren Formen vorbehalten. Aktuell ergeben sich neue therapeutische Perspektiven für Patienten mit MYH9-assoziierter Thrombopenie, denn ein orales Thrombopoetin-Mimetikum erhöht effektiv die Thrombozytenkonzentration.

In dieser Übersicht werden allgemeine Aspekte der erblich bedingten Thrombozytopenien dargestellt. Näher erläutert werden die MYH9-assoziierten Erkrankungen (darunter vier Thrombozytopenien, die zuvor als eigenständige Krankheiten galten) und die jüngst beschriebenen ANKRD26-assoziierten Thrombozytopenien, die zu den häufigsten erblich bedingten Thrombozytopenien gehören.

Summary

The chapter of inherited thrombocytopenias has expanded greatly over the last decade and many “new” forms deriving from mutations in “new” genes have been identified. Nevertheless, nearly half of patients remain without a definite diagnosis because their illnesses have not yet been described. The diagnostic approach to these diseases can still take advantage of the algorithm proposed by the Italian Platelet Study Group in 2003, although an update is required to include the recently described disorders. So far, transfusions of platelet concentrates have represented the main tool for preventing or treating bleedings, while haematopoietic stem cell transplantation has been reserved for patients with very severe forms. However, recent disclosure that an oral thrombopoietin mimetic is effective in increasing platelet count in patients with MYH9-related thrombo cytopenia opened new therapeutic perspectives. This review summarizes the general aspects of inherited thrombocytopenias and describes in more detail MYH9-related diseases (encompassing four thrombocytopenias previously recognized as separate diseases) and the recently described ANKRD26-related thrombocytopenia, which are among the most frequent forms of inherited thrombocytopenia.

Keywords

Inherited thrombocytopenias - MYH9-related disease - ANKRD26-related thrombocytopenia - bleeding disorders

Schlüsselwörter

Erbliche Thrombozytopenien - MYH9-assoziierte Erkrankung - ANKRD26-assoziierte Thrombozytopenie - Gerinnungsstörungen

Keywords

Inherited thrombocytopenias - MYH9-related disease - ANKRD26-related thrombocytopenia - bleeding disorders

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