Abstract Number: OC 21.3
Meeting: ISTH 2021 Congress
Theme: Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies » Platelet Function Disorders, Acquired
Background: Acquired Platelet Dysfunction with Eosinophilia (APDE) is a transient bleeding diathesis characterized by muco-cutaneous bleeding due to platelet dysfunction and eosinophilia. Parasitic infestation may cause eosinophilia, elevated Immunoglobulin E, release of Platelet activating factor from mast cells in turn causing platelet activation, degranulation and acquired platelet dysfunction. Since bleeding diathesis due to APDE is reversible upon treatment of eosinophilia, timely diagnosis is essential to enable cure.
Aims: To describe the spectrum of APDE and diagnostic features.
Methods: Patients presenting with bleeding symptoms from January 2012 to January 2017, diagnosed with APDE were included after informed consent. Detailed questionnaire-based ISTH-Bleeding Assessment Tool (BAT) was used to score bleeding symptoms. Diagnosis was made after comprehensive tests including complete blood count with peripheral smear examination, modified Ivy’s bleeding time, Closure time on Platelet Function Analyzer-200 (PFA-200), light transmission aggregometry (LTA), lumi-aggregometry, Prothrombin time, Activated partial thromboplastin time, Fibrinogen, Factor Assays and Ristocetin Cofactor assay.
Results: Total 54 patients were available for analysis. The median(IQR) age of patients was 8 years(5 – 12 years) with M:F ratio of 1.25:1. The median(IQR) duration of symptoms was 2 months(1-12 months). ISTH-BAT score was elevated in 50% cases, median(IQR) ISTH-BAT score being 3(2-4). Median platelet count was 236×109/L, with 16.6% patients having mild thrombocytopenia. Median(IQR) absolute eosinophil count was 1320 (800-2521.5). Bleeding Time was prolonged in 75% patients while PFA200 closure time was prolonged in 87% patients. The most consistent finding in 100% patients was characteristic platelet morphology comprising of pale, empty-looking platelets with anisogranularity (Figure1). LTA revealed decreased response to ADP(n=49), epinephrine(n=43), Collagen(n=40) or Arachidonic acid(n=22) with normal response to Ristocetin(n=54) and reduced to absent ATP release in 62.5% cases.
| Clinical Features : | Number of patients : |
| Ecchymosis | 36 |
| Epistaxis | 16 |
| Gum Bleeding | 10 |
| Easy Bruising | 11 |
| Prolonged bleeding after trivial trauma | 7 |
| Menorrhagia | 5 |
| Excessive bleeding after circumcision | 2 |
| Hematuria | 3 |
| Gastro-intestinal bleeding | 5 |
Clinical manifestations in patients with APDE (n=54) 
Characteristic platelet morphology in APDE: Pale staining, empty-looking platelets with platelet anisogranularity (shown by arrow)
Conclusions: Abnormal platelet morphology was the most pathognomic finding in 100% cases. Hence, careful peripheral smear examination can enable timely diagnosis of APDE in patients with muco-cutaneous bleeding and eosinophilia.
To cite this abstract in AMA style:
Dave R, Geevar T, Mammen J, Kala M, Vijayan R, Singh S, Nair S. Spectrum of Acquired Platelet Dysfunction with Eosinophilia (APDE) in Tertiary Care Centre in South India [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/spectrum-of-acquired-platelet-dysfunction-with-eosinophilia-apde-in-tertiary-care-centre-in-south-india/. Accessed December 11, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/spectrum-of-acquired-platelet-dysfunction-with-eosinophilia-apde-in-tertiary-care-centre-in-south-india/