Obstetric and Gynaecological Challenges and Outcomes in Women and Girls with Glanzmann's Thrombasthenia

Authors: Obeng-Tuudah, D; Tarawah, A; Ozkan, M; Abdul-Kadir, R

Affiliations: UCL, Royal Free NHS Hosp, Katharine Dormandy Haemophilia & Thrombosis Ctr, Dept Obstet & Gynaecol, London, England; UCL, Inst Womens Hlth, London, England; King Salman Med City, Madinah Hereditary Blood Disorders Ctr, Madinah, Saudi Arabia

Publication: Haemophilia 2025

ABSTRACT: INTRODUCTION: Glanzmann’s thrombasthenia (GT) is an inherited platelet function disorder that may manifest with significant bleeding symptoms; in women and girls (W&Gs), heavy menstrual bleeding (HMB) is very common. GT in pregnancy is associated with an increased risk of postpartum haemorrhage (PPH). AIM: This study highlights the gynaecological and obstetric challenges experienced by W&Gs with GT, and reviews available treatment options. METHODS: Data regarding 38 W&Gs with GT were analyzed from the ISTH REDCap registry, an international multi-center database. RESULTS: Among 38 W&Gs, 76% of Middle Eastern ethnicity, 100% reported HMB; 92% HMB since menarche, and 82% presented with acute HMB and were treated with platelets and packed red blood cells (pRBCs) transfusions in addition to hormonal therapies. Management of chronic HMB required a combination therapy including antifibrinolytics (tranexamic acid [TXA]), hormonal therapies, and recombinant factor VIIa (rFVIIa); rFVIIa was used in 50% of W&Gs. In 16 pregnancies, PPH was reported in 63% of deliveries, of which 83% required blood and platelet transfusions. Despite prophylactic haemostatic agents during labour and delivery in 8/9 pregnancies of women with known GT diagnosis, 78% experienced PPH. Thirty-one percent of neonates developed neonatal alloimmune thrombocytopenia (NAIT). CONCLUSION: HMB and PPH are common bleeding complications in GT. Effective management of HMB and PPH in W&Gs with GT is challenging but can be achieved by a multidisciplinary team, often requiring a combination of haemostatic agents with hormonal therapies. Use of rFVIIa may limit the need for platelet transfusion, thus reducing alloimmunisation and the risk of developing NAIT.