Glanzmann’s thrombasthenia diagnosed following knee arthroscopy
John Zvijac, Sharhabil Ammus, Fernando Aran and Gary Kiebzak describe a case where treatment of an unremarkable knee injury led to diagnosis of Glanzmann’s thrombasthenia.
A 41-year-old man with an unremarkable medical history presented with a painful knee after a sports injury. He was diagnosed with a medial meniscal tear. Symptoms did not abate after six months of physical therapy, and he underwent arthroscopic partial medial meniscectomy. A week after beginning physical therapy he experienced a knee effusion, decreased ROM, and inability to flex his quadriceps. His knee was aspirated. Blood tests were ordered and his complete blood count, liver functions tests and INR/PTT were normal. The patient had recurrent effusions requiring three additional joint aspirations. Ten weeks after the initial surgery, he underwent a second arthroscopy, during which a haematoma was removed and a synovectomy performed. The patient continued bleeding from the incisions after portals were sutured, and he was admitted to the hospital. A haematologist was consulted and comprehensive platelet aggregation testing revealed previously undiagnosed Glanzmann’s thrombasthenia. The patient began treatment with platelet infusions and desmopressin and progressed to a full recovery. Clinical suspicion for surgical patients with unusual repetitive postoperative bleeding should include previously undetected rare bleeding disorders even in adults.
Minor haemarthrosis (bleeding in the joint space) and pain after arthroscopic knee surgery are not uncommon and are usually self-limiting as healing progresses. Occasionally, various events such as failure of the surgical repair, infection, new traumatic injury, unrecognised hypertension, use of anticoagulation medications, or liver disease affecting synthesis of clotting factors may result in…
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