Reduced dense granules in platelet by electron microscopy in a patient with abnormal bleeding after self-applied leech therapy
Case report published in Malays J Pathol (2025)
Abstract
INTRODUCTION: Delta storage pool disease (δ-SPD) is a platelet function disorder due to the decreased number and contents of dense granules causing bleeding symptoms. Diagnosis of δ-SPD is a complex procedure due to the variability of test results in platelet aggregometry and also it requires specialised tests. Electron microscopy (EM) is a promising tool to help in the diagnosis of this disorder. We report here a rare case of δ-SPD confirmed by EM. CASE REPORT: A 42-year-old lady presented with prolonged bleeding history from a leech bite for 3 days. She also has a history of bleeding of variable severity for more than 20 years. On presentation, blood was oozing from the bite mark on her right wrist and there were multiple small bruises over her lower limbs. Full blood count, peripheral blood smear, coagulation profile, factor VIII assay, factor IX assay, von Willebrand Factor antigen and activity, bleeding time, and clot retraction test were normal. Platelet aggregation tests showed poor aggregation with ADP with a lag phase >60 seconds with arachidonic acid. There was poor ATP release reaction with ADP and arachidonic acid suggesting a storage defect. Subsequently, the EM of the platelets was performed and showed reduced dense granules indicating delta storage pool deficiency (δ-SPD). She was counselled about her diet and medication which seems to control her symptoms. CONCLUSIONS: This case report highlights rare δ-SPD confirmed by EM. Diagnosis of this disorder is crucial in managing the patient. Highly specialised tests including platelet aggregometry, EM and molecular analysis are helpful in diagnosing this rare SPD.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Electron-microscopy diagnosis of reduced dense platelet granules in a patient with abnormal bleeding after self-applied leech therapy.
Por qué esto importa para la hirudoterapia
Este caso clínico describe a una mujer de 42 años que consultó por sangrado prolongado durante tres días a partir de la mordedura de una sanguijuela en la muñeca derecha y fue finalmente diagnosticada de enfermedad del pool de almacenamiento delta (δ-SPD), una deficiencia de gránulos densos plaquetarios confirmada por microscopía electrónica. El resumen detalla el estudio diagnóstico, que incluyó perfiles de coagulación normales pero agregación plaquetaria anómala con ADP y ácido araquidónico. Este caso es relevante para ASH porque documenta un desenlace hemorrágico adverso asociado a una mordedura de sanguijuela en una paciente con un trastorno plaquetario subyacente. ADVERTENCIA: se trata de un caso clínico único; el sangrado prolongado fue atribuible a la δ-SPD preexistente de la paciente, y el resumen no especifica la especie de sanguijuela ni las circunstancias de la mordedura.
Citación
Reduced dense granules in platelet by electron microscopy in a patient with abnormal bleeding after self-applied leech therapy.
Yusof et al. · The Malaysian journal of pathology, 2025
Contexto clínico relacionado
Explore cómo esta investigación se conecta con la práctica clínica
Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026