Alternative titles; symbols
ORPHA: 79; DO: 0060601;
| Location | Phenotype |
Phenotype MIM number |
Inheritance |
Phenotype mapping key |
Gene/Locus |
Gene/Locus MIM number |
|---|---|---|---|---|---|---|
| 17p13.3 | Alpha-2-plasmin inhibitor deficiency | 262850 | Autosomal recessive | 3 | PLI | 613168 |
A number sign (#) is used with this entry because alpha-2-plasmin inhibitor deficiency is caused by mutation in the PLI (SERPINF2; 613168) gene.
Alpha-2-plasmin inhibitor deficiency is a rare autosomal recessive hemorrhagic diathesis. Most bleeds are severe, appear during childhood, and, in a few cases, umbilical bleeding is the first manifestation. Some homozygous patients present only moderate bleeding (Favier et al., 2001).
An inherited hemorrhagic diathesis due to plasmin inhibitor deficiency was described by Koie et al. (1978) in a 25-year-old Okinawa man. He had suffered prolonged bleeding and ecchymoses after minor trauma, spontaneous joint hemorrhage, and one episode of hemothorax. The bleeding episodes were reduced in frequency and severity by an antiplasminic drug. Laboratory abnormalities were limited to shortened euglobulin-lysis time and whole blood clot lysis time. No circulating alpha-2-plasmin inhibitor was found in the plasma. Even though only one case was observed, autosomal recessive inheritance was undoubted because the parents were consanguineous and both had plasma antiplasmin levels about half normal. The authors called the condition Miyasato disease after the proband's surname. The same patient was reported by Aoki et al. (1979).
Kluft et al. (1979) reported an apparent homozygote, a 17-year-old boy with unrelated parents and a severe hemorrhagic diathesis. In a full report, Kluft et al. (1987) reported that a younger sister was likewise an apparent homozygote and that 8 heterozygotes were identified by half-normal activities and normal antigen concentrations. The 2 homozygotes were found to have very low functional levels as determined by the immediate plasmin inhibition test but normal plasma concentrations of alpha-2-antiplasmin antigen. The abnormal alpha-2-antiplasmin was designated Enschede after the city of birth of the propositus. The abnormal antiplasmin molecule was defective in the plasmin inhibition test, but had normal plasminogen-binding properties.
Favier et al. (2001) stated that a notable clinical feature is an unusual localization of bleeding, intramedullary hematoma in the diaphyses of long bones, which has been described in 4 cases (Takahashi et al., 1991; Devaussuzenet et al., 1998). Radiography indicated homogeneous hyperlucent lesions with regular limits and without marginal sclerosis, which can be difficult to distinguish from cystic fibrous dysplasia, Langerhans cell histiocytosis, or metastasis of neuroblastoma. Accurate diagnosis of these intramedullary hematomas can be achieved with magnetic resonance imaging, however. Similar bone hematomas have been described in afibrinogenemia cases (Lagier et al., 1980).
Favier et al. (2001) stated that no simple coagulation assay points to the diagnosis of PLI deficiency. Therefore, a specific PLI assay should be performed when a patient has a bleeding diathesis that the usual screening tests do not identify.
Congenital deficiency of alpha-2-plasmin inhibitor is a rare autosomal recessive disorder. Favier et al. (2001) noted that some heterozygotes have bleeding complications, and the bleeding tendency may increase with age (Ikematsu et al., 1996).
In the patient with inherited hemorrhagic diathesis due to plasmin inhibitor deficiency described by Koie et al. (1978), Miura et al. (1989) identified homozygosity for a mutation in the PLI gene (613168.0002). Miura et al. (1989) identified homozygosity for a different mutation in the PLI gene (613168.0001) in affected members of a family reported by Yoshioka et al. (1982).
In a woman and 2 of her children with alpha-2-plasma inhibitor deficiency, Lind and Thorsen (1999) identified heterozygosity for a mutation in the PLI gene (613168.0003). The mother had traumatic breast hematoma and peripostoperative bleeds. An affected daughter required a blood transfusion after a normal delivery, and a son had prolonged bleeding after tooth extraction. The plasma plasmin inhibitor activities were reduced to 49 to 66% of normal.
Aoki, N., Saito, H., Kamiya, T., Koie, K., Sakata, Y., Kobakura, M. Congenital deficiency of alpha-2-plasmin inhibitor associated with severe hemorrhagic tendency. J. Clin. Invest. 63: 877-884, 1979. [PubMed: 156196] [Full Text: https://doi.org/10.1172/jci109387]
Devaussuzenet, V. M. P., Ducou-le-Pointe, H., Doco, A. M., Mary, P. M., Montagne, J.-P. R., Favier, R. A case of intramedullary haematoma associated with congenital alpha-2-plasmin inhibitor deficiency. Pediat. Radiol. 28: 978-980, 1998. [PubMed: 9880645] [Full Text: https://doi.org/10.1007/s002470050513]
Favier, R., Aoki, N., de Moerloose, P. Congenital alpha-2-plasmin inhibitor deficiencies: a review. Brit. J. Haemat. 114: 4-10, 2001. [PubMed: 11472338] [Full Text: https://doi.org/10.1046/j.1365-2141.2001.02845.x]
Ikematsu, S., Fukutake, K., Aoki, N. Heterozygote for plasmin inhibitor deficiency developing hemorrhagic tendency with advancing age. Thromb. Res. 82: 129-136, 1996. [PubMed: 9163066] [Full Text: https://doi.org/10.1016/0049-3848(96)00059-x]
Kluft, C., Nieuwenhuis, H. K., Rijken, D. C., Groeneveld, E., Wijngaards, G., van Berkel, W., Dooijewaard, G., Sixma, J. J. Alpha-2-antiplasmin Enschede: dysfunctional alpha-2-antiplasmin molecule associated with an autosomal recessive hemorrhagic disorder. J. Clin. Invest. 80: 1391-1400, 1987. [PubMed: 2445779] [Full Text: https://doi.org/10.1172/JCI113217]
Kluft, C., Vellenga, E., Brommer, E. J. P. Homozygous alpha-2-antiplasmin deficiency. (Letter) Lancet 314: 206 only, 1979. Note: Originally Volume II. [PubMed: 89324] [Full Text: https://doi.org/10.1016/s0140-6736(79)91481-8]
Koie, K., Ogata, K., Kamiya, T., Takamatsu, J. Alpha-2-plasmin inhibitor deficiency (Miyasato disease). Lancet 312: 1334-1336, 1978. Note: Originally Volume II. [PubMed: 82839] [Full Text: https://doi.org/10.1016/s0140-6736(78)91973-6]
Lagier, R., Bouvier, C. A., Van Strijthem, N. Skeletal changes in congenital fibrinogen abnormalities. Skeletal Radiol. 5: 233-239, 1980. [PubMed: 7209579] [Full Text: https://doi.org/10.1007/BF00580596]
Lind, B., Thorsen, S. A novel missense mutation in the human plasmin inhibitor (alpha-2-antiplasmin) gene associated with a bleeding tendency. Brit. J. Haemat. 107: 317-322, 1999. [PubMed: 10583218] [Full Text: https://doi.org/10.1046/j.1365-2141.1999.01708.x]
Miura, O., Hirosawa, S., Kato, A., Aoki, N. Molecular basis for congenital deficiency of alpha-2-plasmin inhibitor: a frameshift mutation leading to elongation of the deduced amino acid sequence. J. Clin. Invest. 83: 1598-1604, 1989. [PubMed: 2496145] [Full Text: https://doi.org/10.1172/JCI114057]
Miura, O., Sugahara, Y., Aoki, N. Hereditary alpha-2-plasmin inhibitor deficiency caused by a transport-deficient mutation (alpha-2-PI-Okinawa): deletion of glu-137 by a trinucleotide deletion blocks intracellular transport. J. Biol. Chem. 264: 18213-18219, 1989. [PubMed: 2572590]
Takahashi, Y., Tanaka, T., Nakajima, N., Yoshioka, A., Fukui, H., Miyauchi, Y., Mii, Y., Tamai, S. Intramedullary multiple hematomas in siblings with congenital alpha-2-plasmin inhibitor deficiency: orthopedic surgery with protection by tranexamic acid. Haemostasis 21: 321-327, 1991. [PubMed: 1806461] [Full Text: https://doi.org/10.1159/000216243]
Yoshioka, A., Kamitsuji, H., Takase, T., Iida, Y., Tsukada, S., Mikami, S., Fukui, H. Congenital deficiency of alpha(2)-plasmin inhibitor in three sisters. Haemostasis 11: 176-184, 1982. [PubMed: 7095605] [Full Text: https://doi.org/10.1159/000214659]