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Journal of Medical Genetics logoLink to Journal of Medical Genetics
. 2002 Dec;39(12):876–881. doi: 10.1136/jmg.39.12.876

Thrombocytopenia-absent radius syndrome: a clinical genetic study

K Greenhalgh 1, R Howell 1, A Bottani 1, P Ancliff 1, H Brunner 1, C Verschuuren-Bemel 1, E Vernon 1, K Brown 1, R Newbury-Ecob 1
PMCID: PMC1757221  PMID: 12471199

Abstract

The thrombocytopenia-absent radius (TAR) syndrome is a congenital malformation syndrome characterised by bilateral absence of the radii and a thrombocytopenia. The lower limbs, gastrointestinal, cardiovascular, and other systems may also be involved. Shaw and Oliver in 1959 were the first to describe this condition, but it was Hall et al in 1969 who reported the first major series of patients. Since then most reports have been based on single or small numbers of cases. We report the results of a clinical study looking at the phenotype of 34 patients with TAR syndrome. All cases had a documented thrombocytopenia and bilateral radial aplasia, 47% had lower limb anomalies, 47% cow's milk intolerance, 23% renal anomalies, and 15% cardiac anomalies. Congenital anomalies not previously described in association with TAR syndrome included facial capillary haemangiomata, intracranial vascular malformation, sensorineural hearing loss, and scoliosis. Karyotype analysis, chromosome breakage studies including premature centromeric separation and fluorescence in situ hybridisation studies looking for a deletion of chromosome 22q11 were undertaken. Two abnormal karyotypes were identified.

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Selected References

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  1. Adeyokunnu A. A. Radial aplasia and amegakaryocytic thrombocytopenia (TAR syndrome) among Nigerian children. Am J Dis Child. 1984 Apr;138(4):346–348. doi: 10.1001/archpedi.1984.02140420012005. [DOI] [PubMed] [Google Scholar]
  2. Allingham-Hawkins D. J., Tomkins D. J. Heterogeneity in Roberts syndrome. Am J Med Genet. 1995 Jan 16;55(2):188–194. doi: 10.1002/ajmg.1320550208. [DOI] [PubMed] [Google Scholar]
  3. Anyane-Yeboa K., Jaramillo S., Nagel C., Grebin B. Tetraphocomelia in the syndrome of thrombocytopenia with absent radii (TAR syndrome). Am J Med Genet. 1985 Apr;20(4):571–576. doi: 10.1002/ajmg.1320200402. [DOI] [PubMed] [Google Scholar]
  4. Arora M., Wagner J. E., Davies S. M., Blazar B. R., Defor T., Enright H., Miller W. J., Weisdorf D. F. Randomized clinical trial of thalidomide, cyclosporine, and prednisone versus cyclosporine and prednisone as initial therapy for chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2001;7(5):265–273. doi: 10.1053/bbmt.2001.v7.pm11400948. [DOI] [PubMed] [Google Scholar]
  5. Ballmaier M., Schulze H., Strauss G., Cherkaoui K., Wittner N., Lynen S., Wolters S., Bogenberger J., Welte K. Thrombopoietin in patients with congenital thrombocytopenia and absent radii: elevated serum levels, normal receptor expression, but defective reactivity to thrombopoietin. Blood. 1997 Jul 15;90(2):612–619. [PubMed] [Google Scholar]
  6. Barber J. C., Joyce C. A., Collinson M. N., Nicholson J. C., Willatt L. R., Dyson H. M., Bateman M. S., Green A. J., Yates J. R., Dennis N. R. Duplication of 8p23.1: a cytogenetic anomaly with no established clinical significance. J Med Genet. 1998 Jun;35(6):491–496. doi: 10.1136/jmg.35.6.491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bradshaw A., Donnelly L. F., Foreman J. W. Thrombocytopenia and absent radii (TAR) syndrome associated with horseshoe kidney. Pediatr Nephrol. 2000 Jan;14(1):29–31. doi: 10.1007/s004670050007. [DOI] [PubMed] [Google Scholar]
  8. Digilio M. C., Giannotti A., Marino B., Guadagni A. M., Orzalesi M., Dallapiccola B. Radial aplasia and chromosome 22q11 deletion. J Med Genet. 1997 Nov;34(11):942–944. doi: 10.1136/jmg.34.11.942. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Edelberg S. B., Cohn J., Brandt N. J. Congenital hypomegakaryocytic thrombocytopenia associated with bilateral absence of the radius - the TAR syndrome. Hum Hered. 1977;27(2):147–152. doi: 10.1159/000152864. [DOI] [PubMed] [Google Scholar]
  10. Fryns J. P., Bonnet D., De Smet L. Holt-Oram syndrome with associated postaxial and central polydactyly. Further evidence for genetic heterogeneity in the Holt-Oram syndrome. Genet Couns. 1996;7(4):323–324. [PubMed] [Google Scholar]
  11. Giampietro P. F., Adler-Brecher B., Verlander P. C., Pavlakis S. G., Davis J. G., Auerbach A. D. The need for more accurate and timely diagnosis in Fanconi anemia: a report from the International Fanconi Anemia Registry. Pediatrics. 1993 Jun;91(6):1116–1120. [PubMed] [Google Scholar]
  12. Hall J. G., Levin J., Kuhn J. P., Ottenheimer E. J., van Berkum K. A., McKusick V. A. Thrombocytopenia with absent radius (TAR). Medicine (Baltimore) 1969 Nov;48(6):411–439. doi: 10.1097/00005792-196948060-00001. [DOI] [PubMed] [Google Scholar]
  13. Hall J. G. Thrombocytopenia and absent radius (TAR) syndrome. J Med Genet. 1987 Feb;24(2):79–83. doi: 10.1136/jmg.24.2.79. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hays R. M., Bartoshesky L. E., Feingold M. New features of thrombocytopenia and absent radius syndrome. Birth Defects Orig Artic Ser. 1982;18(3B):115–121. [PubMed] [Google Scholar]
  15. Hedberg V. A., Lipton J. M. Thrombocytopenia with absent radii. A review of 100 cases. Am J Pediatr Hematol Oncol. 1988 Spring;10(1):51–64. doi: 10.1097/00043426-198821000-00010. [DOI] [PubMed] [Google Scholar]
  16. Hewitt M., Lunt P. W., Oakhill A. Wilms' tumour and a de novo (1;7) translocation in a child with bilateral radial aplasia. J Med Genet. 1991 Jun;28(6):411–412. doi: 10.1136/jmg.28.6.411. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Hästbacka J., Superti-Furga A., Wilcox W. R., Rimoin D. L., Cohn D. H., Lander E. S. Atelosteogenesis type II is caused by mutations in the diastrophic dysplasia sulfate-transporter gene (DTDST): evidence for a phenotypic series involving three chondrodysplasias. Am J Hum Genet. 1996 Feb;58(2):255–262. [PMC free article] [PubMed] [Google Scholar]
  18. Kari J. A., Shah V., Dillon M. J. Behçet's disease in UK children: clinical features and treatment including thalidomide. Rheumatology (Oxford) 2001 Aug;40(8):933–938. doi: 10.1093/rheumatology/40.8.933. [DOI] [PubMed] [Google Scholar]
  19. Käriäinen H., Ryöppy S., Norio R. RAPADILINO syndrome with radial and patellar aplasia/hypoplasia as main manifestations. Am J Med Genet. 1989 Jul;33(3):346–351. doi: 10.1002/ajmg.1320330312. [DOI] [PubMed] [Google Scholar]
  20. Labrune P., Pons J. C., Khalil M., Mirlesse V., Imbert M. C., Odièvre M., Daffos F., Tchernia G., Frydman R. Antenatal thrombocytopenia in three patients with TAR (thrombocytopenia with absent radii) syndrome. Prenat Diagn. 1993 Jun;13(6):463–466. doi: 10.1002/pd.1970130607. [DOI] [PubMed] [Google Scholar]
  21. Letestu R., Vitrat N., Massé A., Le Couedic J. P., Lazar V., Rameau P., Wendling F., Vuillier J., Boutard P., Plouvier E. Existence of a differentiation blockage at the stage of a megakaryocyte precursor in the thrombocytopenia and absent radii (TAR) syndrome. Blood. 2000 Mar 1;95(5):1633–1641. [PubMed] [Google Scholar]
  22. Li Q. Y., Newbury-Ecob R. A., Terrett J. A., Wilson D. I., Curtis A. R., Yi C. H., Gebuhr T., Bullen P. J., Robson S. C., Strachan T. Holt-Oram syndrome is caused by mutations in TBX5, a member of the Brachyury (T) gene family. Nat Genet. 1997 Jan;15(1):21–29. doi: 10.1038/ng0197-21. [DOI] [PubMed] [Google Scholar]
  23. Luthy D. A., Hall J. G., Graham C. B. Prenatal diagnosis of thrombocytopenia with absent radii. Clin Genet. 1979 Jun;15(6):495–499. doi: 10.1111/j.1399-0004.1979.tb00831.x. [DOI] [PubMed] [Google Scholar]
  24. Newman C. G. Teratogen update: clinical aspects of thalidomide embryopathy--a continuing preoccupation. Teratology. 1985 Aug;32(1):133–144. doi: 10.1002/tera.1420320118. [DOI] [PubMed] [Google Scholar]
  25. Ryan A. K., Goodship J. A., Wilson D. I., Philip N., Levy A., Seidel H., Schuffenhauer S., Oechsler H., Belohradsky B., Prieur M. Spectrum of clinical features associated with interstitial chromosome 22q11 deletions: a European collaborative study. J Med Genet. 1997 Oct;34(10):798–804. doi: 10.1136/jmg.34.10.798. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. SHAW S., OLIVER R. A. Congenital hypoplastic thrombocytopenia with skeletal deformaties in siblings. Blood. 1959 Apr;14(4):374–377. [PubMed] [Google Scholar]
  27. Schnur R. E., Eunpu D. L., Zackai E. H. Thrombocytopenia with absent radius in a boy and his uncle. Am J Med Genet. 1987 Sep;28(1):117–123. doi: 10.1002/ajmg.1320280117. [DOI] [PubMed] [Google Scholar]
  28. Schotland H. M., Eldridge R., Sommer S. S., Malawar M. Neurofibromatosis 1 and osseous fibrous dysplasia in a family. Am J Med Genet. 1992 Jul 15;43(5):815–822. doi: 10.1002/ajmg.1320430513. [DOI] [PubMed] [Google Scholar]
  29. Shalev E., Weiner E., Feldman E., Cohen H., Zuckerman H. Micrognathia-prenatal ultrasonographic diagnosis. Int J Gynaecol Obstet. 1983 Aug;21(4):343–345. doi: 10.1016/0020-7292(83)90027-9. [DOI] [PubMed] [Google Scholar]
  30. Singhal S., Mehta J. Thalidomide in cancer: potential uses and limitations. BioDrugs. 2001;15(3):163–172. doi: 10.2165/00063030-200115030-00003. [DOI] [PubMed] [Google Scholar]
  31. Strippoli P., Savoia A., Iolascon A., Tonelli R., Savino M., Giordano P., D'Avanzo M., Massolo F., Locatelli F., Borgna C. Mutational screening of thrombopoietin receptor gene (c-mpl) in patients with congenital thrombocytopenia and absent radii (TAR). Br J Haematol. 1998 Nov;103(2):311–314. doi: 10.1046/j.1365-2141.1998.00991.x. [DOI] [PubMed] [Google Scholar]
  32. Teufel M., Enders H., Dopfer R. Consanguinity in a Turkish family with thrombocytopenia with absent radii (TAR) syndrome. Hum Genet. 1983;64(1):94–96. doi: 10.1007/BF00289487. [DOI] [PubMed] [Google Scholar]
  33. Thompson E. M., Young I. D., Hall C. M., Pembrey M. E. Recurrence risks and prognosis in severe sporadic osteogenesis imperfecta. J Med Genet. 1987 Jul;24(7):390–405. doi: 10.1136/jmg.24.7.390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Urban M., Opitz C., Bommer C., Enders H., Tinschert S., Witkowski R. Bilaterally cleft lip, limb defects, and haematological manifestations: Roberts syndrome versus TAR syndrome. Am J Med Genet. 1998 Sep 23;79(3):155–160. doi: 10.1002/(sici)1096-8628(19980923)79:3<155::aid-ajmg1>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  35. Van Den Berg D. J., Francke U. Roberts syndrome: a review of 100 cases and a new rating system for severity. Am J Med Genet. 1993 Nov 15;47(7):1104–1123. doi: 10.1002/ajmg.1320470735. [DOI] [PubMed] [Google Scholar]
  36. Whitfield M. F., Barr D. G. Cows' milk allergy in the syndrome of thrombocytopenia with absent radius. Arch Dis Child. 1976 May;51(5):337–343. doi: 10.1136/adc.51.5.337. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. van Haeringen A., Veenstra F., Maaswinkel-Mooij P. D., van de Kamp J. J. Intermittent thrombocytopenia and absent radii: report of a patient with additional unusual manifestations. Am J Med Genet. 1989 Oct;34(2):202–206. doi: 10.1002/ajmg.1320340214. [DOI] [PubMed] [Google Scholar]

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