Award-Winning Student Paper Highlights
Potential New Therapy

Richard Zinke

University of Vermont fourth-year medical student Richard Zinke recently presented his winning Clinical Vignette paper at the American College of Physicians (ACP) Internal Medicine 2009 national meeting in Philadelphia, Pa. Titled "Humate P for Treatment of Persistent, Life Threatening Epistaxis in a Patient with Glanzmann's Thrombasthenia: A Case Report," Zinke's submission was among five Clinical Vignette abstracts selected as winners in the 2009 National Medical Student Abstracts Competition by the Membership Committee of the ACP.

Zinke first encountered Glanzmann's Thrombasthenia — a rare inherited disorder that causes platelet dysfunction — while a third-year medical student on an inpatient internal medicine rotation assigned to the hematology/oncology service and working with Vermont Cancer Center hematologist/oncologist Chris Holmes, M.D., Ph.D., associate professor of medicine, and a patient care team at Fletcher Allen Health Care.

"The patient's treatment course was complex and even life-threatening," explains Zinke. "She had a persistent nosebleed that would not respond to any of the known therapeutic options for Glanzmann's." Following nearly four weeks of persistent bleeding despite the administration of such therapies as blood product transfusions, injected pharmacological treatments, nasal packing and electrocautery, Holmes helped develop an innovative new treatment plan that succeeded in halting the bleeding: Humate-P therapy. Humate-P is a treatment used for both classical hemophilia and Von Willebrand Disease, which is the most-common inherited bleeding disorder.

Zinke, who followed and cared for the patient during and after her hospital stay, wrote a case report of this clinical vignette, highlighting the complications experienced, the patient's lack of response to recognized Glanzmann's Thrombasthenia treatment options, and unexpected response to the new treatment. He first presented the case as a poster at the November 2008 Vermont Chapter Scientific Meeting of the ACP.

"This award shows that this case is stirring up some interest on the national level," says Zinke, who believes Holmes' work has uncovered a potential new therapeutic option for patients living with Glanzmann's Thrombasthenia, and may reveal new information about the molecular mechanisms underlying the disorder. Zinke is currently preparing a manuscript on this clinical vignette for potential journal publication.