The c.406G>T (p.Glu136Ter) variant in GP1BB is a nonsense variant that may cause loss of function of the protein, however it is predicted to escape nonsense mediated decay and remove 34% (>10%) of the protein (PVS1_Strong). At least one patient (Patient 2 in PMID: 33217855) with this variant had impaired aggregation for ristocetin (aggregation in response to other agonists is not specifically mentioned). Additionally, this patient showed less than 10% expression of GPIba (0%) measured by flow cytometry, which is highly specific for Bernard-Soulier syndrome (PP4). Full gene sequencing of all BSS genes was also performed for this patient by WES. Additionally, the patient had excessive mucocutaneous bleeding and macrothrombocytopenia which are consistent with Bernard-Soulier syndrome. The patient is homozygous for the variant (PM3_Supporting). The Grpmax filtering allele frequency in gnomaDv4.1 is 0.000002920 (based on 7/997364 alleles) in the European (non-Finnish) population, which is below the <0.0000651678 threshold for PM2_supporting. In summary, this variant meets the criteria to be classified as Likely Pathogenic for autosomal recessive Bernard-Soulier syndrome based on the ACMG/AMP criteria applied, as specified by the ClinGen PD VCEP: PVS1_Strong, PP4, PM3_Supporting and PM2_Supporting (VCEP specifications version 1).