The c.450G>A (p.Trp150Ter) variant in GP9 is a nonsense variant that may cause loss of function of the protein, however it is predicted to escape nonsense mediated decay and remove 15% of the protein (PVS1_Strong). This variant is absent from gnomAD v4.1 (PM2_Supporting). At least one patient (Case in PMID: 20497174) with this variant had aggregation absent for ristocetin and present for all other agonists, which is highly specific for Bernard-Soulier syndrome (PP4). Surface expression of GP1BA and GP9 were absent. Additionally, the patient had excessive mucocutaneous bleeding and macrothrombocytopenia which is consistent with Bernard-Soulier syndrome. This individual was homozygous for the variant (PM3_supporting, PMID:20497174). In PMID: 20497174, all 12 older siblings of the proband (III:1) died of bleeding but were not genotyped, there are several known heterozygous family members: the mother (II:3) and older cousin (III:2) had decreased expression of GP9 and GPP1BA (PP1). 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, PM2_supporting, PP4, PP1, PM3_supporting.