1
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Friedman KD, Böhm-Weigert M, DeSimone N, Dietzen DJ, Eby C, Flickinger C, Hoyer W, Kahl M, Kottke-Marchant K, Ortel TL, Patzke J, Pipe SW, Stuart M, Timur AA, Sarode R. Evaluation of an automated von Willebrand factor glycoprotein IbM activity assay compared with 3 alternative von Willebrand factor activity assays. Res Pract Thromb Haemost 2024; 8:102422. [PMID: 38840662 PMCID: PMC11152683 DOI: 10.1016/j.rpth.2024.102422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/10/2024] [Indexed: 06/07/2024] Open
Abstract
Background To overcome deficiencies of the traditional von Willebrand factor (VWF) ristocetin cofactor activity assay (VWF:RCo), several automated assays for VWF platelet-binding activity have been developed. Information on the performance of these assays and their diagnostic utility remains limited. Objectives To validate the VWF:glycoprotein IbM assay INNOVANCE VWF Ac and compare it with an automated VWF:RCo assay as well as with an automated assay and a manual VWF:Ab assay and to generate reference ranges and analyze reproducibility of the VWF:glycoprotein IbM assay. Methods Clinical sites enrolled healthy subjects and patients representing the intended use population; VWF activity assays were performed, and results were analyzed. The performance of the INNOVANCE VWF Ac assay was also compared between the BCS XP System and the CS-2500 and CS-5100 analyzers. Results The INNOVANCE VWF Ac assay correlated well with the VWF:RCo assay and the automated HemosIL VWF:Ab assay, with Pearson coefficients of >.9 and a predicted bias of ≤5.0 IU/dL at VWF levels of 30 IU/dL and ≤5.8 IU/dL at the levels of 50 IU/dL, but correlation and bias were not as good when compared with the REAADS manual VWF:Ab assay. Reference ranges observed for healthy subjects correlated well with previously published findings. Reproducibility of the INNOVANCE VWF Ac assay on the BCS XP System and the CS analyzers was excellent, as was correlation among devices. Conclusion The characteristics of the INNOVANCE VWF Ac assay regarding comparability with other VWF activity assays, reference ranges, and precision support the use of this assay for evaluation of patients with concern for von Willebrand disease.
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Affiliation(s)
- Kenneth D. Friedman
- Medical Science Institute, Versiti Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
| | - Martina Böhm-Weigert
- Department of Medical Affairs, Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany
| | - Nicole DeSimone
- Pathology and Internal Medicine (Hematology/Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dennis J. Dietzen
- Department of Pathology and Immunology, Washington University, St. Louis, Missouri, USA
| | - Charles Eby
- Department of Pathology and Immunology, Washington University, St. Louis, Missouri, USA
| | - Cynthia Flickinger
- Department of Clinical Evaluation, Siemens Healthcare Diagnostics Inc, Glasgow, Delaware, USA
| | - Walter Hoyer
- Department of Medical Affairs, Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany
| | - Mareike Kahl
- Department of Medical Affairs, Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany
| | - Kandice Kottke-Marchant
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thomas L. Ortel
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Jürgen Patzke
- Department of Assay Development, Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany
| | - Steven W. Pipe
- Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Morgan Stuart
- Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ayse Anil Timur
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ravindra Sarode
- Pathology and Internal Medicine (Hematology/Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, USA
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2
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Noye J, Beggs J, Mason J. Discrepant low von Willebrand factor activity results on the ACL TOP analyzer are frequent in unselected patients with myeloproliferative neoplasms and show no correlation with high-molecular-weight multimer loss or bleeding phenotype. J Thromb Haemost 2024; 22:965-974. [PMID: 38160725 DOI: 10.1016/j.jtha.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Bleeding complications are common in patients with myeloproliferative neoplasms (MPNs), with a subset developing acquired von Willebrand disease. Despite this association, a wide spectrum of von Willebrand factor (VWF) abnormalities are described, and the performance of modern assays remains unclear. OBJECTIVES To comprehensively describe the pattern of VWF laboratory abnormalities in the MPN population. METHODS We collected samples from 74 unselected clinic patients with MPNs to evaluate VWF quantitatively and qualitatively via multiple methods, correlating findings with a retrospective analysis of clinical bleeding data. VWF assays were performed on both ACL TOP (Instrumentation Laboratory) and Acustar (Instrumentation Laboratory) analyzers using HemosIL reagents (Instrumentation Laboratory), along with multimer analysis by gel electrophoresis. RESULTS Functional VWF measurements were not concordant between assays, with a median ACL TOP VWF glycoprotein IbR to antigen ratio (VWF:GPIbR/VWF:Ag) of 0.57 (IQR, 0.43-0.71) compared to a median Acustar VWF:GPIbR/VWF:Ag of 0.91 (IQR: 0.82-1.03;P < .001). The ACL TOP showed disproportionately lower results, with 73% of patients having a ratio <0.7. Despite this, no patient experienced loss of high-molecular-weight multimers by gel electrophoresis. An inverse relationship was observed between platelet count and functional ratios on both ACL TOP (R2 = 0.20; P < .001) and Acustar (R2 = 0.18; P = .0011) analyzers. While clinically significant bleeding events were relatively common (11% patients), there was no association with VWF assay abnormalities, and generally, an alternate cause(s) was identified. CONCLUSION Discrepancies in functional VWF assays are common in patients with MPN, particularly by ACL TOP VWF:GPIbR. Based on our limited series, a VWF functional to an antigenic ratio of <0.7 ("type 2 pattern") alone is poorly predictive of bleeding risk.
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Affiliation(s)
- Joseph Noye
- Department of Haematology, Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Joanne Beggs
- Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jane Mason
- Department of Haematology, Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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3
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Ay C, Kovacevic KD, Kraemmer D, Schoergenhofer C, Gelbenegger G, Firbas C, Quehenberger P, Jilma-Stohlawetz P, Gilbert JC, Zhu S, Beliveau M, Koenig F, Iorio A, Jilma B, Derhaschnig U, Pabinger I. The von Willebrand factor-binding aptamer rondaptivon pegol as a treatment for severe and nonsevere hemophilia A. Blood 2023; 141:1147-1158. [PMID: 36108308 PMCID: PMC10651782 DOI: 10.1182/blood.2022016571] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 11/20/2022] Open
Abstract
Factor VIII (FVIII) circulates in a noncovalent complex with von Willebrand Factor (VWF), the latter determining FVIII half-life. The VWF-binding aptamer rondaptivon pegol (BT200) increases plasma levels of VWF/FVIII in healthy volunteers. This trial assessed its safety, pharmacokinetics, and pharmacodynamics in hemophilia A. Nineteen adult patients (ages 20-62 years, 4 women) with hemophilia A (8 mild, 2 moderate, and 9 severe) received subcutaneous injections of rondaptivon pegol. After an initial fixed dose of 3 mg on days 0 and 4, patients received weekly doses of 2 to 9 mg until day 28. Severe hemophilia A patients underwent sparse-sampling population pharmacokinetics individual profiling after the final dose of rondaptivon pegol. Adverse events, pharmacokinetics, and pharmacodynamics were assessed. FVIII activity and VWF levels were measured. All patients tolerated rondaptivon pegol well. The geometric mean half-life of rondaptivon pegol was 5.4 days and rondaptivon pegol significantly increased VWF levels. In severe hemophilia A, 6 doses of rondaptivon pegol increased the half-lives of 5 different FVIII products from a median of 10.4 hours to 31.1 hours (range, 20.8-56.0 hours). Median FVIII increased from 22% to 48% in mild hemophilia A and from 3% to 7.5% in moderate hemophilia A. Rondaptivon pegol is a first-in-class prohemostatic molecule that extended the half-life of substituted FVIII approximately 3-fold and increased endogenous FVIII levels approximately 2-fold in hemophilia patients. This trial was registered at www.clinicaltrials.gov as #NCT04677803.
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Affiliation(s)
- Cihan Ay
- Clinical Division of Hematology and Hemastaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Daniel Kraemmer
- Clinical Division of Hematology and Hemastaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Georg Gelbenegger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Christa Firbas
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Peter Quehenberger
- Clinical Institute of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Petra Jilma-Stohlawetz
- Clinical Institute of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Shuhao Zhu
- Guardian Therapeutics, Lexington, Massachusetts
| | | | - Franz Koenig
- CEMSIS, Medical University of Vienna, Vienna, Austria
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ulla Derhaschnig
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ingrid Pabinger
- Clinical Division of Hematology and Hemastaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Seidizadeh O, Peyvandi F. Laboratory Testing for von Willebrand Factor Activity by a Glycoprotein Ib-Binding Assay (VWF:GPIbR): HemosIL von Willebrand Factor Ristocetin Cofactor Activity on ACL TOP ®. Methods Mol Biol 2023; 2663:669-677. [PMID: 37204744 DOI: 10.1007/978-1-0716-3175-1_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
von Willebrand disease (VWD) is a lifelong and common inherited bleeding disorder caused by a quantitative deficiency and/or qualitative defect of von Willebrand factor (VWF). In order to establish the correct diagnosis of VWD, various tests must be conducted, including evaluation of factor VIII activity (FVIII:C), VWF antigen (VWF:Ag), and VWF functional activity. The platelet-dependent VWF activity is measured in different ways, with the historical ristocetin cofactor assay (VWF:RCo) using platelet aggregometry now replaced with newer assays that offer better precision, lower limits of detection, low coefficient of variation, and are fully automated. The VWF activity by glycoprotein Ib-binding assays (VWF:GPIbR) measured on the ACL TOP® platform represents an automated assay that instead of using platelets employs latex beads coated with recombinant wild-type GPIb. VWF in the test sample agglutinates the polystyrene beads coated with GPIb in the presence of ristocetin. The reduction of turbidity as beads agglutinate represents a linear relationship with VWF:GPIbR activity. Using a ratio of VWF:GPIbR/VWF:Ag, the VWF:GPIbR assay also provides good sensitivity and specificity for distinguishing type 1 VWD from type 2. The following chapter describes a detailed protocol for the VWF:GPIbR assay.
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Affiliation(s)
- Omid Seidizadeh
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
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5
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Salazar E, Higgins RA. Automation in the Thrombosis and Hemostasis Laboratory. Methods Mol Biol 2023; 2663:51-62. [PMID: 37204703 DOI: 10.1007/978-1-0716-3175-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Automation continues to advance into hemostasis and thrombosis laboratories. Integration of hemostasis testing into an existing chemistry track systems and adoption of a separate hemostasis track systems are important considerations. Unique issues must be addressed to maintain quality and efficiency when automation is introduced. Among other challenges, this chapter discusses centrifugation protocols, incorporation of specimen-check modules in the workflow, and inclusion of tests amenable to automation.
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Affiliation(s)
- Eric Salazar
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
| | - Russell A Higgins
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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6
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Kassab HS, Morsy EY, Abdirahman AN, Amin NG. Study of the relation between plasma level of von Willebrand factor and diabetic retinopathy in type 2 diabetes. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Purpose
Diabetic retinopathy (DR) is a major preventable health complication of type 2 diabetes (T2DM). Hyperglycemia represents the main mechanism in the pathogenesis of DR leading eventually to endothelial dysfunction. vWF is a marker of endothelial dysfunction, but its relation to DR is not yet well-established.
Methods
The present study included 60 patients with T2DM divided into three equal groups according to the presence and the stage of retinopathy. Each patient was subjected to full history taking, physical examination including fundus examination, and laboratory investigations including glycemic and lipid profile, urinary albumin to creatinine ratio (UACR), and plasma vWF level.
Results
Plasma vWF was significantly higher in patients with DR than in patients without retinopathy. vWF was positively correlated to age, HbA1c, diabetes duration, and UACR in DR groups and the total sample. Univariate regression analysis revealed that HbA1c, vWF, BMI, diabetes duration, and UACR were independent risk factors for DR, while multivariate regression analysis showed none of them to be an independent risk factor for DR. A vWF cut-off value of > 180 could differentiate patients with DR from patients without DR with a sensitivity of 97.5%, specificity of 75%, and AUC 0.937*.
Conclusions
vWF level is higher in patients with DR reflecting the role of endothelial dysfunction in the development of DR. Moreover, it is one of the risk factors affecting DR in univariate but not in multivariate analysis. A cut-off value of vWF level was set to differentiate between patients with and without DR.
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7
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Ziemba YC, Abdulrehman J, Hollestelle MJ, Meijer P, Plumhoff E, Hsu P, Selby R. Diagnostic Testing for von Willebrand Disease: Trends and Insights from North American Laboratories over the Last Decade. Semin Thromb Hemost 2022; 48:700-710. [PMID: 36122573 DOI: 10.1055/s-0042-1754332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Accurate diagnosis of von Willebrand disease (VWD) depends on the quality, precision, and variability of the laboratory assays. The North American Specialized Coagulation Laboratory Association (NASCOLA) is a provider of external quality assessment (EQA) for approximately 60 specialized coagulation laboratories in North America. In this report, NASCOLA EQA data from 2010 to 2021 are reviewed for trends in methodology and precision among various assays. In particular, recent ASH ISTH NHF WFH (American Society of Hematology, International Society on Thrombosis and Haemostasis, National Hemophilia Foundation, and World Hemophilia Federation) guidelines for diagnosis of VWD are reviewed in light of EQA data. In contrast to other geographic regions, laboratories in North America predominantly use three-assay screening panels (antigen, platelet-binding activity, and factor VIII [FVIII] activity) rather than four-assay panels (antigen, platelet-binding activity, FVIII activity, and collagen-binding activity). They also use latex immunoassays rather than chemiluminescence immunoassays, and the classic ristocetin cofactor (VWF:RCo) assay and monoclonal antibody (VWF:Ab) assay to assess VWF platelet-binding activity over newer recommended assays (VWF:GPIbM and VWF:GPIbR). Factors that may be influencing these North American practice patterns include lack of Food and Drug Administration approval of the VWF:GPIbM, VWF:GPIbR, collagen binding assays, and chemiluminescence methodologies, and the influence of the 2008 National Heart, Lung, and Blood Institute guidelines on laboratory practice. Lastly, systems-based solutions are urgently needed to improve the overall accuracy of laboratory testing for VWD by minimizing preanalytical variables and adopting assay standardization.
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Affiliation(s)
- Yonah C Ziemba
- Department of Pathology and Laboratory Medicine, Northwell Health, New York, New York
| | | | | | - Piet Meijer
- ECAT Foundation, Voorschoten, the Netherlands
| | - Elizabeth Plumhoff
- North American Specialized Coagulation Laboratory Association, Rochester, Minnesota
| | - Peihong Hsu
- Department of Pathology and Laboratory Medicine, Northwell Health, New York, New York
| | - Rita Selby
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,North American Specialized Coagulation Laboratory Association, Rochester, Minnesota.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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8
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Tiede A, Zieger B, Lisman T. Acquired bleeding disorders. Haemophilia 2022; 28 Suppl 4:68-76. [PMID: 35521729 DOI: 10.1111/hae.14548] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 12/19/2022]
Abstract
Acquired bleeding disorders can accompany hematological, neoplastic, autoimmune, cardiovascular or liver diseases, but can sometimes also arise spontaneously. They can manifest as single factor deficiencies or as complex hemostatic abnormalities. This review addresses (a) acquired hemophilia A, an autoimmune disorder characterized by inhibitory autoantibodies against coagulation factor VIII; (b) acquired von Willebrand syndrome in patients with cardiovascular disorders, where shear stress abnormalities result in destruction of von Willebrand factor; and (c) liver function disorders that comprise complex changes in pro- and anti-hemostatic factors, whose clinical implications are often difficult to predict. The article provides an overview on the pathophysiology, diagnostic tests and state-of-the-art treatment strategies.
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Affiliation(s)
- Andreas Tiede
- Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Barbara Zieger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ton Lisman
- Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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9
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Kanji R, Vandenbriele C, Arachchillage DRJ, Price S, Gorog DA. Optimal Tests to Minimise Bleeding and Ischaemic Complications in Patients on Extracorporeal Membrane Oxygenation. Thromb Haemost 2022; 122:480-491. [PMID: 33984868 DOI: 10.1055/a-1508-8230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Patients supported with extracorporeal membrane oxygenation (ECMO) experience a very high frequency of bleeding and ischaemic complications, including stroke and systemic embolism. These patients require systemic anticoagulation, mainly with unfractionated heparin (UFH) to prevent clotting of the circuit and reduce the risk of arterial or venous thrombosis. Monitoring of UFH can be very challenging. While most centres routinely monitor the activated clotting time and activated partial thromboplastin time (aPTT) to assess UFH, measurement of anti-factor Xa (anti-Xa) level best correlates with heparin dose, and appears to be predictive of circuit thrombosis, although aPTT may be a better predictor of bleeding. Although monitoring of prothrombin time, platelet count and fibrinogen is routinely undertaken to assess haemostasis, there is no clear guidance available regarding the optimal test.Additional tests, including antithrombin level and thromboelastography, can be used for risk stratification of patients to try and predict the risks of thrombosis and bleeding. Each has their specific role, strengths and limitations. Increased thrombin generation may have a role in predicting thrombosis. Acquired von Willebrand syndrome is frequent with ECMO, contributing to bleeding risk and can be detected by assessing the von Willebrand factor activity-to-antigen ratio, while the platelet function analyser can be used in urgent situations to detect this, with a high negative predictive value. Tests of platelet aggregation can aid in the prediction of bleeding.To personalise management, a selection of complementary tests to collectively assess heparin-effect, coagulation, platelet function and platelet aggregation is proposed, to optimise clinical outcomes in these high-risk patients.
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Affiliation(s)
- Rahim Kanji
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Christophe Vandenbriele
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
| | - Deepa R J Arachchillage
- Haematology Department, Royal Brompton Hospital, London, United Kingdom.,Centre for Haematology, Imperial College Healthcare NHS Trust & Imperial College, London, United Kingdom
| | - Susanna Price
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.,Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
| | - Diana Adrienne Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
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10
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Von Willebrand Factor and Platelet Aggregation: from Bench to Clinical Practice. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Laboratory Assays of VWF Activity and Use of Desmopressin Trials in the Diagnosis of VWD: A Systematic Review and Meta-Analysis. Blood Adv 2022; 6:3735-3745. [PMID: 35192687 PMCID: PMC9631556 DOI: 10.1182/bloodadvances.2021005431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/02/2022] [Indexed: 11/20/2022] Open
Abstract
The findings of these reviews support VWF multimer analysis or VWF:CB/VWF:Ag to diagnose type 2 VWD. The reviews confirm that desmopressin trial is the test of choice to confirm increased VWF clearance in patients with suspected VWD type 1C.
von Willebrand Disease (VWD) is associated with significant morbidity because of excessive bleeding. Early diagnosis and treatment are important to prevent and treat these symptoms. We systematically reviewed the accuracy of any von Willebrand factor (VWF) activity assay in the diagnosis and classification of patients for VWD. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and the certainty of evidence using the GRADE framework. We pooled estimates of sensitivity and specificity. The review included 77 studies that evaluated the use of newer tests of VWF platelet binding activity (VWF:GPIbR, VWF:GPIbM) and VWF:RCo for the diagnosis of VWD (13 studies), VWF propeptide to VWF:Ag ratio, and desmopressin trial for the diagnosis of type 1C VWD (5 studies), VWF multimer analysis and VWF:CB/VWF:Ag ratio for the classification of type 2 VWD (11 studies), genetic testing and ristocetin-induced platelet aggregation to diagnose type 2B VWD (14 studies), genetic testing and FVIII:VWF binding to diagnose type 2N VWD (17 studies). Based on available diagnostic test accuracy, there appear to be comparable test accuracy results between newer tests of platelet binding activity of VWF function and VWF:RCo. The findings of these reviews support VWF multimer analysis or VWF:CB/VWF:Ag to diagnose type 2 VWD. The desmopressin trial test with 1- and 4-hour postinfusion blood work is the test of choice to confirm increased VWF clearance in patients with suspected VWD type 1C. Additionally, genetic testing is most useful in diagnosing type 2B VWD and has a role in the diagnostic algorithm of suspected type 2N VWD.
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Lapić I, Radić Antolic M, Dejanović Bekić S, Coen-Herak D, Bilić E, Rogić D, Zadro R. Reevaluation of von Willebrand disease diagnosis in a Croatian paediatric cohort combining bleeding scores, phenotypic laboratory assays and next generation sequencing: a pilot study. Biochem Med (Zagreb) 2022; 32:010707. [PMID: 35210927 PMCID: PMC8833252 DOI: 10.11613/bm.2022.010707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction This study reevaluated von Willebrand disease (vWD) diagnosis in a Croatian paediatric cohort by combining bleeding scores (BS), phenotypic laboratory testing, and next-generation sequencing (NGS). Materials and methods A total of 25 children (11 males and 14 females, median age 10 years, from 2 to 17) previously diagnosed with vWD were included. BS were calculated using an online bleeding assessment tool. Phenotypic laboratory analyses included platelet count, platelet function analyser closure times, prothrombin time, activated partial thromboplastin time, von Willebrand factor antigen (vWF:Ag), vWF gain-of-function mutant glycoprotein Ib binding activity (vWF:GPIbM), vWF collagen binding activity (vWF:CBA), factor VIII activity (FVIII:C) and multimeric analysis. Next-generation sequencing covered regions of both vWF and FVIII genes and was performed on MiSeq (Illumina, San Diego, USA). Results Disease-associated variants identified in 15 patients comprised 11 distinct heterozygous vWF gene variants in 13 patients and one novel FVIII gene variant (p.Glu2085Lys) in two male siblings. Four vWF variants were novel (p.Gln499Pro, p.Asp1277Tyr, p.Asp1277His, p.Lys1491Glu). Three patients without distinctive variants had vWF:GPIbM between 30 and 50%. Patients with identified vWF gene variants had statistically significant lower values of vWF:GPIbM (P = 0.002), vWF:Ag (P = 0.007), vWF:CBA (P < 0.001) and FVIII:C (P = 0.002), compared to those without. Correlations between BS and phenotypic laboratory test results were not statistically significant for either of the tests. Conclusion The applied diagnostic approach confirmed the diagnosis of vWD in 13 patients and mild haemophilia A in two. Limited utility of BS in the paediatric population was evidenced.
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Affiliation(s)
- Ivana Lapić
- Department of Laboratory Diagnostics,University Hospital Center Zagreb, Zagreb, Croatia
- Corresponding author:
| | | | - Sara Dejanović Bekić
- Referral Center for Pediatrics Hematology and Oncology, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Désirée Coen-Herak
- Department of Laboratory Diagnostics,University Hospital Center Zagreb, Zagreb, Croatia
| | - Ernest Bilić
- Referral Center for Pediatrics Hematology and Oncology, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Dunja Rogić
- Department of Laboratory Diagnostics,University Hospital Center Zagreb, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Renata Zadro
- Medical Biochemistry Laboratory, St Catherine Specialty Hospital, Zagreb, Croatia
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Maas DPMSM, Atiq F, Blijlevens NMA, Brons P, Krouwel S, Laros‐van Gorkom BAP, Leebeek F, Nieuwenhuizen L, Schoormans SCM, Simons A, Meijer D, van Heerde WL, Schols SEM. Von Willebrand disease type 2M: Correlation between genotype and phenotype. J Thromb Haemost 2022; 20:316-327. [PMID: 34758185 PMCID: PMC9299039 DOI: 10.1111/jth.15586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/21/2021] [Accepted: 11/05/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND An appropriate clinical diagnosis of von Willebrand disease (VWD) can be challenging because of a variable bleeding pattern and laboratory phenotype. Genotyping is a powerful diagnostic tool and may have an essential role in the diagnostic field of VWD. OBJECTIVES To unravel the clinical and laboratory heterogeneity of genetically confirmed VWD type 2M patients and to investigate their relationship. METHODS Patients with a confirmed VWD type 2M genetic variant in the A1 or A3 domain of von Willebrand factor (VWF) and normal or only slightly aberrant VWF multimers were selected from all subjects genotyped at the Radboud university medical center because of a high suspicion of VWD. Bleeding scores and laboratory results were analyzed. RESULTS Fifty patients had a clinically relevant genetic variant in the A1 domain. Median bleeding score was 5. Compared with the nationwide Willebrand in the Netherlands study type 2 cohort, bleeding after surgery or delivery was reported more frequently and mucocutaneous bleedings less frequently. Median VWF activity/VWF antigen (VWF:Act/VWF:Ag) ratio was 0.32, whereas VWF collagen binding activity/VWF antigen (VWF:CB/VWF:Ag) ratio was 0.80. Variants in the A3 domain were only found in two patients with low to normal VWF:Act/VWF:Ag ratios (0.45, 1.03) and low VWF:CB/VWF:Ag ratios (0.45, 0.63). CONCLUSION Genetically confirmed VWD type 2M patients have a relatively mild clinical phenotype, except for bleeding after surgery and delivery. Laboratory phenotype is variable and depends on the underlying genetic variant. Addition of genotyping to the current phenotypic characterization may improve diagnosis and classification of VWD.
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Affiliation(s)
- Dominique P. M. S. M. Maas
- Department of HematologyRadboud university medical centerNijmegenthe Netherlands
- Hemophilia Treatment Center Nijmegen‐Eindhoven‐Maastrichtthe Netherlands
| | - Ferdows Atiq
- Department of HematologyErasmus University Medical CenterRotterdamthe Netherlands
| | | | - Paul P. T. Brons
- Hemophilia Treatment Center Nijmegen‐Eindhoven‐Maastrichtthe Netherlands
- Department of Pediatric Hemato‐OncologyRadboud university medical centerNijmegenthe Netherlands
| | - Sandy Krouwel
- Department of Laboratory MedicineLaboratory of HematologyRadboud university medical centerNijmegenthe Netherlands
| | - Britta A. P. Laros‐van Gorkom
- Department of HematologyRadboud university medical centerNijmegenthe Netherlands
- Hemophilia Treatment Center Nijmegen‐Eindhoven‐Maastrichtthe Netherlands
| | - Frank W. G. Leebeek
- Department of HematologyErasmus University Medical CenterRotterdamthe Netherlands
| | - Laurens Nieuwenhuizen
- Hemophilia Treatment Center Nijmegen‐Eindhoven‐Maastrichtthe Netherlands
- Department of HematologyMaxima Medical CenterEindhoventhe Netherlands
| | - Selene C. M. Schoormans
- Department of Laboratory MedicineLaboratory of HematologyRadboud university medical centerNijmegenthe Netherlands
| | - Annet Simons
- Department of Human GeneticsRadboud university medical centerNijmegenthe Netherlands
| | - Daniëlle Meijer
- Department of Laboratory MedicineLaboratory of HematologyRadboud university medical centerNijmegenthe Netherlands
| | - Waander L. van Heerde
- Department of HematologyRadboud university medical centerNijmegenthe Netherlands
- Hemophilia Treatment Center Nijmegen‐Eindhoven‐Maastrichtthe Netherlands
- Enzyre BVNovio Tech CampusNijmegenthe Netherlands
| | - Saskia E. M. Schols
- Department of HematologyRadboud university medical centerNijmegenthe Netherlands
- Hemophilia Treatment Center Nijmegen‐Eindhoven‐Maastrichtthe Netherlands
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14
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OUP accepted manuscript. Lab Med 2022; 53:349-359. [DOI: 10.1093/labmed/lmac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Harris NS, Pelletier JP, Marin MJ, Winter WE. Von Willebrand factor and disease: a review for laboratory professionals. Crit Rev Clin Lab Sci 2021; 59:241-256. [DOI: 10.1080/10408363.2021.2014781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Neil S. Harris
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - J. Peter Pelletier
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Maximo J. Marin
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - William E. Winter
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida, Gainesville, FL, USA
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16
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Luiro K, Holopainen E. Heavy Menstrual Bleeding in Adolescent: Normal or a Sign of an Underlying Disease? Semin Reprod Med 2021; 40:23-31. [PMID: 34734398 DOI: 10.1055/s-0041-1739309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Heavy, and often irregular, menstrual bleeding (HMB) is a common gynecologic complaint among adolescents. During the first few post-menarcheal years, anovulatory cycles related to immaturity of the hypothalamic-pituitary-ovarian axis are the most common etiology for abnormal uterine bleeding and should be considered as a part of normal pubertal development rather than a disease. If an already regular menstrual cycle becomes irregular, secondary causes of anovulation should be ruled out. Inherited and acquired bleeding disorders, such as von Willebrand disease, and quantitative and qualitative abnormalities of platelets are relatively common findings in adolescents with HMB from menarche. History of excessive bleeding or a diagnosed bleeding disorder in the family supports this etiology, warranting specialized laboratory testing. First-line treatment of HMB among adolescents is medical management with hormonal therapy or nonhormonal options. Levonorgestrel-releasing intrauterine device is an effective tool also for all adolescents with menstrual needs.
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Affiliation(s)
- Kaisu Luiro
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Elina Holopainen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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17
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Nair D, Sreejith N, Bhambra A, Bruce J, Mellor S, Brown LJ, Harky A. Cardiac Surgery in Patients With Blood Disorders. Heart Lung Circ 2021; 31:167-176. [PMID: 34686413 DOI: 10.1016/j.hlc.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/18/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Blood disorders that can contribute to abnormal bleeding can have a detrimental effect during cardiac surgery. Patients who are known to have such pathologies should be investigated thoroughly and cautious measures would need to be taken when cardiac surgery is needed in this cohort. The majority of current literature for cardiac surgery in patients with von Willebrand Disease and haemophilia are case reports. Nevertheless, evidence shows that optimising factor levels pre, intra and postoperatively offers outcomes similar to that of patients without these disorders. Preoperative screening followed by appropriate iron therapy reduces mortality for patients with anaemia. In this group, haemoglobin levels can be improved postoperatively through iron supplementation. The management strategy of cardiac surgery for people with blood disorders requires a multidisciplinary approach that is highly individualised for each patient. It is essential to adequately adjust preoperative, perioperative and postoperative care to the patient's blood disorder in order to achieve outcomes similar to that of patients without blood disorders.
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Affiliation(s)
- Devika Nair
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Amman Bhambra
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jonathan Bruce
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sophie Mellor
- Sandwell & West Birmingham NHS Trust, Sandwell General Hospital, West Bromwich, UK
| | - Louise J Brown
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK; Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK.
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18
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Seaman CD, Bertolet M, Zhang J, Ragni MV. Quality of periprocedural care in patients with von Willebrand disease. Haemophilia 2021; 27:830-836. [PMID: 34343372 DOI: 10.1111/hae.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION While it has been shown that haemophilia patients receiving care at Haemophilia Treatment Centres (HTCs) experience decreased morbidity and mortality, little research has been done on the outcomes of patients with von Willebrand disease (VWD). AIM To compare the quality of periprocedural care received by patients with VWD at HTCs and non-HTCs. METHODS We performed a retrospective chart review on all adult VWD patients undergoing an invasive procedure from 2015 to 2017. Quality of periprocedural care was measured using the following surrogate outcomes: periprocedural VWD-specific therapy use per 2007 National Heart, Lung, and Blood Institute (NHLBI) guidelines, procedural estimated blood loss (EBL), and post-procedure bleeding. Comparisons were performed according to the setting of care at the time of the invasive procedure, HTC versus non-HTC. RESULTS There were 668 invasive procedures performed on 305 patients, of which 8.2% were HTC cases. Non-type 1 VWD was more likely in HTC cases. VWD-specific therapy was used per NHLBI guidelines in 100% of HTC cases compared with 10.6% of non-HTC cases. Procedural EBL > = 100 ml was more likely to occur in HTC differences cases (OR = 2.34; 95% CI, 1.05 to 5.25). There was no difference in post-procedure bleeding between the two groups (OR = 1.26, 95% CI, .20- 7.86). CONCLUSION Despite widespread periprocedural use of VWD-specific therapy outside established guidelines at non-HTCs, there was no difference in periprocedural bleeding. Possible explanations include diagnostic error, in disease severity and procedure types, and dataset limitations. Additional studies are needed to investigate this further and compare other patient care outcomes between HTCs and non-HTCs.
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Affiliation(s)
- Craig D Seaman
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, USA
| | - Marnie Bertolet
- Departments of Epidemiology, Biostatistics, and the Clinical and Translational Science Institute, Pittsburgh, Pennsylvania, USA
| | - Jun Zhang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Margaret V Ragni
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, USA
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19
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Gardiner C, Coleman R, de Maat MPM, Dorgalaleh A, Echenagucia M, Gosselin RC, Ieko M, Kitchen S. International Council for Standardization in Haematology (ICSH) laboratory guidance for the verification of haemostasis analyser-reagent test systems. Part 2: Specialist tests and calibrated assays. Int J Lab Hematol 2021; 43:907-916. [PMID: 33876567 DOI: 10.1111/ijlh.13550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 12/28/2022]
Abstract
Before a new method is used for clinical testing, it is essential that it is evaluated for suitability for its intended purpose. This document gives guidance for the performance, verification and implementation processes required by regulatory and accreditation bodies. It covers the planning and verification of specialist haemostatic tests, including factor assays, D-dimers, direct anticoagulants and thrombophilia testing.
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Affiliation(s)
- Chris Gardiner
- Haemostasis Research Unit, University College London, London, U.K
| | - Robyn Coleman
- Department of Haematology, Sullivan Nicolaides Pathology, Bowen Hills, QLD, Australia
| | - Moniek P M de Maat
- Department of Haematology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Akbar Dorgalaleh
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marión Echenagucia
- Centro Nacional de Hemofilia, Banco Municipal de Sangre del Distrito Capital, Caracas, Venezuela
| | - Robert C Gosselin
- Thrombosis and Hemostasis Center, University of California, Davis Health System, Sacramento, CA, USA
| | - Masahiro Ieko
- Department of Hematology/Clinical Laboratory, Iwate Prefectural Chubu Hospital, Kitakami, Japan
| | - Steve Kitchen
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, U.K
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20
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Jo SY, Kim IS, Kim H. Potential misdiagnosis of von Willebrand disease caused by insufficient mixing after thawing frozen plasma. Int J Lab Hematol 2020; 43:831-836. [PMID: 33369143 DOI: 10.1111/ijlh.13445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION von Willebrand disease (vWD) is a common inherited bleeding disorder caused by a deficiency in von Willebrand factor (vWF), but many laboratories and clinicians continue to struggle with diagnosing or excluding vWD. Its diagnosis requires laboratory testing, which may be compromised by preanalytical events, including poor specimen quality. This study assessed 17 different preanalytical conditions as potential causes of vWD misdiagnosis. METHODS Specimens from healthy controls (N = 21) were obtained. vWF antigen and vWF activity were analyzed using a newly developed automatic coagulation analyzer according to various preanalytic conditions such as centrifugation conditions, storage room temperature before centrifugation, cold storage temperature after centrifugation, thawing conditions, and inadequate mixing of thawed citrated plasma following the recommendations of the Clinical and Laboratory Standards Institute (CLSI) H21-A5 guidelines. RESULTS The only condition that was significantly different from the reference condition was lack of mixing after thawing frozen citrated plasma (vWF activity and antigen were reduced by 58.7% and 49.6%, respectively). Our study showed that mixing after thawing was more important than the chosen method of mixing. CONCLUSION Thawed plasma should be mixed because of the risk of misdiagnosing vWD. Further education regarding the importance of appropriate mixing is warranted to achieve results comparable to those of freshly centrifuged samples.
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Affiliation(s)
- Su-Yeon Jo
- Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - In-Suk Kim
- Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyerim Kim
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, Korea
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21
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Seaman CD, Ragni MV. The Effect of Age on von Willebrand Factor and Bleeding Symptoms in von Willebrand Disease. Thromb Haemost 2020; 120:1159-1165. [DOI: 10.1055/s-0040-1713636] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstractvon Willebrand disease (VWD) is a quantitative or qualitative defect in von Willebrand factor (VWF) resulting in mucocutaneous bleeding symptoms and hemorrhage following hemostatic challenges, such as trauma or surgery. VWD-specific therapy, DDAVP (1-desamino-8-D-arginine vasopressin) and VWF concentrates, is necessary periprocedurally to ensure adequate hemostasis. The aging VWD patient may complicate this matter. The plasma concentration of many coagulation proteins, including VWF, increases with age. While it has been established that VWF levels increase with age in a healthy population, emerging research demonstrates this occurs in certain subtypes of VWD, too. Thus, the management of periprocedural VWD-specific therapy in the aging VWD patient is problematic when VWF levels increase over time to normal, and hematologists are left with uncertainty regarding whether or not periprocedural VWD-specific therapy is still necessary. In this article, we will review the current state of the literature regarding the effect of age on VWF levels in the healthy population and VWD while exploring possible etiologies for this phenomenon. Further, we will detail how this affects bleeding symptoms and highlight what research remains to be done to optimize care in this patient population.
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Affiliation(s)
- Craig D. Seaman
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, United States
| | - Margaret V. Ragni
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, United States
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22
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Tiede A, Zieger B, Lisman T. Acquired bleeding disorders. Haemophilia 2020; 27 Suppl 3:5-13. [PMID: 32476241 DOI: 10.1111/hae.14033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 12/19/2022]
Abstract
Acquired bleeding disorders can accompany hematological, neoplastic, autoimmune, cardiovascular or liver diseases, but can sometimes also arise spontaneously. They can manifest as single factor deficiencies or as complex hemostatic abnormalities. This review addresses (a) acquired hemophilia A, an autoimmune disorder characterized by inhibitory autoantibodies against coagulation factor VIII; (b) acquired von Willebrand syndrome in patients with cardiovascular disorders, where shear stress abnormalities result in destruction of von Willebrand factor; and (c) liver function disorders that comprise complex changes in pro- and anti-hemostatic factors, whose clinical implications are often difficult to predict. The article provides an overview on the pathophysiology, diagnostic tests and state-of-the-art treatment strategies.
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Affiliation(s)
- Andreas Tiede
- Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Barbara Zieger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ton Lisman
- Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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23
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Fogarty H, Doherty D, O'Donnell JS. New developments in von Willebrand disease. Br J Haematol 2020; 191:329-339. [PMID: 32394456 DOI: 10.1111/bjh.16681] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022]
Abstract
Von Willebrand disease (VWD) constitutes the most common inherited human bleeding disorder. It is associated with a mucocutaneous bleeding phenotype that can significantly impact upon quality of life. Despite its prevalence and associated morbidity, the diagnosis and subclassification of VWD continue to pose significant clinical challenges. This is in part attributable to the fact that plasma von Willebrand factor (VWF) levels vary over a wide range in the normal population, together with the multiple different physiological functions played by VWF in vivo. Over recent years, substantial progress has been achieved in elucidating the biological roles of VWF. Significant advances have also been made into defining the pathophysiological mechanisms underpinning both quantitative and qualitative VWD. In particular, several new laboratory assays have been developed that enable more precise assessment of specific aspects of VWF activity. In the present review, we discuss these recent developments in the field of VWD diagnosis, and consider how these advances can impact upon clinical diagnostic algorithms for use in routine clinical practice. In addition, we review some important recent advances pertaining to the various treatment options available for managing patients with VWD.
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Affiliation(s)
- Helen Fogarty
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.,National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Dearbhla Doherty
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James S O'Donnell
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.,National Coagulation Centre, St James's Hospital, Dublin, Ireland.,National Children's Research Centre, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
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24
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Multi-Modal Characterization of the Coagulopathy Associated With Extracorporeal Membrane Oxygenation. Crit Care Med 2020; 48:e400-e408. [DOI: 10.1097/ccm.0000000000004286] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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25
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Rezaei H, Motovali-bashi M, Radfar S. An enzyme-free electrochemical biosensor for simultaneous detection of two hemophilia A biomarkers: Combining target recycling with quantum dots-encapsulated metal-organic frameworks for signal amplification. Anal Chim Acta 2019; 1092:66-74. [DOI: 10.1016/j.aca.2019.09.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/28/2019] [Accepted: 09/12/2019] [Indexed: 01/17/2023]
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