1
|
Tiede A, Susen S, Lisman T. Acquired bleeding disorders. Haemophilia 2024; 30 Suppl 3:29-38. [PMID: 38562115 DOI: 10.1111/hae.14995] [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: 01/23/2024] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
Acquired bleeding disorders can develop in previously healthy people irrespective of age or gender but are particularly common in patients with certain underlying conditions. Here, we review recent advances in the management of acquired haemophilia A (AHA), acquired von Willebrand syndrome (AVWS), and patients with hemostatic abnormalities due to chronic liver disease (CLD). Patients with AHA can now benefit from prophylaxis with emicizumab, a therapeutic antibody that mimics the function of activated coagulation factor VIII. The treatment of AVWS remains challenging in many situations and requires careful consideration of the underlying condition. Haemostatic abnormalities in CLD are often compensated by proportional reduction in pro and anti-haemostatic factors resulting in sustained or even increased thrombin generation. Consequently, bleeding in CLD is rarely caused by haemostatic failure and infusion of plasma or coagulation factor concentrates may not be effective.
Collapse
Affiliation(s)
- Andreas Tiede
- Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Sophie Susen
- Hemostasis and Transfusion Department, University of Lille, Lille University Hospital, Lille, France
| | - Ton Lisman
- Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| |
Collapse
|
2
|
Suárez EU, Vidal-Laso R. Heyde syndrome. Ann Hematol 2023; 102:2617-2618. [PMID: 37246201 DOI: 10.1007/s00277-023-05299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/24/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Edwin Uriel Suárez
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain.
| | - Rosa Vidal-Laso
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| |
Collapse
|
3
|
Alkhalid Y, Darji Z, Shenkar R, Clancy M, Dyamenahalli U, Awad IA. Multidisciplinary coordinated care of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease). Vasc Med 2023; 28:153-165. [PMID: 36890671 DOI: 10.1177/1358863x231151731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is a rare disorder with a case prevalence as high as one in 5000, causing arteriovenous malformations in multiple organ systems. HHT is familial with autosomal dominant inheritance, with genetic testing allowing confirmation of the diagnosis in asymptomatic kindreds. Common clinical manifestations are epistaxis and intestinal lesions causing anemia and requiring transfusions. Pulmonary vascular malformations predispose to ischemic stroke and brain abscess and may cause dyspnea and cardiac failure. Brain vascular malformations can cause hemorrhagic stroke and seizures. Rarely, liver arteriovenous malformations can cause hepatic failure. A form of HHT can cause juvenile polyposis syndrome and colon cancer. Specialists in multiple fields may be called to care for one or more aspects of HHT, but few are familiar with evidence-based guidelines for HHT management or see a sufficient number of patients to gain experience with the unique characteristics of the disease. Primary care physicians and specialists are often unaware of the important manifestations of HHT in multiple systems and the thresholds for their screening and appropriate management. To improve familiarity, experience, and coordinated multisystem care for patients with HHT, the Cure HHT Foundation, which advocates for patients and families with this disease, has accredited 29 centers in North America with designated specialists for the evaluation and care of patients with HHT. Team assembly and current screening and management protocols are described as a model for evidence-based, multidisciplinary care in this disease.
Collapse
Affiliation(s)
- Yasmine Alkhalid
- Department of Neurological Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Zeena Darji
- Department of Neurological Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Robert Shenkar
- Department of Neurological Surgery, University of Chicago Medicine, Chicago, IL, USA
| | | | - Umesh Dyamenahalli
- Department of Pediatrics, Section of Pediatric Cardiology, University of Chicago Medicine, Chicago, IL, USA
| | - Issam A Awad
- Department of Neurological Surgery, University of Chicago Medicine, Chicago, IL, USA.,Multidisciplinary faculty of the HHT Center of Excellence at University of Chicago Medicine, Chicago, IL, USA includes: Remzi Bag, Section of Pulmonary Medicine; Fuad Baroody, Section of Otolaryngology and Head and Neck Surgery; Elizabeth Blair, Section of Otolaryngology and Head and Neck Surgery; Diana Bolotin, Section of Dermatology; James R Brorson, Department of Neurology; Kenneth S Cohen, Section of Hematology and Oncology; Brian Funaki, Section of Interventional Radiology; Hilary Jericho, Section of Pediatric Gastroenterology; Tarek Kass-Hout: Department of Neurology; Sonia Kupfer, Section of Gastroenterology; James K Liao, Section of Cardiology; Anjana Pillai, Section of Gastroenterology; Jayant Pinto, Section of Otolaryngology and Head and Neck Surgery; Christopher Roxbury, Section of Otolaryngology and Head and Neck Surgery; Carol E Semrad, Section of Gastroenterology; Sarah Stein, Section of Dermatology; Mary E Strek: Section of Pulmonary Medicine; Darrel J Waggoner, Department of Human Genetics; Steven Zangan, Section of Interventional Radiology
| | -
- Multidisciplinary faculty of the HHT Center of Excellence at University of Chicago Medicine, Chicago, IL, USA includes: Remzi Bag, Section of Pulmonary Medicine; Fuad Baroody, Section of Otolaryngology and Head and Neck Surgery; Elizabeth Blair, Section of Otolaryngology and Head and Neck Surgery; Diana Bolotin, Section of Dermatology; James R Brorson, Department of Neurology; Kenneth S Cohen, Section of Hematology and Oncology; Brian Funaki, Section of Interventional Radiology; Hilary Jericho, Section of Pediatric Gastroenterology; Tarek Kass-Hout: Department of Neurology; Sonia Kupfer, Section of Gastroenterology; James K Liao, Section of Cardiology; Anjana Pillai, Section of Gastroenterology; Jayant Pinto, Section of Otolaryngology and Head and Neck Surgery; Christopher Roxbury, Section of Otolaryngology and Head and Neck Surgery; Carol E Semrad, Section of Gastroenterology; Sarah Stein, Section of Dermatology; Mary E Strek: Section of Pulmonary Medicine; Darrel J Waggoner, Department of Human Genetics; Steven Zangan, Section of Interventional Radiology
| |
Collapse
|
4
|
Lai Y, Xu H, Su Q, Zhou Z. A breath-taking total knee arthroplasty in a patient with acquired von willebrand syndrome: A case report and literature review. Asian J Surg 2023; 46:896-898. [PMID: 35963683 DOI: 10.1016/j.asjsur.2022.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/15/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Yahao Lai
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, PR China
| | - Hong Xu
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, PR China
| | - Qiang Su
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, PR China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, PR China.
| |
Collapse
|
5
|
Yang X, Zhang J, Lai Y, Yan X, Guo X, Han J, Liu J, Wang J, Zhu H. Acquired von Willebrand Syndrome Secondary to Normally Functioning Mechanical Aortic Valve and High-Output Cardiac State. J Cardiovasc Dev Dis 2022; 9:jcdd9120454. [PMID: 36547451 PMCID: PMC9786303 DOI: 10.3390/jcdd9120454] [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: 10/21/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Acquired von Willebrand syndrome (AVWS) is caused by an acquired deficiency of von Willebrand factor (VWF), a multimeric protein required for primary hemostasis. For patients with heart valve diseases, high gradient across the malfunctioning valves could cause elevated shear stress and damage the most effective large VWF, eventually resulting in AVWS. However, AVWS has not been reported in association with normally functioning mechanical valves. Herein, we reported a 74-year-old female who suffered from recurrent gastrointestinal bleeding with a history of mechanical aortic and mitral valve replacement. This patient's function/antigen ratio of VWF was decreased and gel electrophoresis revealed the loss of large VWF, which confirmed the diagnosis of AVWS. Echocardiogram showed that the function of the prostheses was normal. However, the gradient across aortic valve was increased due to a high cardiac state which is secondary to chronic anemia, resulting in the disruption of large VWF multimers and exacerbation of gastrointestinal (GI) bleeding. After managing the patient's anemia with transfusion, the gradient across the aortic valve had improved, with the resolution of GI bleeding. This is the first case report of AVWS that is associated with a normally functioning mechanical valve. AVWS should be considered one of the differential diagnoses if patients present with unexplained GI bleeding on the background of having prosthetic heart valves. The management of the underlying condition is essential.
Collapse
Affiliation(s)
- Xinglin Yang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jinghong Zhang
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Yamin Lai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xuemin Yan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiaoxiao Guo
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jianhua Han
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jihai Liu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jiangshan Wang
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Correspondence:
| | - Huadong Zhu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
6
|
Jones E, Dillon B, Swan D, Thachil J. Practical management of the haemorrhagic complications of myeloproliferative neoplasms. Br J Haematol 2022; 199:313-321. [PMID: 35724983 PMCID: PMC9796684 DOI: 10.1111/bjh.18322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 01/07/2023]
Abstract
Myeloproliferative neoplasms can be associated with bleeding manifestations which can cause significant morbidities. Although haematologists are aware of the likelihood of this complication in the setting of myeloproliferative neoplasms, it may often be overlooked especially in patients with no extreme elevation of blood counts and those with myelofibrosis. Acquired von Willebrand syndrome and platelet dysfunction are the two common diagnoses to be considered in this regard. In this review article, we discuss the mechanisms for the development of these rare bleeding disorders, their diagnosis and practical management.
Collapse
Affiliation(s)
- Edward Jones
- Department of HaematologySt James' HospitalDublinIreland
| | - Bryan Dillon
- Department of HaematologySt James' HospitalDublinIreland
| | - Dawn Swan
- National University IrelandGalwayIreland
| | - Jecko Thachil
- Department of HaematologyManchester University Hospitals NHS Foundation TrustManchesterUK
| |
Collapse
|
7
|
Salazar E, Long TA, Smock KJ, Wool GD, Rollins-Raval M, Chen D, Harris NS, Chan CW, Olson JD, Pham HP, Ritter J, Unold D, VanSandt AM, Goodwin Iv AJ. Analysis of College of American Pathologists von Willebrand Factor Proficiency Testing Program. Semin Thromb Hemost 2022. [PMID: 36063852 DOI: 10.1055/s-0042-1757132] [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
Von Willebrand factor (VWF) level and/or function is altered in von Willebrand disease (VWD), the most common heritable bleeding disorder worldwide. Laboratory assessment of VWF is continually evolving. Historically, the primary method for the assessment of VWF platelet-binding activity was the ristocetin cofactor assay (VWF:RCo). Contemporary alternative measures of VWF platelet-binding activity include VWF:GPIbR (recombinant; using ristocetin), VWF:GPIbM (recombinant; gain-of-function mutant), and monoclonal antibody. Recently, the American Society of Hematology, International Society on Thrombosis and Haemostasis, National Hemophilia Foundation, and World Federation of Hemophilia collaboration issued guidelines recommending the use of newer assays of VWF platelet-binding activity (VWF: GPIbM, VWF: GPIbR) over VWF:RCo, given known limitations of the VWF:RCo assay. Despite this recommendation, the newer VWF:GPIbM and VWF:GPIbR assays are not United States Food and Drug Administration cleared, limiting their availability in the United States. We sought to assess assay utilization trends, agreement of VWF testing methods, and imprecision of VWF testing (based on assigned sample type) from the College of American Pathologists Proficiency Testing Surveys. The analysis confirms that, while VWF antigen testing has low imprecision, the various VWF activity assays have significant interassay variability, with VWF:RCo showing greater imprecision than the newer GPIb-binding assays. The overall trends in assay utilization reflect the barriers to complete compliance with modern VWD diagnostic guidelines in North America.
Collapse
Affiliation(s)
- Eric Salazar
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas
| | - Thomas A Long
- Department of Biostatistics, College of American Pathologists, Northfield, Illinois
| | - Kristi Johnson Smock
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah
| | - Geoffrey D Wool
- Department of Pathology, University of Chicago, Chicago, Illinois
| | | | - Dong Chen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Clarence W Chan
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois
| | - John D Olson
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas
| | - Huy P Pham
- Seattle Apheresis Collection Center, National Marrow Donor Program (NMDP)Seattle, Washington
| | - Jacob Ritter
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas
| | - David Unold
- Department of Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, California
| | - Amanda Matzke VanSandt
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, Oregon
| | | |
Collapse
|
8
|
Salazar E, Long TA, Smock KJ, Wool GD, Rollins-Raval M, Chen D, Harris NS, Chan CW, Olson JD, Pham HP, Ritter J, Unold D, VanSandt AM, Goodwin Iv AJ. Analysis of College of American Pathologists von Willebrand Factor Proficiency Testing Program. Semin Thromb Hemost 2022; 48:690-699. [PMID: 36055272 DOI: 10.1055/s-0042-1749591] [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
Von Willebrand factor (VWF) level and/or function is altered in von Willebrand disease (VWD), the most common heritable bleeding disorder worldwide. Laboratory assessment of VWF is continually evolving. Historically, the primary method for the assessment of VWF platelet-binding activity was the ristocetin cofactor assay (VWF:RCo). Contemporary alternative measures of VWF platelet-binding activity include VWF:GPIbR (recombinant; using ristocetin), VWF:GPIbM (recombinant; gain-of-function mutant), and monoclonal antibody. Recently, the American Society of Hematology, International Society on Thrombosis and Haemostasis, National Hemophilia Foundation, and World Federation of Hemophilia collaboration issued guidelines recommending the use of newer assays of VWF platelet-binding activity (VWF: GPIbM, VWF: GPIbR) over VWF:RCo, given known limitations of the VWF:RCo assay. Despite this recommendation, the newer VWF:GPIbM and VWF:GPIbR assays are not United States Food and Drug Administration cleared, limiting their availability in the United States. We sought to assess assay utilization trends, agreement of VWF testing methods, and imprecision of VWF testing (based on assigned sample type) from the College of American Pathologists Proficiency Testing Surveys. The analysis confirms that, while VWF antigen testing has low imprecision, the various VWF activity assays have significant interassay variability, with VWF:RCo showing greater imprecision than the newer GPIb-binding assays. The overall trends in assay utilization reflect the barriers to complete compliance with modern VWD diagnostic guidelines in North America.
Collapse
Affiliation(s)
- Eric Salazar
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas
| | - Thomas A Long
- Department of Biostatistics, College of American Pathologists, Northfield, Illinois
| | - Kristi Johnson Smock
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah
| | - Geoffrey D Wool
- Department of Pathology, University of Chicago, Chicago, Illinois
| | | | - Dong Chen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Clarence W Chan
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois
| | - John D Olson
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas
| | - Huy P Pham
- Seattle Apheresis Collection Center, National Marrow Donor Program (NMDP)Seattle, Washington
| | - Jacob Ritter
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas
| | - David Unold
- Department of Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, California
| | - Amanda Matzke VanSandt
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, Oregon
| | | |
Collapse
|
9
|
Salazar E, Long TA, Smock KJ, Wool GD, Rollins-Raval M, Chen D, Harris NS, Chan CW, Olson JD, Pham HP, Ritter J, Unold D, VanSandt AM, Goodwin IV AJ. Analysis of College of American Pathologists von Willebrand Factor Proficiency Testing Program. Semin Thromb Hemost 2022; 48:690-699. [DOI: 10.1055/s-0042-1758161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractVon Willebrand factor (VWF) level and/or function is altered in von Willebrand disease (VWD), the most common heritable bleeding disorder worldwide. Laboratory assessment of VWF is continually evolving. Historically, the primary method for the assessment of VWF platelet-binding activity was the ristocetin cofactor assay (VWF:RCo). Contemporary alternative measures of VWF platelet-binding activity include VWF:GPIbR (recombinant; using ristocetin), VWF:GPIbM (recombinant; gain-of-function mutant), and monoclonal antibody. Recently, the American Society of Hematology, International Society on Thrombosis and Haemostasis, National Hemophilia Foundation, and World Federation of Hemophilia collaboration issued guidelines recommending the use of newer assays of VWF platelet-binding activity (VWF: GPIbM, VWF: GPIbR) over VWF:RCo, given known limitations of the VWF:RCo assay. Despite this recommendation, the newer VWF:GPIbM and VWF:GPIbR assays are not United States Food and Drug Administration cleared, limiting their availability in the United States. We sought to assess assay utilization trends, agreement of VWF testing methods, and imprecision of VWF testing (based on assigned sample type) from the College of American Pathologists Proficiency Testing Surveys. The analysis confirms that, while VWF antigen testing has low imprecision, the various VWF activity assays have significant interassay variability, with VWF:RCo showing greater imprecision than the newer GPIb-binding assays. The overall trends in assay utilization reflect the barriers to complete compliance with modern VWD diagnostic guidelines in North America.
Collapse
Affiliation(s)
- Eric Salazar
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas
| | - Thomas A. Long
- Department of Biostatistics, College of American Pathologists, Northfield, Illinois
| | - Kristi Johnson Smock
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah
| | - Geoffrey D. Wool
- Department of Pathology, University of Chicago, Chicago, Illinois
| | | | - Dong Chen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Clarence W. Chan
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois
| | - John D. Olson
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas
| | - Huy P. Pham
- Seattle Apheresis Collection Center, National Marrow Donor Program (NMDP)Seattle, Washington
| | - Jacob Ritter
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas
| | - David Unold
- Department of Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, California
| | - Amanda Matzke VanSandt
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, Oregon
| | | |
Collapse
|
10
|
Wieland I, Diekmann F, Carlens J, Hinze L, Lambeck K, Jack T, Hansmann G. Acquired von Willebrand syndrome (AVWS) type 2, characterized by decreased high molecular weight multimers, is common in children with severe pulmonary hypertension (PH). Front Pediatr 2022; 10:1012738. [PMID: 36452355 PMCID: PMC9701817 DOI: 10.3389/fped.2022.1012738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Emerging evidence suggests that increased degradation of von Willebrand factor and decrease in high molecular weight multimers occurs in patients with pulmonary hypertension (PH). However, the link between acquired von Willebrand Syndrome (AVWS) type 2 and PH remains poorly understood. MATERIAL AND METHODS We retrospectively evaluated the charts of 20 children with PH who underwent bilateral lung transplantation (LuTx) between 2013 and 2022. Von Willebrand variables were determined in 14 of these patients; 11 patients had complete diagnostics including multimer analysis. RESULTS We confirmed AVWS in 82% of the children studied (9 of 11 patients by multimer analysis). The two remaining patients had suspected AVWS type 2 because of a VWF:Ac/VWF:Ag ratio of <0.7. Platelet dysfunction or suspicion of VWD type 1 were found in two separate patients. All but one of the 14 children with severe PH had a coagulation disorder. Most patients (9 proven, 2 suspected) had AVWS type 2. Notably, 3 of 5 patients (60%) with normal VWF:Ac/VWF:Ag ratio >0.7 had abnormal VWF multimers, indicating AVWS type 2. Hemostatic complications were observed in 4 of 12 (33%) patients with VWS and 3 of 6 (50%) patients without diagnostics and therapy. CONCLUSION For children with moderate to severe PH, we recommend systematic analysis of von Willebrand variables, including multimer analysis, PFA-100 and platelet function testing. Awareness of the diagnosis "AVWS" and adequate therapy may help to prevent these patients from bleeding complications in case of surgical interventions or trauma.
Collapse
Affiliation(s)
- Ivonne Wieland
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Franziska Diekmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Julia Carlens
- Department of Pediatric Pulmonology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Laura Hinze
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Katharina Lambeck
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Thomas Jack
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| |
Collapse
|