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Hamiko M, Gerdes L, Silaschi M, Seidel H, Westhofen P, Kruppenbacher J, Hertfelder HJ, Oldenburg J, Bakhtiary F, Velten M, Oezkur M, Duerr GD. Investigation of von Willebrand factor multimer abnormalities before and after aortic valve replacement using the Hydragel-5 assay. Thromb Res 2024; 241:109094. [PMID: 38991494 DOI: 10.1016/j.thromres.2024.109094] [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: 02/08/2024] [Revised: 06/24/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Severe aortic stenosis (sAS) is associated with acquired von Willebrand syndrome (AVWS) by loss of high-molecular-weight multimers (HMWM) of von Willebrand factor (VWF), potentially resulting in perioperative bleeding. Analysis of VWF multimers remains challenging. Recently, the new, rapid Hydragel 5 assay has been developed, using electrophoretic protein separation for dividing VWF-multimers into low (LMWM), intermediate (IMWM), and HMWM, the hemostatically active part of VWF. Here, we evaluated its impact on predicting blood loss in presence of AVWS after surgical aortic valve replacement (SAVR). METHODS We prospectively examined 52 patients (age: 68 ± 7 years; 54 % male) admitted to SAVR. They were divided in two groups (A: normal VWF, n = 28; B: abnormal VWF, n = 24, defined as VWF-activity/antigen (VWF:Ac/Ag)-ratio < 0.7 and/or HMWM loss). Blood samples and echocardiographic data were collected before, seven days and three months after SAVR. Blood loss and transfusions were recorded. RESULTS Baseline characteristics and clinical data were similar in both groups. HMWM loss was present in 38.5 % of all patients. HMWM, the VWF:Ac/Ag- and HMWM/(IMWM+LMWM)-ratios were significantly decreased preoperatively in group B but normalized after SAVR. Bleeding, re-thoracotomy and transfusion rates were comparable. HMWM loss was inversely correlated with the peak aortic gradient (Pmax) and positively with the aortic valve area (AVA), while HMWM/(IMWM+LMWM)-ratio negatively correlated with the mean aortic gradient (Pmean). CONCLUSION HMWM and HMWM/(IMWM+LMWM)-ratio inversely correlate with severity of AS and normalize after SAVR. The Hydragel-5 assay's might be valuable for routine diagnostics to assess bleeding risk and postoperative normalization of AS and VWF abnormalities in SAVR patients.
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Affiliation(s)
- Marwan Hamiko
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Lena Gerdes
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Holger Seidel
- Center for Bleeding Disorders and Transfusion Medicine, (CBT), Bonn, Germany
| | - Philipp Westhofen
- Center for Bleeding Disorders and Transfusion Medicine, (CBT), Bonn, Germany
| | | | - Hans-Joerg Hertfelder
- Center for Bleeding Disorders and Transfusion Medicine, (CBT), Bonn, Germany; Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Markus Velten
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mehmet Oezkur
- Department of Cardiovascular Surgery, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
| | - Georg Daniel Duerr
- Department of Cardiovascular Surgery, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
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Platton S, Baker P, Bowyer A, Keenan C, Lawrence C, Lester W, Riddell A, Sutherland M. Guideline for laboratory diagnosis and monitoring of von Willebrand disease: A joint guideline from the United Kingdom Haemophilia Centre Doctors' Organisation and the British Society for Haematology. Br J Haematol 2024; 204:1714-1731. [PMID: 38532595 DOI: 10.1111/bjh.19385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Sean Platton
- Royal London Hospital Haemophilia Centre, London, UK
| | - Peter Baker
- Oxford Haemophilia and Thrombosis Centre, Nuffield Orthopaedic Hospital, Oxford, UK
| | - Annette Bowyer
- Department of Coagulation, Royal Hallamshire Hospital, Sheffield, UK
| | - Catriona Keenan
- Department of Haematology & the National Coagulation Centre, St. James's Hospital, Dublin, Ireland
| | | | - Will Lester
- Haemophilia Unit, University Hospitals, Birmingham, UK
| | - Anne Riddell
- Katharine Dormandy Haemophilia Centre, Royal Free Hospital, London, UK
| | - Megan Sutherland
- North West Genomic Laboratory Hub, Manchester University NHS Foundation Trust, Manchester, UK
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Chen D, Pruthi R. A Brief History of Hemostasis and Thrombosis at the Mayo Clinic. Semin Thromb Hemost 2024; 50:26-33. [PMID: 36940712 DOI: 10.1055/s-0043-1764470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Coagulation is a crucial biological mechanism in human bodies to prevent blood loss. Abnormal coagulation can cause bleeding diathesis or thrombosis, common pathologic conditions in our clinical practice. Many individuals and organizations have dedicated their efforts in the past decades to understanding the biological and pathological mechanisms of coagulation and developing laboratory testing tools and treatment options to help patients with bleeding or thrombotic conditions. Since 1926, the Mayo Clinic coagulation group has made significant contributions to the clinical and laboratory practice, basic and translational research on various hemostatic and thrombotic disorders, and the education and collaboration to share and advance our knowledge in coagulation through a highly integrated team and practice model. We would like to use this review to share our history and inspire medical professionals and trainees to join the efforts to advance our understanding of coagulation pathophysiology and improve our care for patients with coagulation disorders.
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Affiliation(s)
- Dong Chen
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Rajiv Pruthi
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
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Saadalla A, Seheult J, Pruthi RK, Chen D. Von Willebrand Factor Multimer Analysis and Classification: A Comprehensive Review and Updates. Semin Thromb Hemost 2023; 49:580-591. [PMID: 36174612 DOI: 10.1055/s-0042-1757183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Von Willebrand factor (VWF) is a multimeric glycoprotein with essential roles in primary hemostasis. Patients with von Willebrand disease (VWD), due to quantitative and/or qualitative defects of VWF usually experience mucocutaneous bleeding. Based on the laboratory results of VWF antigen, various VWF activities, factor VIII activity, and VWF multimer patterns, VWD can be categorized as type 1, 2, and 3 VWD. VWF multimer analysis by either manual or semi-automated electrophoresis and immunoblotting is a critical part of the laboratory testing to differentiate type 1, type 2 VWD, and subtypes of type 1 or 2 VWD. The multimer distribution patterns can also help to understand the underlying molecular mechanism of VWF synthesis, multimerization, and clearance defects in VWD. This review will cover VWF synthesis, multimerization, secretion, VWF multimer analysis, and VWF multimer interpretation of various types and subtypes of VWD.
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Affiliation(s)
- Abdulrahman Saadalla
- Department of Pathology, University of Utah Health Sciences Center and ARUP Laboratories, Salt Lake City, Utah
| | - Jansen Seheult
- Division of Hematopathology, Special Coagulation Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Rajiv K Pruthi
- Division of Hematopathology, Special Coagulation Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Dong Chen
- Division of Hematopathology, Special Coagulation Laboratory, Mayo Clinic, Rochester, Minnesota
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CHEN G, GUO Z, CAO Y, FAN L, LIU W, MA Y, CAO C, ZHANG Q. In-site electrophoretic elution of excessive fluorescein isothiocyanate from fluorescent particles in gel for image analysis. Se Pu 2022; 40:610-615. [PMID: 35791599 PMCID: PMC9404076 DOI: 10.3724/sp.j.1123.2022.04023] [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] [Indexed: 11/25/2022] Open
Abstract
去除荧光标记后残余荧光染料可以提高荧光颗粒检测的灵敏度、准确度和效率。该文发展了一种原位电泳洗脱(electrophoretic elution, EE)模型,用于在荧光标记后快速去除多余的荧光探针,实现荧光颗粒的灵敏检测。将牛血清蛋白(BSA)和磁珠(MBs)作为模式蛋白和微颗粒,混合孵育获得MBs-BSA,用异硫氰酸荧光素(FITC)对MBs-BSA标记,得到MBs-BSAFITC复合物。将含有多余FITC的MBs-BSAFITC溶液与低凝聚温度琼脂糖凝胶溶液按1:5的体积比混合,并将混合物凝胶和纯琼脂糖凝胶分段填充到电泳通道中。电泳过程中,利用颗粒尺寸与凝胶孔径的差异来保留MBs-BSAFITC,同时将游离的FITC洗脱。经过30 min的电泳洗脱,通道内多余的FITC清除率达到97.6%,同时目标颗粒荧光信号保留了27.8%。成像系统曝光时间为1.35 s时,电泳洗脱将颗粒与背景的荧光信号比(P/B ratio, PBr)从1.08增加到12.2。CCD相机的曝光时间增加到2.35 s,可以将PBr提高到15.5,可进一步实现对微弱荧光亮点的高灵敏检测。该模型有以下优点:(1)能对颗粒表面非特异性吸附的FITC实现有效洗脱,提高了检测的特异性;(2)能够将97%以上的游离FITC清除;(3) 30 min内能够使凝胶内的背景荧光大幅降低,提高了PBr和检测灵敏度。因此,该方法具有在凝胶中进行基于磁珠/荧光颗粒点的免疫检测、在免疫电泳或凝胶电泳中对蛋白质/核酸条带进行荧光染色等领域的应用潜力。
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Benchtop von Willebrand Factor Testing: Comparison of Commercially Available Ventricular Assist Devices and Evaluation of Variables for a Standardized Test Method. ASAIO J 2020; 65:481-488. [PMID: 30004942 DOI: 10.1097/mat.0000000000000849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Gastrointestinal bleeding occurs in 20-30% of patients receiving ventricular assist devices (VADs) due, in part, to acquired von Willebrand syndrome. We examined factors to optimize a benchtop method to quantify changes in von Willebrand Factor (VWF) multimer distribution and function in VADs, then applied them to evaluate commercially available devices. Human plasma was circulated through flow loops with VADs. Several experimental conditions were examined, including temperature, viscosity, and enzyme inhibition. Samples were analyzed for VWF collagen-binding activity (VWF:CB) and VWF antigen level. von Willebrand Factor multimer profiles were quantified using gel electrophoresis, near-infrared in-gel visualization, and densitometric analysis. The VWF:CB/antigen ratio in the HeartMate II, CentriMag, and HVAD exhibited average decreases of 46%, 44%, and 36% from baseline after 360 minutes of operation. High molecular weight (hVWF) multimer loss occurred within 30 minutes, although the Levacor and control loop profiles were unchanged. Varying temperature and viscosity altered hVWF degradation rate, but not the final results. Inhibition of a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13 (ADAMTS13) can potentially distinguish mechanoenzymatic cleavage of VWF from mechanical degradation. We developed a repeatable benchtop method to evaluate VWF compatibility of VADs similar to hemolysis testing that can be adopted for preclinical VAD evaluation.
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Favaloro EJ, Oliver S, Mohammed S, Vong R. Comparative assessment of von Willebrand factor multimers vs activity for von Willebrand disease using modern contemporary methodologies. Haemophilia 2020; 26:503-512. [PMID: 32159272 DOI: 10.1111/hae.13957] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Diagnosis of von Willebrand disease (VWD) is challenging due to heterogeneity of VWD and test limitations. Many von Willebrand factor (VWF) assays are utilized, including antigen (Ag), activity and multimer analysis. Activity assays include ristocetin cofactor using platelets (VWF:RCo) or other particles incorporating recombinant glycoprotein I ('VWF:GPIbR'), or other GPI binding assays using gain-of-function mutations ('VWF:GPIbM'), or collagen binding (VWF:CB). AIM To comparatively evaluate modern contemporary VWF activity assays vs VWF multimer analysis using modern contemporary methods. MATERIALS AND METHODS Several VWF activity assays (VWF:RCo, VWF:GPIbR, VWF:GPIbM, VWF:CB) assessed (typically as a ratio against VWF:Ag) against a new semi-automated procedure for different types of VWD (1, 3, 2A, 2B, 2M), plus control material (n = 580). The evaluation also focussed on relative loss of high and very high molecular weight multimers (HMWM and VHMWM) by densitometric scanning. RESULTS All evaluated VWF activity/Ag ratios showed high correlation to the presence/absence of HMWM and VHMWM, although VWF:CB/Ag and VWF:GPIbR/Ag ratios using an automated chemiluminescence method yielded highest correlation coefficients (r = .909 and .874, respectively, for HMWM). Use of the investigative procedure (VHMWM) identified fewer false positives for 'loss' in type 1 VWD. CONCLUSIONS This comparative investigation identified that new automated chemiluminescence VWF activity assays best identified relative loss or presence of HMWM and VHMWM according to activity to Ag ratios and an alternative investigative method for identifying VHMWM in multimer testing for a new commercial multimer method may lead to fewer false identifications of HMW loss in type 1 VWD.
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Affiliation(s)
- Emmanuel J Favaloro
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW, Australia
| | - Susan Oliver
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Soma Mohammed
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Ronny Vong
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
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Evidence for the Misfolding of the A1 Domain within Multimeric von Willebrand Factor in Type 2 von Willebrand Disease. J Mol Biol 2019; 432:305-323. [PMID: 31628947 PMCID: PMC7028320 DOI: 10.1016/j.jmb.2019.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/13/2019] [Accepted: 09/24/2019] [Indexed: 12/25/2022]
Abstract
Von Willebrand factor (VWF), an exceptionally large multimeric plasma glycoprotein, functions to initiate coagulation by agglutinating platelets in the blood stream to sites of vascular injury. This primary hemostatic function is perturbed in type 2 dysfunctional subtypes of von Willebrand disease (VWD) by mutations that alter the structure and function of the platelet GPIbα adhesive VWF A1 domains. The resulting amino acid substitutions cause local disorder and misfold the native structure of the isolated platelet GPIbα-adhesive A1 domain of VWF in both gain-of-function (type 2B) and loss-of-function (type 2M) phenotypes. These structural effects have not been explicitly observed in A1 domains of VWF multimers native to blood plasma. New mass spectrometry strategies are applied to resolve the structural effects of 2B and 2M mutations in VWF to verify the presence of A1 domain structural disorder in multimeric VWF harboring type 2 VWD mutations. Limited trypsinolysis mass spectrometry (LTMS) and hydrogen-deuterium exchange mass spectrometry (HXMS) are applied to wild-type and VWD variants of the single A1, A2, and A3 domains, an A1A2A3 tridomain fragment of VWF, plasmin-cleaved dimers of VWF, multimeric recombinant VWF, and normal VWF plasma concentrates. Comparatively, these methods show that mutations known to misfold the isolated A1 domain increase the rate of trypsinolysis and the extent of hydrogen-deuterium exchange in local secondary structures of A1 within multimeric VWF. VWD mutation effects are localized to the A1 domain without appreciably affecting the structure and dynamics of other VWF domains. The intrinsic dynamics of A1 observed in recombinant fragments of VWF are conserved in plasma-derived VWF. These studies reveal that structural disorder does occur in VWD variants of the A1 domain within multimeric VWF and provides strong support for VWF misfolding as a result of some, but not all, type 2 VWD variants.
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Thomazini CM, Soares RDPS, da Rocha TRF, Sachetto ATA, Santoro ML. Optimization of von Willebrand factor multimer analysis in vertical mini-gel electrophoresis systems: A rapid procedure. Thromb Res 2019; 175:76-83. [PMID: 30731387 DOI: 10.1016/j.thromres.2019.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/15/2019] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
Von Willebrand disease (VWD) is a common cause of bleeding worldwide. Analysis of von Willebrand factor (VWF) multimer distribution (VWF:MD) is essential to properly classify and treat different types of VWD, and it is performed using a SDS agarose gel electrophoresis followed by Western blotting, a handmade technique that demands days to be completed and requires skillful execution. Aiming both to facilitate gel production and to shorten the preparation time, we developed an uncomplicated technique to provide agility in the analysis of VWF:MD, so that it can be easily accomplished in the routine practice of hemostasis laboratories. On that account, we used a commercial vertical mini-gel electrophoresis system for SDS-PAGE and a semi-dry transfer system, which allowed us to analyze VWF:MD of various samples in a period shorter than 12 h. This technique differentiated VWF:MD in human and animal plasmas under normal, congenital and acquired (experimental envenomation by Bothrops jararaca snake) conditions. This optimized method is cheap, rapid, reproducible, easy to be performed, and uses electrophoresis and Western blotting systems available in most laboratories. All these advantages encourage hemostasis professionals to use it in their routine practices. In order to facilitate the setup and accomplishment of the whole procedure step by step, videos were appended to the article.
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Affiliation(s)
- Camila Martos Thomazini
- Instituto Butantan, Laboratório de Fisiopatologia, São Paulo, SP, Brazil; Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Tania Rubia Flores da Rocha
- Fundação Pró-Sangue, Hemocentro de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Teresa Azevedo Sachetto
- Instituto Butantan, Laboratório de Fisiopatologia, São Paulo, SP, Brazil; Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Larami Santoro
- Instituto Butantan, Laboratório de Fisiopatologia, São Paulo, SP, Brazil; Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Bowyer AE, Goodfellow KJ, Seidel H, Westhofen P, Stufano F, Goodeve A, Kitchen S, Makris M. Evaluation of a semi-automated von Willebrand factor multimer assay, the Hydragel 5 von Willebrand multimer, by two European Centers. Res Pract Thromb Haemost 2018; 2:790-799. [PMID: 30349898 PMCID: PMC6178608 DOI: 10.1002/rth2.12141] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 06/14/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The phenotypic diagnosis of von Willebrand disease (VWD) is a multistep process with classification dependent on the quantification of von Willebrand factor (VWF) multimeric structure. VWF multimer analysis is a technically challenging, lengthy and non-standardised assay, usually performed in specialist laboratories. Recently, a new semi-automated multimer assay, the Hydragel 5 von Willebrand multimers (H5VWM) has become available. OBJECTIVES This study, performed in two European centres, compared existing in-house multimer assays to the H5VWM in individuals with and without VWD. RESULTS Overall agreement of 91.1% was observed in 74 individuals with normal VWF levels, 57 patients grouped as type 1 VWD, 33 type 2A, 16 type 2B, 28 type 2M, 11 type 2N. Patients tested following Desmopressin or VWF concentrate, with thrombotic thrombocytopenic purpura and acquired von Willebrand syndrome were also evaluated. Many of the discrepancies between methods were in patients with genetic mutations linked to more than one type of VWD including p.R1374C/H and p.R1315C. Quantifiable multimer results were available within one working day. Densitometry improved the interpretation of the multimers with slight structural variations that were not apparent by visual inspection of the in-house method. CONCLUSIONS 5VWM was a rapid, sensitive, standardised assay which used existing technology and could be included as an initial screen of VWF multimers in a VWD diagnostic algorithm in conjunction with traditional multimer analysis.
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Affiliation(s)
- Annette E. Bowyer
- Department of CoagulationSheffield Haemophilia and Thrombosis CentreSheffieldUK
| | - Karen J. Goodfellow
- Department of CoagulationSheffield Haemophilia and Thrombosis CentreSheffieldUK
| | - Holger Seidel
- Centrum für Blutgerinnungsstörungen und TransfusionsmedizinBonnGermany
| | - Philipp Westhofen
- Centrum für Blutgerinnungsstörungen und TransfusionsmedizinBonnGermany
| | - Francesca Stufano
- Angelo Bianchi Bonomi Hemophilia and Thrombosis CenterFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and Luigi Villa FoundationMilanItaly
| | - Anne Goodeve
- Department of Infection, Immunity and Cardiovascular DiseaseUniversity of Sheffield Medical SchoolSheffieldUK
| | - Stephen Kitchen
- Angelo Bianchi Bonomi Hemophilia and Thrombosis CenterFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and Luigi Villa FoundationMilanItaly
| | - Michael Makris
- Department of CoagulationSheffield Haemophilia and Thrombosis CentreSheffieldUK
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Crist RA, Heikal NM, Rodgers GM, Grenache DG, Smock KJ. Evaluation of a new commercial method for von Willebrand factor multimeric analysis. Int J Lab Hematol 2018; 40:586-591. [PMID: 29920949 DOI: 10.1111/ijlh.12869] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Evaluation of von Willebrand factor (VWF) multimeric distribution is useful for subclassification of von Willebrand disease (VWD). Multimer analysis has historically been a manual, labor-intensive laboratory-developed test. The first commercial method for multimeric analysis was recently developed that utilizes a single instrument for gel electrophoresis, staining, and densitometry. The current study was undertaken to evaluate the performance characteristics of the new commercial method. METHODS Studies performed with the commercial method included evaluation of accuracy (method comparison), reference intervals (establishment of normal migration patterns in normal donor specimens), precision (multimer pattern reproducibility), and analytical sensitivity. RESULTS In the method comparison studies, concordant interpretations were obtained in 19 of 24 comparisons, including normal and abnormal specimens. The 5 specimens with discordant interpretations all involved slight differences and none were considered clinically significant. Thirty-eight normal donor specimens demonstrated normal multimer patterns. Multimer pattern reproducibility was demonstrated in normal and abnormal controls tested on each gel. In the sensitivity studies, adequate visualization of multimers was determined to require VWF protein concentrations of approximately 5%-10% of normal. CONCLUSION The commercial multimer method is a streamlined test that demonstrates comparable performance characteristics to our current laboratory-developed method and that provides the advantage of both electrophoresis gels and densitometry scans to aid interpretation.
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Affiliation(s)
- R A Crist
- ARUP Laboratories Institute for Clinical and Experimental Pathology, University of Utah, Salt Lake City, UT, USA
| | - N M Heikal
- ARUP Laboratories Institute for Clinical and Experimental Pathology, University of Utah, Salt Lake City, UT, USA.,Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - G M Rodgers
- ARUP Laboratories Institute for Clinical and Experimental Pathology, University of Utah, Salt Lake City, UT, USA.,Department of Pathology, University of Utah, Salt Lake City, UT, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - D G Grenache
- ARUP Laboratories Institute for Clinical and Experimental Pathology, University of Utah, Salt Lake City, UT, USA.,Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - K J Smock
- ARUP Laboratories Institute for Clinical and Experimental Pathology, University of Utah, Salt Lake City, UT, USA.,Department of Pathology, University of Utah, Salt Lake City, UT, USA
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12
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Pikta M, Zemtsovskaja G, Bautista H, Nouadje G, Szanto T, Viigimaa M, Banys V. Preclinical evaluation of a semi-automated and rapid commercial electrophoresis assay for von Willebrand factor multimers. J Clin Lab Anal 2018; 32:e22416. [PMID: 29453814 DOI: 10.1002/jcla.22416] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/31/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The von Willebrand factor (VWF) multimer test is required to correctly subtype qualitative type 2 von Willebrand disease (VWD). The current VWF multimer assays are difficult, nonstandardized, and time-consuming. The purpose of this study was to evaluate the clinical utility of the commercial VWF multimer kit by Sebia (Lisses, France), an electrophoresis technique yielding same-day results. METHODS Ten healthy volunteer plasma samples, in-house reference plasma (IRP) and commercial normal plasma (CNP) samples, 10 plasma samples from patients with a known VWD type, 1 hemophilia A plasma sample, and 7 external quality assurance (EQA) samples were analyzed using the commercial VWF multimer kit. Additional coagulation testing included measurements of VWF antigen (VWF:Ag), VWF activity (VWF:Ac), and FVIII activity (FVIII:C). RESULTS The CNP results revealed a relative loss of the highest molecular weight multimers; therefore, IRP was preferred as the reference sample. The interpretations of 10 patients with a known VWD type could be successfully reproduced and agreed with previous VWF multimer results. In all EQA surveys, the multimer results and final VWD diagnosis agreed with expert opinion. CONCLUSIONS The VWF multimer assay by Sebia is easy to perform and can be successfully implemented in any clinical laboratory for second-stage evaluation of VWD. The resolution power of multimer distribution is adequate to correctly classify VWD types 1, 2A, 2B, and 3.
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Affiliation(s)
- Marika Pikta
- North Estonia Medical Centre Laboratory, Tallinn, Estonia.,Department of Health Technologies, School of Information Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Galina Zemtsovskaja
- North Estonia Medical Centre Laboratory, Tallinn, Estonia.,Department of Health Technologies, School of Information Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Hector Bautista
- Sebia, Research and Developments Department, Parc Technologique Léonard de Vinci, Evry Cedex, France
| | - Georges Nouadje
- Sebia, Research and Developments Department, Parc Technologique Léonard de Vinci, Evry Cedex, France
| | - Timea Szanto
- Coagulation Disorders Unit, HUSLAB Laboratory Services, Department of Hematology and Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland
| | - Margus Viigimaa
- Department of Health Technologies, School of Information Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Valdas Banys
- Faculty of Medicine, Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Vilnius University, Vilnius, Lithuania
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13
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Austin CO, Chen D, Thomas CS, Safford RE, Shapiro BP, Bryan JA, Ray JC, Blackshear JL. Von Willebrand factor multimer quantitation for assessment of cardiac lesion severity and bleeding risk. Res Pract Thromb Haemost 2018; 2:155-161. [PMID: 30046716 PMCID: PMC6055563 DOI: 10.1002/rth2.12062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/25/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND von Willebrand factor (VWF) multimer quantitation has been utilized in the assessment of valvular heart disease, however, there is no standardized method for quantitation. We compared three methods of assessment which utilized a normal plasma control. METHODS We analyzed 476 samples and their control plasma from 368 patients with valvular heart disease, hypertrophic cardiomyopathy, or LVAD therapy, and 27 normal subjects. VWF multimers were assessed as normalized VWF multimer ratios (NMR) of gel bands >15/2-15 (NMR15) or gel bands >10/2-10 (NMR10). Associations of VWF laboratory and multimeric assessments with cardiac lesion severity and acquired bleeding were investigated. RESULTS Abnormal multimers were present in 78% of patients with moderate to severe hemodynamic abnormalities compared to 19% of patients with normal or mildly abnormal hemodynamics. NMR showed strong association with severe cardiac lesions (NMR15: OR 15.29, CI 9.04-27.18; NMR10: OR 14.18, CI 8.88-23.21). PFA-CADP was strongly associated with moderate to severe cardiac lesions (OR 14.91, CI 9.08-24.50). PFA-CADP and NMR15 showed excellent ability to discriminate ≥moderate (AUC 0.86, CI 0.83-0.89 and 0.83, CI 0.79-0.87 respectively) and severe cardiac lesions (AUC 0.84, CI 0.81-0.88 and 0.85, CI 0.81-0.88 respectively). NMR was less strongly associated with bleeding (OR 4.01 for NMR10, CI 2.49-6.58). CONCLUSION Quantification of VWF multimers may provide clinical utility in circumstances where clinical estimation of cardiac lesion severity is challenging, such as with dysfunctional prosthetic valves. The presence of abnormal VWF multimers is associated with bleeding, however further quantitation provided only modest improvement in risk stratification.
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Affiliation(s)
| | - Dong Chen
- Division of HematopathologyMayo ClinicRochesterMNUSA
| | | | | | | | - Justin A. Bryan
- Division of Cardiovascular DiseaseMayo ClinicJacksonvilleFLUSA
| | - Jordan C. Ray
- Division of Cardiovascular DiseaseMayo ClinicJacksonvilleFLUSA
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14
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Zlobina KE, Guria GT. Platelet activation risk index as a prognostic thrombosis indicator. Sci Rep 2016; 6:30508. [PMID: 27461235 PMCID: PMC4962318 DOI: 10.1038/srep30508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/04/2016] [Indexed: 01/28/2023] Open
Abstract
Platelet activation in blood flow under high, overcritical shear rates is initiated by Von Willebrand factor. Despite the large amount of experimental data that have been obtained, the value of the critical shear rate, above which von Willebrand factor starts to activate platelets, is still controversial. Here, we recommend a theoretical approach to elucidate how the critical blood shear rate is dependent on von Willebrand factor size. We derived a diagram of platelet activation according to the shear rate and von Willebrand factor multimer size. We succeeded in deriving an explicit formula for the dependence of the critical shear rate on von Willebrand factor molecule size. The platelet activation risk index was introduced. This index is dependent on the flow conditions, number of monomers in von Willebrand factor, and platelet sensitivity. Probable medical applications of the platelet activation risk index as a universal prognostic index are discussed.
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Affiliation(s)
- K E Zlobina
- National Research Center for Hematology, 125167, Novy Zykovsky pr. 4, Moscow, Russia
| | - G Th Guria
- National Research Center for Hematology, 125167, Novy Zykovsky pr. 4, Moscow, Russia.,Moscow Institute of Physics and Technology, 141700, Institututski per. 9, Dolgoprudny, Russia
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15
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Immediate recovery of acquired von Willebrand syndrome after left ventricular assist device explantation: implications for heart transplantation. ASAIO J 2015; 61:e1-4. [PMID: 25251586 DOI: 10.1097/mat.0000000000000157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
All patients supported with continuous flow-left ventricular assist devices (CF-LVADs) develop acquired von Willebrand syndrome due to the loss of von Willebrand factor (vWF) high molecular weight (HMW) multimers and this phenomenon has been associated with clinical manifestation of bleeding diatheses. The precise timing of postoperative recovery of HMW multimers and correction of this condition after CF-LVAD explantation and heart transplantation is unknown. We sought to determine the specific timing of HMW multimer recovery by serially quantifying plasma vWF multimer ratios after CF-LVAD explant and orthotopic heart transplantation (OHT) in a patient implanted with a HeartWare ventricular assist device. Using densitometric analysis of multimer patterns, we demonstrated complete recovery of HMW multimers within the first few hours following CF-LVAD explant and OHT. These findings have critical implications in the context of perioperative bleeding diatheses in patients bridged to transplantation with a CF-LVAD.
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16
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Costello JP, Diab YA, Philippe-Auguste M, Jones MB, Shankar V, Friedman KD, Nath DS. Acquired von Willebrand syndrome in a child following Berlin Heart EXCOR Pediatric Ventricular Assist Device implantation: case report and concise literature review. World J Pediatr Congenit Heart Surg 2015; 5:592-8. [PMID: 25324261 DOI: 10.1177/2150135114539521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The development of acquired von Willebrand syndrome (AVWS) after placement of a pulsatile-flow left ventricular assist device (LVAD) is rare and only recently recognized. We report the case of a young infant who was diagnosed with ventricular assist device (VAD)-related AVWS following implantation of a Berlin Heart EXCOR Pediatric Ventricular Assist Device (Berlin Heart Inc., The Woodlands, Texas, USA) for treatment of severe heart failure. Despite significant bleeding, the patient was successfully managed with von Willebrand factor-containing concentrate until VAD explantation led to definitive resolution of the AVWS. This case demonstrates that the possibility of this diagnosis should be considered in pediatric patients when extensive, nonsurgical bleeding is encountered after pulsatile-flow VAD implantation.
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Affiliation(s)
- John P Costello
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Yaser A Diab
- Department of Hematology, Children's National Health System, Washington, DC, USA
| | | | - Melissa B Jones
- Department of Critical Care Medicine, Children's National Health System, Washington, DC, USA
| | - Venkat Shankar
- Department of Critical Care Medicine, Children's National Health System, Washington, DC, USA
| | - Kenneth D Friedman
- Hemostasis Reference Laboratory, Blood Center of Wisconsin, Milwaukee, WI, USA
| | - Dilip S Nath
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
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17
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Laffan MA, Lester W, O'Donnell JS, Will A, Tait RC, Goodeve A, Millar CM, Keeling DM. The diagnosis and management of von Willebrand disease: a United Kingdom Haemophilia Centre Doctors Organization guideline approved by the British Committee for Standards in Haematology. Br J Haematol 2014; 167:453-65. [PMID: 25113304 DOI: 10.1111/bjh.13064] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Mike A Laffan
- Centre for Haematology, Imperial College London, London, UK
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18
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Abstract
Thrombosis following venous stent placement is a morbid clinical outcome. Whether to target platelets or coagulation factors for venous stent thromboprophylaxis remains unclear. We sought to determine whether integrin α(IIb)β3 antagonism with lamifiban would inhibit platelet recruitment to venous stent thrombosis. Anti-thrombotic efficacy was compared between venous and arterial circulations. Pigs received either lamifiban (0.2 mg/kg bolus plus 0.2 mg/kg/h infusion; n = 6) or saline (n = 12). Carotid arteries were crush injured and then harvested 30 min later to provide an assessment of antithrombotic efficacy in the arterial circulation. Iliac venous stents were then deployed and thrombi allowed to propagate for 2 h before harvesting. Platelet deposition was measured by scintillation detection of autologous (111)In-platelets. Venous thrombi were quantified by weight and compared to platelet, Von Willebrand factor (VWF) and fibrinogen content. Arterial platelet deposition (×10(6)/cm(2)) was reduced >80% by lamifiban (398 ± 437) compared to controls (1,540 ± 883; p < 0.005). Lamifiban also reduced venous thrombus platelet deposition (139 ± 88 vs. 281 ± 167) however did not prevent thrombosis. In control animals, venous stent platelet deposition correlated with plasma fibrinogen content (R(2) = 0.29; p = 0.03). Fibrinogen content correlated directly with venous stent platelet deposition (p = 0.03) but not thrombus weight. Neither venous platelet deposition nor thrombus weights varied by VWF content. Platelet recruitment to venous stent thrombi occurs in part through the integrin α(IIb)β3 receptor. Unlike arterial thrombosis, inhibition of this receptor is insufficient to prevent venous stent thrombosis.
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19
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Pasotti F, Martini G, Caimi L, Ricotta D. von Willebrand Factor multimers profiling with a semi-automated system. Electrophoresis 2013; 34:818-24. [DOI: 10.1002/elps.201200538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 10/31/2012] [Accepted: 10/31/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Fabio Pasotti
- Department of Diagnostics; Spedali Civili of Brescia; Brescia; Italy
| | - Giuliana Martini
- Department of Diagnostics; Spedali Civili of Brescia; Brescia; Italy
| | - Luigi Caimi
- Department of Biomedical Sciences and Biotechnologies; Faculty of Medicine; University of Brescia; Brescia; Italy
| | - Doris Ricotta
- Department of Biomedical Sciences and Biotechnologies; Faculty of Medicine; University of Brescia; Brescia; Italy
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20
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Blackshear JL, Wysokinska EM, Safford RE, Thomas CS, Stark ME, Shapiro BP, Ung S, Johns GS, Chen D. Indexes of von Willebrand factor as biomarkers of aortic stenosis severity (from the Biomarkers of Aortic Stenosis Severity [BASS] study). Am J Cardiol 2013; 111:374-81. [PMID: 23168287 DOI: 10.1016/j.amjcard.2012.10.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/04/2012] [Accepted: 10/04/2012] [Indexed: 01/28/2023]
Abstract
We correlated von Willebrand factor (VWF) activity indexes and brain natriuretic peptide (BNP) with measures of aortic stenosis (AS) severity, bleeding, symptoms, and freedom from death or aortic valve replacement. Patients with AS (n = 66 [16 mild, 20 moderate, and 30 severe]) and aortic valve replacement (n = 21) were assessed with VWF antigen, VWF latex agglutination immunoturbidic activity, platelet function analyzer collagen plus adenosine diphosphate (PFA-CADP), VWF multimer ratio, and BNP level after echocardiography. In patients with AS, the mean gradient correlated with BNP (Spearman r = 0.29, p = 0.02), VWF latex agglutination immunoturbidic activity/VWF antigen ratio (r = -0.41, p <0.001), PFA-CADP (r = 0.49, p <0.001), and VWF multimer ratio (r = -0.76, p <0.001). The area under the curve for detection of severe AS was 0.62 (95% confidence interval [CI] 0.48 to 0.77) by elevated BNP, 0.81 (95% CI 0.69 to 0.92) by PFA-CADP closure time, 0.69 (95% CI 0.55 to 0.82) by VWF latex agglutination immunoturbidic activity/VWF antigen ratio, and 0.86 (95% CI 0.76 to 0.95) by VWF multimer ratio. For the VWF multimer ratio, a threshold of 0.15 yielded a sensitivity and specificity for severe AS of 77% and positive predictive value of 74%. Bleeding (in 14%) was associated with a prolonged PFA-CADP time and reduced VWF latex agglutination immunoturbidic activity/VWF antigen ratio. Symptoms were associated with elevated BNP and low Duke Activity Status Index score. In 66 patients with AS, freedom from death (n = 4) or aortic valve replacement (n = 22) was associated with PFA-CADP (p = 0.003), VWF high-molecular-weight multimers (p = 0.009), and VWF latex agglutination immunoturbidic activity/VWF antigen ratio (p <0.001) but not BNP (p = 0.32). In severe AS versus aortic valve replacement, the PFA-CADP and VWF multimer ratio differed (p <0.001), but BNP and the VWF latex agglutination immunoturbidic activity/VWF antigen ratio did not. In conclusion, the VWF activity indexes were associated with AS severity and bleeding and were predictive of cardiovascular outcomes.
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21
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Djamiatun K, van der Ven AJAM, de Groot PG, Faradz SMH, Hapsari D, Dolmans WMV, Sebastian S, Fijnheer R, de Mast Q. Severe dengue is associated with consumption of von Willebrand factor and its cleaving enzyme ADAMTS-13. PLoS Negl Trop Dis 2012; 6:e1628. [PMID: 22563509 PMCID: PMC3341341 DOI: 10.1371/journal.pntd.0001628] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 03/08/2012] [Indexed: 12/27/2022] Open
Abstract
Background Thrombocytopenia, bleeding and plasma leakage are cardinal features of severe dengue. Endothelial cell activation with exocytosis of Weibel-Palade bodies (WPBs) may play an etiological role in this condition. Methods and Principal Findings In a cohort of 73 Indonesian children with dengue hemorrhagic fever (DHF), of which 30 with dengue shock syndrome (DSS), we measured plasma levels of the WPB constituents von Willebrand factor antigen (VWF:Ag), VWF propeptide and osteoprotegerin (OPG), together with activity levels of the VWF-cleaving enzyme ADAMTS-13 and the amount of VWF in a platelet binding conformation (VWF activation factor). Compared with healthy controls (n = 17), children with DHF/DSS had significantly higher levels of VWF:Ag, VWF propeptide and OPG and decreased ADAMTS-13 activity. The VWF activation factor was also significantly higher in DHF/DSS and highest in children who died. There were significant differences in the kinetics of the various WPB constituents: VWF propeptide and OPG levels decreased toward discharge, while VWF:Ag levels were lower than expected at enrollment with plasma levels increasing toward discharge. Moreover, VWF propeptide levels correlated better with markers of disease severity (platelet count, liver enzymes, serum albumin and pleural effusion index) than corresponding VWF levels. Together, these findings suggest that there is consumption of VWF in DHF/DSS. In 4 out of 15 selected children with low ADAMTS-13 levels on admission, we found a remarkable reduction in the large and intermediate VWF multimers in the discharge blood samples, consistent with an acquired von Willebrand disease. Conclusion These findings suggest that severe dengue is associated with exocytosis of WPBs with increased circulating levels of VWF:Ag, VWF propeptide and OPG. High circulating levels of VWF in its active conformation, together with low ADAMTS-13 activity levels, are likely to contribute to the thrombocytopenia and complications of dengue. During the convalescence phase, qualitative defects in VWF with loss of larger VWF multimers may develop. Severe dengue infections are characterized by thrombocytopenia, clinical bleeding and plasma leakage. Activation of the endothelium, the inner lining of blood vessels, leads to the secretion of storage granules called Weibel Palade bodies (WPBs). We demonstrated that severe dengue in Indonesian children is associated with a strong increase in plasma levels of the WPB constituents von Willebrand factor (VWF), VWF propeptide and osteoprotegerin (OPG). An increased amount of the hemostatic protein VWF was in a hyperreactive, platelet binding conformation, and this was most pronounced in the children who died. VWF levels at enrollment were lower than expected from concurrent VWF propeptide and OPG levels and VWF levels did not correlate well with markers of disease severity. Together, this suggests that VWF is being consumed during severe dengue. Circulating levels of the VWF-cleaving enzyme ADAMTS-13 were reduced. VWF is a multimeric protein and a subset of children had a decrease in large and intermediate VWF multimers at discharge. In conclusion, severe dengue is associated with exocytosis of WPBs with consumption of VWF and low ADAMTS-13 activity levels. This may contribute to the thrombocytopenia and complications of dengue.
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Affiliation(s)
- Kis Djamiatun
- Department of Parasitology, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Andre J. A. M. van der Ven
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Philip G. de Groot
- Laboratory for Thrombosis and Haemostasis, Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Sultana M. H. Faradz
- Division of Human Genetics, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - D. Hapsari
- Department of Pediatrics, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Wil M. V. Dolmans
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Silvie Sebastian
- Laboratory for Thrombosis and Haemostasis, Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Rob Fijnheer
- Laboratory for Thrombosis and Haemostasis, Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Quirijn de Mast
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- * E-mail:
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22
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Kim D, Karns K, Tia SQ, He M, Herr AE. Electrostatic Protein Immobilization Using Charged Polyacrylamide Gels and Cationic Detergent Microfluidic Western Blotting. Anal Chem 2012; 84:2533-40. [DOI: 10.1021/ac3000013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dohyun Kim
- Department of Bioengineering, University of California, Berkeley, 342 Stanley Hall,
Berkeley, California 94720, United States
| | - Kelly Karns
- The UC Berkeley − UCSF Graduate Program in Bioengineering, Berkeley,
California 94720, United States
| | - Samuel Q. Tia
- The UC Berkeley − UCSF Graduate Program in Bioengineering, Berkeley,
California 94720, United States
| | - Mei He
- Department of Bioengineering, University of California, Berkeley, 342 Stanley Hall,
Berkeley, California 94720, United States
| | - Amy E. Herr
- Department of Bioengineering, University of California, Berkeley, 342 Stanley Hall,
Berkeley, California 94720, United States
- The UC Berkeley − UCSF Graduate Program in Bioengineering, Berkeley,
California 94720, United States
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23
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Ammash N, Konik EA, McBane RD, Chen D, Tange JI, Grill DE, Herges RM, McLeod TG, Friedman PA, Wysokinski WE. Left atrial blood stasis and Von Willebrand factor-ADAMTS13 homeostasis in atrial fibrillation. Arterioscler Thromb Vasc Biol 2012; 31:2760-6. [PMID: 21852562 DOI: 10.1161/atvbaha.111.232991] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Left atrial blood stasis is associated with increased risk for left atrial appendage thrombus (LAAT) and stroke in atrial fibrillation (AF). Von Willebrand factor (VWF) is associated with thromboembolism in AF. VWF thrombogenic activity is proportional to multimer size, which is regulated by VWF-cleaving protease (ADAMTS13). METHODS AND RESULTS To assess the association between left atrial blood stasis and VWF-ADAMTS13 system, plasma VWF antigen (VWF:Ag), VWF activity (VWF:Act), and ADAMTS13 activity were measured in 414 consecutive patients with nonvalvular AF (age 63±13 years; 25% women) and in 100 patients (age 64±14 years; 39% women) with normal sinus rhythm. Spontaneous echocardiographic contrast (SEC), left atrial appendage emptying velocity, and LAAT were assessed by transesophageal echocardiography. Presence and intensity of SEC varied directly with VWF:Ag and VWF:Act but not with ADAMTS13 activity. AF patients with LAAT had higher VWF:Ag (200±61 versus 155±52, P=0.0006) and VWF:Act (179±57 versus 141±51 P=0.0026) compared with those without LAAT. VWF:Ag and VWF:Act were independent predictors of LAAT after adjustment for CHADS2 score (P=0.0179 and P=0.0497, respectively). CONCLUSION The association between VWF and SEC may explain the thrombotic propensity in AF. Elevated VWF:Ag may help identify AF patients at risk for LAAT.
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Affiliation(s)
- Naser Ammash
- Department of Internal Medicine, Mayo Clinic and Foundation for Education and Research, Rochester, MN 55905, USA
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24
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Chen D, Tange JI, Meyers BJ, Pruthi RK, Nichols WL, Heit JA. Validation of an automated latex particle-enhanced immunoturbidimetric von Willebrand factor activity assay. J Thromb Haemost 2011; 9:1993-2002. [PMID: 21824283 DOI: 10.1111/j.1538-7836.2011.04460.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Laboratory diagnosis of von Willebrand disease (VWD) requires accurate measurement of plasma von Willebrand factor (VWF) activity. OBJECTIVES To evaluate laboratory characteristics, diagnostic accuracy and testing utilities of an automated latex particle-enhanced immunoturbidimetric VWF assay (VWF:Lx) based on a monoclonal antibody recognizing the VWF-platelet glycoprotein (GP) Ib binding domain. METHODS Laboratory characteristics including lower detection limit, linearity, precision, sample stability, and method comparison between VWF:Lx and VWF ristocetin cofactor activity by platelet aggregometry (VWF:RCo) were examined. To assess VWF:Lx diagnostic accuracy, 492 patient plasma samples, including 40 previously characterized VWD patient samples, were tested for VWF antigen (VWF:Ag) and VWF:RCo by either aggregometry or flow cytometry, and VWF:Lx with supplemental VWF multimer analysis when indicated. Based on results of VWF:Ag, VWF:RCo and VWF multimer analysis, and available clinical information, samples were categorized as: normal; VWD types 1, 2A/B, 2M, or severe 1 vs. 2M; or acquired VWF abnormalities (AVWA) due to subtle loss of highest molecular weight multimers. RESULTS VWF:Lx had excellent laboratory characteristics and linear correlation with VWF:RCo (R(2) = 0.93). VWF:Lx accurately classified virtually all normal and VWD patient samples. Compared with VWF:RCo, VWF:Lx had superior sensitivity and specificity for distinguishing severe type 1 vs. 2M VWD and identifying AVWA. A proposed screening panel comprising VWF:Ag and VWF:Lx had 100% and 83% sensitivity for detecting VWD and AVWA, respectively. CONCLUSIONS VWF:Lx has excellent laboratory characteristics and diagnostic accuracy compared with VWF:RCo, and can be used as part of an initial VWD screening panel and as a supplementary test.
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Affiliation(s)
- D Chen
- Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
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25
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GILL JC, SHAPIRO A, VALENTINO LA, BERNSTEIN J, FRIEDMAN C, NICHOLS WL, MANCO-JOHNSON M. von Willebrand factor/factor VIII concentrate (Humate-P) for management of elective surgery in adults and children with von Willebrand disease. Haemophilia 2011; 17:895-905. [DOI: 10.1111/j.1365-2516.2011.02534.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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26
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Pruthi RK. Hypertrophic obstructive cardiomyopathy, acquired von Willebrand syndrome, and gastrointestinal bleeding. Mayo Clin Proc 2011; 86:181-2. [PMID: 21364110 PMCID: PMC3046936 DOI: 10.4065/mcp.2011.0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Rajiv K. Pruthi
- Address correspondence to Rajiv K. Pruthi, MBBS, Division of Hematopathology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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27
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Blackshear JL, Schaff HV, Ommen SR, Chen D, Nichols WL. Hypertrophic obstructive cardiomyopathy, bleeding history, and acquired von Willebrand syndrome: response to septal myectomy. Mayo Clin Proc 2011; 86:219-24. [PMID: 21364113 PMCID: PMC3046942 DOI: 10.4065/mcp.2010.0309] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bleeding with severe aortic stenosis is linked to acquired von Willebrand syndrome and loss of high-molecular-weight multimers of von Willebrand factor. Valve replacement resolves bleeding tendency and loss of high-molecular-weight multimers. We report outcomes in 5 patients with symptomatic obstructive hypertrophic cardiomyopathy and spontaneous gastrointestinal, mucosal, or excessive postsurgical bleeding in whom acquired von Willebrand syndrome was documented. All 5 patients underwent surgical septal myectomy with resolution of acquired von Willebrand syndrome.
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Affiliation(s)
- Joseph L Blackshear
- Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224, USA.
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