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Mehic D, Gebhart J, Pabinger I. Bleeding Disorder of Unknown Cause: A Diagnosis of Exclusion. Hamostaseologie 2024; 44:287-297. [PMID: 38412996 DOI: 10.1055/a-2263-5706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Patients with an unexplained mild to moderate bleeding tendency are diagnosed with bleeding disorder of unknown cause (BDUC), a classification reached after ruling out other mild to moderate bleeding disorders (MBD) including von Willebrand disease (VWD), platelet function defects (PFDs), coagulation factor deficiencies (CFDs), and non-hemostatic causes for bleeding. This review outlines our diagnostic approach to BDUC, a diagnosis of exclusion, drawing on current guidelines and insights from the Vienna Bleeding Biobank (VIBB). According to guidelines, we diagnose VWD based on VWF antigen and/or activity levels ≤50 IU/dL, with repeated VWF testing if VWF levels are <80 IU/dL. This has been introduced in our clinical routine after our findings of diagnostically relevant fluctuations of VWF levels in a high proportion of MBD patients. PFDs are identified through repeated abnormalities in light transmission aggregometry (LTA), flow cytometric mepacrine fluorescence, and glycoprotein expression analysis. Nevertheless, we experience diagnostic challenges with regard to reproducibility and unspecific alterations of LTA. For factor (F) VIII and FIX deficiency, a cutoff of 50% is utilized to ensure detection of mild hemophilia A or B. We apply established cutoffs for other rare CFD being aware that these do not clearly reflect the causal role of the bleeding tendency. Investigations into very rare bleeding disorders due to hyperfibrinolysis or increase in natural anticoagulants are limited to cases with a notable family history or distinct bleeding phenotypes considering cost-effectiveness. While the pathogenesis of BDUC remains unknown, further explorations of this intriguing area may reveal new mechanisms and therapeutic targets.
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Affiliation(s)
- Dino Mehic
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Johanna Gebhart
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ingrid Pabinger
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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2
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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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Sacco M, Lancellotti S, Branchini A, Tardugno M, Testa MF, Lunghi B, Bernardi F, Pinotti M, Giusti B, Castaman G, De Cristofaro R. The p.P1127S pathogenic variant lowers von Willebrand factor levels through higher affinity for the macrophagic scavenger receptor LRP1: Clinical phenotype and pathogenic mechanisms. J Thromb Haemost 2022; 20:1818-1829. [PMID: 35596664 PMCID: PMC9545986 DOI: 10.1111/jth.15765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/28/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The index case is a 21-year-old Italian woman with a mild hemorrhagic syndrome and von Willebrand factor antigen (VWF:Ag) = 34.3 U/dl, VWF recombinant glycoprotein Ib (VWF:GpIbR) = 32.8 U/dl, and factor VIII (FVIII) = 55.3 IU/dl. AIMS The aim of this study is to characterize from a genetic and biochemical standpoint this low VWF phenotype. METHODS Coagulation and biochemical methods were used to study the structural and functional pattern of VWF multimers in the index case's plasma. Recombinant wild-type and p.P1127S VWF variants were produced using human embryonic kidney (HEK)-293 cells. In addition, genetic screening was carried out to detect single nucleotide variants of some scavenger VWF/FVIII receptor genes such as CLEC4M, STAB2, and ASGR2. RESULTS Genetic investigation revealed that the index case inherited from her mother the heterozygous missense mutation c.3379C > T (VWF exon 25), causing the p.P1127S substitution in the VWF D'D3 domain. The index case was also homozygous for the scavenger receptor ASGR2 c.-95 CC-genotype. Desmopressin normalized the VWF level of the patient, although its clearance was faster (t1/2 = 6.7 h) than in normal subjects (t1/2 = 12 ± 0.7 h). FVIII-VWF interaction, A Disintegrin And Metalloprotease with ThromboSpondin type 1 motif-13 levels, ristocetin-induced-platelet-aggregation, and VWF multimeric pattern were normal. The p.P1127S variant was normally synthesized and secreted by HEK-293 cells, and molecular modeling predicts a conformational change showing higher affinity for the macrophagic scavenger receptor lipoprotein receptor-related protein 1 (LRP1), as also experimentally verified. CONCLUSIONS The p.P1127S variant may cause a low VWF phenotype, stemming from an increased VWF affinity for the scavenger receptor LRP1 and, consequently, an accelerated clearance of VWF.
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Affiliation(s)
- Monica Sacco
- Dipartimento di Medicina e Chirurgia TraslazionaleFacoltà di Medicina e Chirurgia “Agostino Gemelli,” Università Cattolica S. CuoreRomaItaly
| | - Stefano Lancellotti
- Servizio Malattie Emorragiche e TromboticheFondazione Policlinico Universitario “A. Gemell” IRCCSRomaItaly
| | - Alessio Branchini
- Dipartimento di Scienze della Vita e BiotecnologieUniversità di FerraraFerraraItaly
| | - Maira Tardugno
- Dipartimento di Medicina e Chirurgia TraslazionaleFacoltà di Medicina e Chirurgia “Agostino Gemelli,” Università Cattolica S. CuoreRomaItaly
| | | | - Barbara Lunghi
- Dipartimento di Scienze della Vita e BiotecnologieUniversità di FerraraFerraraItaly
| | - Francesco Bernardi
- Dipartimento di Scienze della Vita e BiotecnologieUniversità di FerraraFerraraItaly
| | - Mirko Pinotti
- Dipartimento di Scienze della Vita e BiotecnologieUniversità di FerraraFerraraItaly
| | - Betti Giusti
- Dipartimento di Medicina Sperimentale e ClinicaUniversità di FirenzeFirenzeItaly
- Laboratorio Genetico Molecolare Avanzato, SOD Malattie AterotromboticheAzienda Ospedaliero‐ Universitaria “Careggi"FirenzeItaly
| | - Giancarlo Castaman
- Dipartimento di Oncologia, Centro Malattie Emorragiche e della CoagulazioneOspedale Universitario “Careggi”FirenzeItaly
| | - Raimondo De Cristofaro
- Dipartimento di Medicina e Chirurgia TraslazionaleFacoltà di Medicina e Chirurgia “Agostino Gemelli,” Università Cattolica S. CuoreRomaItaly
- Servizio Malattie Emorragiche e TromboticheFondazione Policlinico Universitario “A. Gemell” IRCCSRomaItaly
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ASH ISTH NHF WFH 2021 guidelines on the diagnosis of von Willebrand disease. Blood Adv 2021; 5:280-300. [PMID: 33570651 DOI: 10.1182/bloodadvances.2020003265] [Citation(s) in RCA: 226] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/23/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND von Willebrand disease (VWD) is the most common inherited bleeding disorder known in humans. Accurate and timely diagnosis presents numerous challenges. OBJECTIVE These evidence-based guidelines of the American Society of Hematology (ASH), the International Society on Thrombosis and Haemostasis (ISTH), the National Hemophilia Foundation (NHF), and the World Federation of Hemophilia (WFH) are intended to support patients, clinicians, and other health care professionals in their decisions about VWD diagnosis. METHODS ASH, ISTH, NHF, and WFH established a multidisciplinary guideline panel that included 4 patient representatives and was balanced to minimize potential bias from conflicts of interest. The Outcomes and Implementation Research Unit at the University of Kansas Medical Center (KUMC) supported the guideline-development process, including performing or updating systematic evidence reviews up to 8 January 2020. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subsequently subject to public comment. RESULTS The panel agreed on 11 recommendations. CONCLUSIONS Key recommendations of these guidelines include the role of bleeding-assessment tools in the assessment of patients suspected of VWD, diagnostic assays and laboratory cutoffs for type 1 and type 2 VWD, how to approach a type 1 VWD patient with normalized levels over time, and the role of genetic testing vs phenotypic assays for types 2B and 2N. Future critical research priorities are also identified.
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Seidizadeh O, Peyvandi F, Mannucci PM. Von Willebrand disease type 2N: An update. J Thromb Haemost 2021; 19:909-916. [PMID: 33497541 DOI: 10.1111/jth.15247] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/18/2022]
Abstract
Quantitative or qualitative defects of von Willebrand factor (VWF) are responsible for the most common inherited bleeding disorder, von Willebrand disease (VWD). Type 2N VWD is an uncommon recessive disorder that results from gene mutations located in the region coding for the binding site of VWF for factor VIII (FVIII). This narrative review describes the pathophysiology, diagnostic procedures and treatment as well as the molecular biology of type 2N VWD. Although other VWF-dependent functions like binding to platelets and collagen are preserved, FVIII plasma levels are low due to the rapid clearance of this moiety in the absence or reduction of its binding to VWF. The diagnosis of type 2N should be considered in patients with low FVIII coagulant activity (FVIII:C) and disproportionally higher VWF antigen, especially when they present with an autosomal recessive pattern of inheritance. Because an accurate diagnosis is essential for genetic counseling and optimal treatment, type 2N must be distinguished from mild/moderate hemophilia A and its carrier state. This differential diagnosis can be obtained by using the laboratory assay of the FVIII binding capacity of VWF (VWF:FVIIIB) or analysis of the FVIII binding site on the VWF gene.
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Affiliation(s)
- Omid Seidizadeh
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
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Baronciani L, Peyvandi F. How we make an accurate diagnosis of von Willebrand disease. Thromb Res 2020; 196:579-589. [DOI: 10.1016/j.thromres.2019.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/27/2019] [Accepted: 07/14/2019] [Indexed: 11/28/2022]
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7
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Szederjesi A, Baronciani L, Budde U, Castaman G, Colpani P, Lawrie AS, Liu Y, Montgomery R, Peyvandi F, Schneppenheim R, Patzke J, Bodó I. Comparison of von Willebrand factor platelet-binding activity assays: ELISA overreads type 2B with loss of HMW multimers. J Thromb Haemost 2020; 18:2513-2523. [PMID: 32573891 PMCID: PMC7722054 DOI: 10.1111/jth.14971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/22/2020] [Accepted: 06/10/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND A number of new assays with different measuring principles are available to measure von Willebrand factor (VWF) glycoprotein Ib (GPIb)-binding activity, but little is known about how these assays might behave differently for subtypes of von Willebrand disease (VWD). OBJECTIVES The Comparison of Assays to Measure VWF Activity (COMPASS-VWF) study was designed to compare all available VWF GPIb-binding activity assays for VWF. We specifically searched for particular assay behavior differences. PATIENTS/METHODS To sort out random differences from systematic assay behavior deviations, all assays were performed in different laboratories on the same samples in a blinded fashion. Samples from 53 normal controls and 42 well-characterized VWD patients were reanalyzed in this study to dissect assay-specific discrepancies. RESULTS No assay behavior differences were found for 53 normal controls. For VWD patients, we found the following systematic assay behavior patterns: (a) All ELISA assays for VWF:GPIbR as well as VWF:GPIbM are insensitive to detect the low VWF activity of VWD type 2B patients with loss of high molecular weight multimers; (b) VWF:Ab assay reports higher activity for the p.V1665E mutation than all other assays; and (c) all ristocetin-based assays (including VWF:RCo using fixed platelets) but the AcuStar assay report discrepantly low VWF activity for the p.P1467S polymorphism. No systematic assay-specific difference was observed for either the particle agglutination VWF:GPIbM assay or the AcuStar assay using magnetic beads. CONCLUSIONS Different assay principles may lead to discrepant results for certain VWD types or mutations. Therefore, a more extensive study for a large number of patients is needed to better characterize the incidence and relevance of such assay-specific differences.
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Affiliation(s)
- Attila Szederjesi
- Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Luciano Baronciani
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Ulrich Budde
- Laboratory of Hemostasis, Medilys Laboratory, Hamburg, Germany
| | - Giancarlo Castaman
- Careggi University Hospital, Center for Bleeding Disorders, Florence, Italy
| | - Paola Colpani
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Andrew S. Lawrie
- Haemostasis Research Unit, University College London, London, UK
| | - Yuan Liu
- Winship Cancer Institute, Emory University, Atlanta, GA, U.S.A
| | | | - Flora Peyvandi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Reinhard Schneppenheim
- Dept. of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Patzke
- Siemens Healthcare Diagnostics Products GmbH, Dept. of Assay Development, Marburg, Germany
| | - Imre Bodó
- Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary
- Winship Cancer Institute, Emory University, Atlanta, GA, U.S.A
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Noncanonical type 2B von Willebrand disease associated with mutations in the VWF D'D3 and D4 domains. Blood Adv 2020; 4:3405-3415. [PMID: 32722784 DOI: 10.1182/bloodadvances.2020002334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/22/2020] [Indexed: 11/20/2022] Open
Abstract
We observed a 55-year-old Italian man who presented with mucosal and cutaneous bleeding. Results of his blood analysis showed low levels of von Willebrand factor (VWF) antigen and VWF activity (both VWF ristocetin cofactor and VWF collagen binding), mild thrombocytopenia, increased ristocetin-induced platelet aggregation, and a deficiency of high-molecular-weight multimers, all typical phenotypic hallmarks of type 2B von Willebrand disease (VWD). The analysis of the VWF gene sequence revealed heterozygous in cis mutations: (1) c.2771G>A and (2) c.6532G>T substitutions in the exons 21 and 37, respectively. The first mutation causes the substitution of an Arg residue with a Gln at position 924, in the D'D3 domain. The second mutation causes an Ala to Ser substitution at position 2178 in the D4 domain. The patient's daughter did not present the same fatherly mutations but showed only the heterozygous polymorphic c.3379C>T mutation in exon 25 of the VWF gene causing the p.P1127S substitution, inherited from her mother. The in vitro expression of the heterozygous in cis VWF mutant rVWFWT/rVWF924Q-2178S confirmed and recapitulated the ex vivo VWF findings. Molecular modeling showed that these in cis mutations stabilize a partially stretched and open conformation of the VWF monomer. Transmission electron microscopy and atomic force microscopy showed in the heterozygous recombinant form rVWFWT/rVWF924Q-2178S a stretched conformation, forming strings even under static conditions. Thus, the heterozygous in cis mutations 924Q/2178S promote conformational transitions in the VWF molecule, causing a type 2B-like VWD phenotype, despite the absence of typical mutations in the A1 domain of VWF.
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Stufano F, Baronciani L, Bucciarelli P, Boscarino M, Colpani P, Pagliari MT, Peyvandi F. Evaluation of a fully automated von Willebrand factor assay panel for the diagnosis of von Willebrand disease. Haemophilia 2020; 26:298-305. [PMID: 32107842 DOI: 10.1111/hae.13929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/08/2019] [Accepted: 01/03/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION von Willebrand disease (VWD) diagnosis starts with first level tests: factor VIII coagulant activity, VWF antigen (VWF:Ag) and platelet-dependent VWF activity (VWF:RCo, VWF:Ab, VWF:GPIbR or VWF:GPIbM). The VWF collagen binding (VWF:CB) assay measures the binding capacity of von Willebrand factor (VWF) to collagen. AIM To assess, in previously diagnosed VWD patients, the performance of a fully automated chemiluminescent test panel including VWF:Ag, VWF:GPIbR and VWF:CB assays. METHODS The patients, historically evaluated using in-house VWF:Ag and VWF:CB assays and an automated latex enhanced immunoassay VWF:GPIbR method, were re-evaluated using the VWF test panel HemosIL AcuStar. RESULTS The VWF:GPIbR/VWF:Ag and VWF:CB/VWF:Ag obtained by means of AcuStar showed an overall good concordance with the corresponding data obtained at the time of the historical diagnosis. When discrepancies occurred, these were generally due to the lower VWF:CB/VWF:Ag obtained with AcuStar as compared with that obtained with the historical methods and this affected particularly the diagnosis of VWD type 2M. Together, the AcuStar VWF:GPIbR/VWF:Ag and VWF:CB/VWF:Ag were able to distinguish type 1 from types 2A, 2B and 2M, whereas no distinction was possible between type 2A and 2B. CONCLUSION The AcuStar panel offers a good performance in the differential diagnosis between VWD type 1 and 2A/2B patients. A high rate of coincidence with historical diagnosis was obtained for VWD types 3, 2A/2B and 1. Even though in some cases more tests (eg, RIPA/multimeric analysis) are needed to complete an accurate VWD classification, the AcuStar panel is considered a sensitive, rapid and reliable tool to diagnose VWD patients.
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Affiliation(s)
- Francesca Stufano
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa, Milan, Italy
| | - Luciano Baronciani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa, Milan, Italy
| | - Paolo Bucciarelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa, Milan, Italy
| | - Marco Boscarino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa, Milan, Italy
| | - Paola Colpani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa, Milan, Italy
| | - Maria Teresa Pagliari
- 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, Fondazione Luigi Villa, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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10
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Calcoen B, Van Horenbeeck I, Debasse M, Toelen J, Vanlinthout I, Schoeters J, Peerlinck K, Jacquemin MG. The concentration of GPIbα magnetic particles is a critical parameter occasionally responsible for poor reproducibility of the VWF:GPIbR chemiluminescent immunoassay. Int J Lab Hematol 2019; 41:e79-e80. [DOI: 10.1111/ijlh.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Bas Calcoen
- Clinical Department of Laboratory Medicine; University Hospitals Leuven; Leuven Belgium
| | - Isa Van Horenbeeck
- Clinical Department of Laboratory Medicine; University Hospitals Leuven; Leuven Belgium
| | - Mirjam Debasse
- Clinical Department of Laboratory Medicine; University Hospitals Leuven; Leuven Belgium
| | - Jelle Toelen
- Clinical Department of Laboratory Medicine; University Hospitals Leuven; Leuven Belgium
| | - Ingrid Vanlinthout
- Clinical Department of Laboratory Medicine; University Hospitals Leuven; Leuven Belgium
| | - Joke Schoeters
- Clinical Department of Laboratory Medicine; University Hospitals Leuven; Leuven Belgium
| | - Kathelijne Peerlinck
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology; University of Leuven; Leuven Belgium
- Department of Vascular Medicine and Hemostasis; University Hospitals Leuven and National Coordinating Hemophilia Center, University Hospitals Leuven; Leuven Belgium
| | - Marc G. Jacquemin
- Clinical Department of Laboratory Medicine; University Hospitals Leuven; Leuven Belgium
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology; University of Leuven; Leuven Belgium
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11
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Higgins RA, Goodwin AJ. Automated assays for von Willebrand factor activity. Am J Hematol 2019; 94:496-503. [PMID: 30592326 DOI: 10.1002/ajh.25393] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 12/30/2022]
Abstract
von Willebrand factor (VWF) ristocetin cofactor activity (VWF:RCo) by platelet aggregometry has been considered the gold standard for evaluating the ability of VWF to bind platelets for over 40 years. Many automated systems no longer require platelets and rather rely on agglutination of latex particles. Automated methods of measuring VWF activity have improved performance characteristics and are performed on the same coagulation instruments used for routine testing via immunoturbidimetric methodology. Alternatively, a newer chemiluminescence assay system for measuring VWF activity demonstrates excellent performance characteristics. As these methods are becoming widely used, it is important to assess their performance in diagnosing and monitoring different types of von Willebrand disease. We review the automated methodologies and the published performance of these VWF assays. Advantages and limitations of these automated methods are discussed.
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Affiliation(s)
- Russell A. Higgins
- Department of Pathology and Laboratory Medicine University of Texas Health Science Center San Antonio San Antonio Texas
| | - Andrew J. Goodwin
- Department of Pathology and Laboratory Medicine Larner College of Medicine, University of Vermont Burlington Vermont
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12
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Rottenstreich A, Kleinstern G, Amsalem H, Kalish Y. The course of acquired von Willebrand syndrome during pregnancy among patients with essential thrombocytosis. J Thromb Thrombolysis 2018; 46:304-309. [PMID: 29654448 DOI: 10.1007/s11239-018-1663-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To investigate the course of acquired type 2A von Willebrand syndrome (AVWS) in relation to patient management and outcomes among pregnant patients with essential thrombocytosis (ET). A review of pregnant women with ET evaluated for AVWS at the beginning of pregnancy and at the third trimester. Eighteen women with 24 pregnancies were included in this study. A history of bleeding was noted in 8 (44%) patients. In 20 (83%) pregnancies AVWS was evident at the initial testing. Following initial testing, antithrombotic therapy was administered in 22 (92%) pregnancies (aspirin, n = 20 and low-molecular-weight heparin, n = 2). In the remaining two pregnancies, VWF:RCo levels were below 30%; thus, aspirin was given only after repeat testing at 14-16 weeks. At third trimester testing, median VWF:RCo levels were significantly higher than at the initial testing (86 vs. 48%, P < 0.001), with no evidence of AVWS in any of the patients. Significant increases were also observed in the VWF:Ag level (127 vs. 84%, P < 0.001), the VWF:RCo/VWF:Ag ratio (0.75 vs. 0.54, P < 0.001) and the FVIII level (103 vs. 68%, P < 0.001); while platelet count (359 vs. 701 × 109/l, P < 0.001) and hemoglobin level (11.6 vs. 13.4 g/dl, P < 0.001) decreased. Neuraxial anesthesia was safely performed in 17 (71%) pregnancies. No significant bleeding events occurred during pregnancy and delivery. AVWS-related abnormalities in women with ET mostly improved during pregnancy, with favorable maternal and fetal outcomes. VWF parameters should be tested at early pregnancy and repeated at the third trimester, to guide pregnancy and delivery management.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Geffen Kleinstern
- Braun School of Public Health and Community Medicine, Faculty of Medicine of the Hebrew University and Hadassah, Jerusalem, Israel.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Hagai Amsalem
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yosef Kalish
- Department of Hematology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
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13
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Szederjesi A, Baronciani L, Budde U, Castaman G, Lawrie AS, Liu Y, Montgomery R, Peyvandi F, Schneppenheim R, Várkonyi A, Patzke J, Bodó I. An international collaborative study to compare different von Willebrand factor glycoprotein Ib binding activity assays: the COMPASS-VWF study. J Thromb Haemost 2018; 16:1604-1613. [PMID: 29897666 PMCID: PMC6292779 DOI: 10.1111/jth.14206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Indexed: 01/25/2023]
Abstract
Essentials New VWF activity assays are increasingly used but information on their comparability is limited. This is an ISTH SSC-organized study (expert labs, 5 countries) to compare all available assays. VWF activity by six assays correlated well with each other. The new assays show improved characteristics - minor differences are noted. SUMMARY: Background Several new assays have become available to measure von Willebrand factor (VWF) activity. The new assays appear to have improved performance characteristics compared with the old reference standard, ristocetin cofactor activity (VWF:RCo), but information is limited about how they compare with VWF:RCo and each other. Methods The von Willebrand factor Subcommittee of the International Society for Thrombosis and Haemostasis (ISTH) Scientific and Standardization Committee (SSC) designed a collaborative study involving expert laboratories from several countries to compare available tests with each other and with VWF:RCo. Eight laboratories from five countries were provided with blinded samples from normal healthy individuals and well-characterized clinical cases. Laboratories measured VWF activity using all tests available to them; data from six laboratories, not affected by thawing during transportation, are included in this study. Results All tests correlated well with VWF:RCo activity (r-values ranged from 0.963 to 0.989). Slightly steeper regression lines for VWF:Ab and VWF:GPIbM were clinically insignificant. The new assays showed improved performance characteristics. Of the commercially available assays, the VWF:GPIbR using the AcuStar system was the most sensitive and could reliably detect VWF activity below 1 IU dL-1 . The lower limit of the measuring interval for the VWF:GPIbM and the VWF:GPIbR assays was in the 3-4 and 3-6 IU dL-1 range, respectively. Inter-laboratory variation was also improved for most new assays. Conclusion All VWF activity assays correlated well with each other and the VWF:RCo assay. The slight differences in characteristics found in the COMPASS-VWF study will assist the VWF community in interpreting and comparing activity results.
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Affiliation(s)
- A Szederjesi
- Szent István and Szent László Hospital, Budapest, Hungary
| | - L Baronciani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - U Budde
- Laboratory of Hemostasis, University Hospital Hamburg, Hamburg, Germany
| | - G Castaman
- Center for Bleeding Disorders, Careggi University Hospital, Florence, Italy
| | - A S Lawrie
- Haemostasis Research Unit, University College London, London, UK
| | - Y Liu
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - R Montgomery
- MFRC, Medical College of Wisconsin, Milwaukee, WI, USA
| | - F Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - R Schneppenheim
- University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - A Várkonyi
- Szent István and Szent László Hospital, Budapest, Hungary
| | - J Patzke
- Department of Assay Development, Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany
| | - I Bodó
- Szent István and Szent László Hospital, Budapest, Hungary
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
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14
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Pérez-Rodríguez A, Batlle J, Corrales I, Borràs N, Rodríguez-Trillo Á, Lourés E, Cid AR, Bonanad S, Cabrera N, Moret A, Parra R, Mingot-Castellano ME, Navarro N, Altisent C, Pérez-Montes R, Marcellini S, Moreto A, Herrero S, Soto I, Fernández Mosteirín N, Jiménez-Yuste V, Alonso N, de Andrés Jacob A, Fontanes E, Campos R, Paloma MJ, Bermejo N, Berrueco R, Mateo J, Arribalzaga K, Marco P, Palomo Á, Castro Quismondo N, Iñigo B, Nieto MDM, Vidal R, Martínez MP, Aguinaco R, Tenorio M, Ferreiro M, García-Frade J, Rodríguez-Huerta AM, Cuesta J, Rodríguez-González R, García-Candel F, Dobón M, Aguilar C, Batlle F, Vidal F, López-Fernández MF. Role of multimeric analysis of von Willebrand factor (VWF) in von Willebrand disease (VWD) diagnosis: Lessons from the PCM-EVW-ES Spanish project. PLoS One 2018; 13:e0197876. [PMID: 29924855 PMCID: PMC6010290 DOI: 10.1371/journal.pone.0197876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022] Open
Abstract
The multimeric analysis (MA) of plasma von Willebrand factor (VWF) evaluates structural integrity and helps in the diagnosis of von Willebrand disease (VWD). This assay is a matter of controversy, being considered by some investigators cumbersome and only slightly informative. The centralised study ‘Molecular and Clinical Profile of von Willebrand Disease in Spain (PCM-EVW-ES)’ has been carried out by including the phenotypic assessment and the genetic analysis by next generation sequencing (NGS) of the VWF gene (VWF). The aim of the present study was to evaluate the role of MA to the diagnosis of these patients and their potential discrepancies. Two hundred and seventy out of 480 patients centrally diagnosed with VWD had normal multimers, 168 had abnormal multimers and 42 a total absence of multimers. VWF MA was of great significance in the diagnosis of 83 patients (17.3%), it was also of help in the diagnosis achieved in 365 additional patients (76%) and was not informative in 32 cases (6.7%). With regard to discrepancies, 110 out of 480 (23%) patients centrally diagnosed with VWD presented some kind of discordance between VWF:RCo/VWF:Ag and/or VWF:CB/VWF:Ag ratios, multimeric study and/or genetic results. The VWF MA was key in the presence of novel mutations as well as in cases with phenotypic discrepancies. A comparison between the contribution of MA and VWF:CB showed a clearly higher contribution of the former in the diagnostic process. These data seem to reinforce the relevance of the VWF MA in VWD diagnosis, despite all its limitations.
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Affiliation(s)
| | - Javier Batlle
- Servicio Hematología, Complexo Hospitalario Universitario A Coruña, INIBIC, A Coruña, Spain
- * E-mail:
| | - Irene Corrales
- Banc de Sang i Teixits, Barcelona, Spain
- Unitat d’Hemofilia, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Nina Borràs
- Banc de Sang i Teixits, Barcelona, Spain
- Unitat d’Hemofilia, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | | | - Esther Lourés
- Servicio Hematología, Complexo Hospitalario Universitario A Coruña, INIBIC, A Coruña, Spain
| | - Ana Rosa Cid
- Servicio Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Santiago Bonanad
- Servicio Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Noelia Cabrera
- Servicio Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Andrés Moret
- Servicio Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Parra
- Unitat d’Hemofilia, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- Servicio Hematología, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | | | - Nira Navarro
- Servicio Hematología, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Carmen Altisent
- Servicio Hematología, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Rocío Pérez-Montes
- Servicio Hematología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Ana Moreto
- Servicio Hematología, Hospital Universitario Cruces, Barakaldo, Spain
| | - Sonia Herrero
- Servicio Hematología, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Inmaculada Soto
- Servicio Hematología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Nieves Alonso
- Servicio Hematología, Hospital Infanta Cristina, Badajoz, Spain
| | | | - Emilia Fontanes
- Servicio Hematología, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Rosa Campos
- Servicio Hematología, Hospital Jerez de la Frontera, Cádiz, Spain
| | | | - Nuria Bermejo
- Servicio Hematología, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Rubén Berrueco
- Servicio Hematología, Hospital Sant Joan de Deu, Barcelona, Spain
| | - José Mateo
- Servicio Hematología, Hospital Sta Creu i St Pau, Barcelona, Spain
| | - Karmele Arribalzaga
- Servicio Hematología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Pascual Marco
- Servicio Hematología, Hospital General de Alicante, Alicante, Spain
| | - Ángeles Palomo
- Servicio Hematología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Belén Iñigo
- Servicio Hematología, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Rosa Vidal
- Servicio Hematología, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Reyes Aguinaco
- Servicio Hematología, Hospital Joan XXIII, Tarragona, Spain
| | - Maria Tenorio
- Servicio Hematología, Hospital Ramón y Cajal, Madrid, Spain
| | - María Ferreiro
- Servicio Hematología, Hospital Montecelo, Pontevedra, Spain
| | | | | | - Jorge Cuesta
- Servicio Hematología, Hospital Virgen de la Salud, Toledo, Spain
| | | | | | - Manuela Dobón
- Servicio Hematología, Hospital Lozano Blesa, Zaragoza, Spain
| | - Carlos Aguilar
- Servicio Hematología, Hospital Santa Bárbara, Soria, Spain
| | - Fernando Batlle
- Department of Research, Lapisoft Project S.L., A Coruña, Spain
| | - Francisco Vidal
- Banc de Sang i Teixits, Barcelona, Spain
- Unitat d’Hemofilia, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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15
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Rottenstreich A, Shai E, Kleinstern G, Spectre G, Varon D, Kalish Y. Assessment of procoagulant potential in patients with reactive thrombocytosis and its association with platelet count. Eur J Haematol 2018; 100:286-293. [PMID: 29240268 DOI: 10.1111/ejh.13012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to determine hemostatic changes and characterize the procoagulant potential among patients with reactive thrombocytosis (RT). METHODS Sixty patients with RT (median platelet count 718 × 109 /L) and 20 healthy persons were tested for complete blood count, C-reactive protein, von Willebrand factor (VWF), factor VIII and fibrinogen, and thrombin generation. Platelet studies, including light transmission aggregometry and Cone and Plate(let) Analyzer, were also conducted. Reticulated platelets and platelet P-selectin expression were measured using flow cytometry. RESULTS Compared to patients with mild thrombocytosis (platelet count 500-700 × 109 /L; n = 27), those with moderate-to-severe thrombocytosis (platelet count >700 × 109 /L; n = 33) had significantly higher fibrinogen, factor VIII, and VWF antigen and activity levels; higher endogenous thrombin potential, peak thrombin generation and velocity index levels, and shorter time-to-peak thrombin level. VWF antigen and activity, fibrinogen, and factor VIII were positively associated with platelet count, whereas VWF activity/antigen ratio was inversely correlated. In a multivariate analysis of RT and control participants, only platelet count predicted endogenous thrombin potential with a positive-linear correlation. No patients developed acquired von Willebrand syndrome. CONCLUSIONS As determined by thrombin generation, RT was associated with in vitro prothrombotic tendency, which correlated with platelet count. This may explain the increased thromboembolic risk previously reported in patients with RT.
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Affiliation(s)
- Amihai Rottenstreich
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ela Shai
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Geffen Kleinstern
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Galia Spectre
- Institute of Hematology, Coagulation Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Varon
- Hematology Department, Sourasky Medical Center, Tel Aviv, Israel
| | - Yosef Kalish
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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16
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Rottenstreich A, Elazary R, Yuval JB, Spectre G, Kleinstern G, Kalish Y. Assessment of the procoagulant potential after laparoscopic sleeve gastrectomy: a potential role for extended thromboprophylaxis. Surg Obes Relat Dis 2018; 14:1-7. [DOI: 10.1016/j.soard.2017.09.526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/03/2017] [Accepted: 09/23/2017] [Indexed: 11/26/2022]
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17
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Rottenstreich A, Kleinstern G, Krichevsky S, Varon D, Lavie D, Kalish Y. Factors related to the development of acquired von Willebrand syndrome in patients with essential thrombocythemia and polycythemia vera. Eur J Intern Med 2017; 41:49-54. [PMID: 27919526 DOI: 10.1016/j.ejim.2016.11.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE We characterized acquired von Willebrand syndrome (AVWS) among essential thrombocythemia (ET) and polycythemia vera (PV) patients. METHODS A review of patients with ET or PV evaluated for AVWS. RESULTS Of 116 patients with ET, 64 (55%) developed AVWS; of 57 with PV, 28 (49%) developed AVWS. Median platelet counts of ET and PV patients who developed AVWS were 920×109/L and 679×109/L, respectively (P=0.01). Of patients who developed AVWS, 69.5% had platelet counts below 1000×109/L. Bleeding was more common in patients with AVWS, among both ET and PV patients (P<0.001). VWF:RCo levels and VWF:RCo/VWF:Ag ratio were lower among JAK2 V617F positive- vs. JAK2 V617F negative- ET patients (P=0.02 and P=0.002, respectively); whereas VWF:Ag levels were comparable (P=0.96). ET patients harboring the JAK2 V617F mutation were more likely to develop AVWS than were calreticulin-positive patients (70.3% vs. 45.7%, P=0.02), despite lower platelet counts (median 773 vs. 920×109/L, P=0.05). In multivariable analysis, younger age (P=0.002), platelet count (P<0.001), hemoglobin level (P=0.01) and JAK2 V617F mutation (P=0.01) independently predicted the development of AVWS among ET patients; whereas only platelet count predicted its development among PV patients (P<0.001). CONCLUSION Among ET and PV patients, AVWS was common and associated with higher bleeding rates and higher platelet count; nonetheless, most AVWS patients had platelet counts under 1000×109/L. Thus, AVWS screening should be included in routine assessment of ET and PV patients. Among ET patients, JAK2 V617F was a main driver for the development of AVWS.
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Affiliation(s)
- A Rottenstreich
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - G Kleinstern
- Braun School of Public Health and Community Medicine, Faculty of Medicine of the Hebrew University and Hadassah, Jerusalem, Israel; Health Sciences Research, Mayo Clinic, Rochester, MN
| | - S Krichevsky
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - D Varon
- Hematology Department, Sourasky Medical Center, Tel Aviv, Israel
| | - D Lavie
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Y Kalish
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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18
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Ettel M, Nardi MA, McVoy L. Validation of automated latex von Willebrand factor activity assay in a new prospective study including post-treatment patient samples. Int J Lab Hematol 2017; 39:286-292. [PMID: 28120508 DOI: 10.1111/ijlh.12622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/06/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Von Willebrand disease (VWD) is the most prevalent inherited bleeding disorder. Diagnosis requires measurement of VWF-platelet binding function, for which VWF ristocetin cofactor activity (VWF:RCo) is the reference method. Recently, an automated latex particle-enhanced immunoturbidimetric von Willebrand factor activity assay (VWF:Ab) has been validated showing superior characteristics. We further validate VWF:Ab in a prospective study including post-treatment patient samples. METHODS A total of 1151 samples were collected from patients tested for VWD, including 119 samples from patients treated with desmopressin or VWF replacement product. All samples were tested for VWF:Ab and VWF:RCo, and the methods were compared using linear regression. Imprecision, linearity and lower detection limit were determined for both assays. RESULTS VWF:Ab showed improved precision compared to VWF:RCo. Linear regression of VWF:Ab and VWF:RCo across all samples exhibited good agreement (R2 = 0.89) with statistical significance (P < 0.001) and bias of -8.7. Concordance was high in classifying samples as normal or abnormal. Analysis of treated samples showed excellent agreement (R2 = 0.91) with statistical significance (P < 0.001) and bias of -4.3. CONCLUSIONS Our analysis validates the VWF:Ab assay in a prospective study of a large cohort of patient samples and extends these results to post-treatment patient samples.
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Affiliation(s)
- M Ettel
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - M A Nardi
- Department of Pathology, New York University School of Medicine, New York, NY, USA.,Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - L McVoy
- Department of Pathology, New York University School of Medicine, New York, NY, USA
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Patzke J, Favaloro EJ. Laboratory Testing for von Willebrand Factor Activity by Glycoprotein Ib Binding Assays (VWF:GPIb). Methods Mol Biol 2017; 1646:453-460. [PMID: 28804847 DOI: 10.1007/978-1-4939-7196-1_33] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In addition to assessment of von Willebrand factor (VWF) antigen (VWF:Ag), the first-line laboratory investigation of possible von Willebrand disease (VWD) often includes an assay to measure GPIb (glycoprotein Ib) binding activity of VWF. A decreased GPIb binding activity is characteristic for most of the VWD types. For many years, the most frequently used assay for measuring GPIb binding activity was the ristocetin cofactor assay (VWF:RCo), which measures the agglutination of fixed human platelets by VWF in the presence of ristocetin. Because of performance issues, including high assay variability and a lack of VWF sensitivity, this assay is currently being replaced or supplemented by assays based on the binding of VWF to recombinant GPIb. One published method (now abbreviated VWF:GPIbR) uses wild-type GPIb for triggering the binding reaction in the presence of ristocetin. Another more widely used method (now abbreviated VWF:GPIbM) uses gain-of-function GPIb without ristocetin; this permits spontaneous binding of VWF to GPIb and avoids problems associated with the nonphysiological substance ristocetin. The binding of VWF to GPIb can be quantified by using different principles, e.g., ELISA, particle agglutination, or chemiluminescence. The following chapter describes a ristocetin-free method based on particle agglutination in more detail.
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Affiliation(s)
- Jürgen Patzke
- Siemens Healthcare Diagnostics Products GmbH, Assay Development, Emil-von-Behring-Str. 76, 35041, Marburg, Germany.
| | - Emmanuel J Favaloro
- Haematology Department, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, NSW Health Pathology, Westmead, NSW, 2145, Australia
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20
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Favaloro EJ, Pasalic L, Curnow J. Laboratory tests used to help diagnose von Willebrand disease: an update. Pathology 2016; 48:303-18. [DOI: 10.1016/j.pathol.2016.03.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/15/2016] [Accepted: 03/20/2016] [Indexed: 10/21/2022]
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Evaluation of a von Willebrand factor three test panel and chemiluminescent-based assay system for identification of, and therapy monitoring in, von Willebrand disease. Thromb Res 2016; 141:202-11. [DOI: 10.1016/j.thromres.2015.12.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/06/2015] [Accepted: 12/12/2015] [Indexed: 01/31/2023]
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22
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Sagheer S, Rodgers S, Yacoub O, Dauer R, Mcrae S, Duncan E. Comparison of von Willebrand factor (VWF) activity levels determined by HemosIL AcuStar assay and HemosIL LIA assay with ristocetin cofactor assay by aggregometry. Haemophilia 2016; 22:e200-7. [PMID: 27076201 DOI: 10.1111/hae.12937] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Diagnosis of von Willebrand disease (VWD) requires quantitative as well as qualitative determination of von Willebrand factor (VWF) levels. For functional assessment of VWF, ristocetin cofactor assay by aggregometry is considered to be the gold standard. However, need for technical expertise, labour intensiveness, difficult standardization and high intra- and inter- assay variabilities are some of the limitations of this methodology. Various assays for determination of VWF adhesive function using different methodologies have been developed in recent years. AIM To evaluate the HemosIL AcuStar chemiluminescence assay (VWF:RCo[Acu]) and the HemosIL latex immunoassay (VWF:act) as diagnostic tests for VWD and identification of type 2 VWD in comparison with the ristocetin cofactor assay performed by aggregometry (VWF:RCo[Agg]). METHODS Results from 96 samples analysed by VWF:RCo[Acu] and 128 samples by VWF:act were compared with VWF:RCo[Agg]. Sixty of these samples (25 normal, 17 type 1 and 18 type 2) were analysed by all three assays. RESULTS VWF:RCo[Acu] showed excellent agreement with VWF:RCo[Agg], and readily identified all type 2 VWD samples tested. VWF:act showed reasonable agreement with VWF:RCo[Agg] for most patients, but had a slightly lower sensitivity for detection of type 2 VWD. CONCLUSION VWF:RCo[Acu] assay has the potential to replace VWF:RCo[Agg] for the diagnosis of VWD.
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Affiliation(s)
- S Sagheer
- Haematology Division, SA Pathology, Adelaide, Australia
| | - S Rodgers
- Haematology Division, SA Pathology, Adelaide, Australia
| | - O Yacoub
- Haematology Division, SA Pathology, Adelaide, Australia
| | - R Dauer
- Haematology Department, The Alfred, Prahan, Australia
| | - S Mcrae
- Haematology Division, SA Pathology, Adelaide, Australia
| | - E Duncan
- Haematology Division, SA Pathology, Adelaide, Australia
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Rapid discrimination of the phenotypic variants of von Willebrand disease. Blood 2016; 127:2472-80. [PMID: 26917779 DOI: 10.1182/blood-2015-11-664680] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/15/2016] [Indexed: 11/20/2022] Open
Abstract
Approximately 20% to 25% of patients with von Willebrand disease (VWD) have a qualitative defect of the von Willebrand factor (VWF) protein activities. Variant VWD typically is classified as type 1C, 2A, 2B, 2M, or 2N depending on the VWF activity defect. Traditionally, diagnosis has relied on multiple clinical laboratory assays to assign VWD phenotype. We developed an enzyme-linked immunosorbent assay (ELISA) to measure the various activities of VWF on a single plate and evaluated 160 patient samples enrolled in the Zimmerman Program for the Molecular and Clinical Biology of von Willebrand Disease with type 2 VWD. Using linear discriminate analysis (LDA), this assay was able to identify type 1C, 2A, 2B, 2M, or 2N VWD with an overall accuracy of 92.5% in the patient study cohort. LDA jackknife analysis, a statistical resampling technique, identified variant VWD with an overall accuracy of 88.1%, which predicts the assay's performance in the general population. In addition, this assay demonstrated correlation with traditional clinical laboratory VWF assays. The VWF multiplex activity assay may be useful as a same-day screening assay when considering the diagnosis of variant VWD in an individual patient.
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Maxillary pseudotumor as initial manifestation of von Willebrand disease, type 2: report of a rare case and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2016. [DOI: 10.1016/j.oooo.2015.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Batlle J, Pérez-Rodríguez A, Corrales I, López-Fernández MF, Rodríguez-Trillo Á, Lourés E, Cid AR, Bonanad S, Cabrera N, Moret A, Parra R, Mingot-Castellano ME, Balda I, Altisent C, Pérez-Montes R, Fisac RM, Iruín G, Herrero S, Soto I, de Rueda B, Jiménez-Yuste V, Alonso N, Vilariño D, Arija O, Campos R, Paloma MJ, Bermejo N, Toll T, Mateo J, Arribalzaga K, Marco P, Palomo Á, Sarmiento L, Iñigo B, Nieto MDM, Vidal R, Martínez MP, Aguinaco R, César JM, Ferreiro M, García-Frade J, Rodríguez-Huerta AM, Cuesta J, Rodríguez-González R, García-Candel F, Cornudella R, Aguilar C, Borràs N, Vidal F. Molecular and clinical profile of von Willebrand disease in Spain (PCM-EVW-ES): Proposal for a new diagnostic paradigm. Thromb Haemost 2015; 115:40-50. [PMID: 26245874 DOI: 10.1160/th15-04-0282] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/26/2015] [Indexed: 12/15/2022]
Abstract
The diagnosis of von Willebrand disease (VWD) remains difficult in a significant proportion of patients. A Spanish multicentre study investigated a cohort of 556 patients from 330 families who were analysed centrally. VWD was confirmed in 480. Next generation sequencing (NGS) of the whole coding VWF was carried out in all recruited patients, compared with the phenotype, and a final diagnosis established. A total of 238 different VWF mutations were found, 154 were not included in the Leiden Open Variation Database (LOVD). Of the patients, 463 were found to have VWF mutation/s. A good phenotypic/genotypic association was estimated in 96.5% of the patients. One hundred seventy-four patients had two or more mutations. Occasionally a predominant phenotype masked the presence of a second abnormality. One hundred sixteen patients presented with mutations that had previously been associated with increased von Willebrand factor (VWF) clearance. RIPA unavailability, central phenotypic results disagreement and difficult distinction between severe type 1 and type 3 VWD prevented a clear diagnosis in 70 patients. The NGS study facilitated an appropriate classification in 63 of them. The remaining seven patients presented with a VWF novel mutation pending further investigation. In five patients with a type 3 and two with a type 2A or 2B phenotype with no mutation, an acquired von Willebrand syndrome (AVWS) was suspected/confirmed. These data seem to support NGS as a first line efficient and faster paradigm in VWD diagnosis.
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Affiliation(s)
- Javier Batlle
- Francisco Javier Batlle Fonrodona, M. D., Servicio de Hematología y Hemoterapia. INIBIC., Complexo Hospitalario Universitario A Coruña, Edificio Hospital Materno Infantil, Carretera del Pasaje s/n, 15006 - A Coruña, Spain, Tel.: +34 981 178000 Ext. 292113, Fax: +34 981 178392, E-mail:
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van Meegeren MER, Mancini TL, Schoormans SCM, van Haren BJT, van Duren C, Diekstra A, Laros-van Gorkom BAP, Brons PPT, Simons A, Hoefsloot L, van Heerde WL. Clinical phenotype in genetically confirmed von Willebrand disease type 2N patients reflects a haemophilia A phenotype. Haemophilia 2015. [DOI: 10.1111/hae.12733] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- M. E. R. van Meegeren
- Hemophilia Treatment Center; Radboud University Medical Center; Nijmegen The Netherlands
| | - T. L. Mancini
- Unit Thrombosis Hemostasis; Laboratory of Hematology; Department of Laboratory Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - S. C. M. Schoormans
- Unit Thrombosis Hemostasis; Laboratory of Hematology; Department of Laboratory Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - B. J. T. van Haren
- Unit Thrombosis Hemostasis; Laboratory of Hematology; Department of Laboratory Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - C. van Duren
- Unit Thrombosis Hemostasis; Laboratory of Hematology; Department of Laboratory Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - A. Diekstra
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - B. A. P. Laros-van Gorkom
- Hemophilia Treatment Center; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Hematology; Radboud University Medical Center; Nijmegen The Netherlands
| | - P. P. T. Brons
- Hemophilia Treatment Center; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Pediatrics; Radboud University Medical Center; Nijmegen The Netherlands
| | - A. Simons
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - L. Hoefsloot
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - W. L. van Heerde
- Hemophilia Treatment Center; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Pediatrics; Radboud University Medical Center; Nijmegen The Netherlands
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Lancellotti S, Dragani A, Ranalli P, Petrucci G, Basso M, Tartaglione R, Rocca B, De Cristofaro R. Qualitative and quantitative modifications of von Willebrand factor in patients with essential thrombocythemia and controlled platelet count. J Thromb Haemost 2015; 13:1226-37. [PMID: 25876231 DOI: 10.1111/jth.12967] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Essential thrombocythemia (ET) is characterized by increased platelets and prevalent thrombosis. An acquired von Willebrand factor (VWF) disease has been hypothesized and inconsistently associated with extreme thrombocytosis or rare bleeding in ET. Whether VWF is modified in ET patients with controlled platelet count remains unclear. OBJECTIVES We studied different VWF- and platelet-associated parameters in ET patients treated according to current recommendations. PATIENTS/METHODS Sixty-nine ET patients (M = 29; median age, 62 [48-70] years; platelets, 432 [337-620] × 10(3) μL(-1) ), 69 matched controls and 10 subjects with reactive thrombocytosis (RT) were studied. VWF:antigen (Ag), activity (act), electrophoretic patterns, VWF:propeptide, plasma glycocalycin (GC), glycoproteinV (GpV), ADAMTS-13, elastase, C-reactive protein and serum thromboxane (TX)B2 were measured. RESULTS In ET patients, VWF:Ag was increased by 31 ± 13% vs. controls (P < 0.01), without dependence of blood groups, while VWF:act was reduced by 21 ± 12% vs. controls and by 50 ± 24% vs. RT (P < 0.01). The VWF:act/VWF:Ag ratios in ET were reduced by 35 ± 17% vs. controls and RT patients (P < 0.001) and significantly associated with: immature or total platelet counts, GC, GpV and TXB2 . In multivariable analysis, only GC inversely predicted ET patients' VWF:act/VWF:Ag ratios (β = -0.42, P = 0.01). By electrophoresis analyses, high-molecular-weight VWF multimers were variably reduced with atypical cleavage bands in ET only. VWF:propeptide, ADAMTS-13 and elastase levels were normal in ET patients. Platelet-associated ADAM-10 and ADAM-17 hydrolyzed VWFm in vitro, showing patterns similar to those in ET samples. CONCLUSIONS In ET patients with controlled platelet counts, the VWF:act/VWF:Ag ratio is decreased and predicted by GC, a product of platelet activation. ADAM-10 and/or ADAM-17 might be involved. In vivo platelet activation, which characterizes ET, might contribute to disease-specific VWF alterations.
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Affiliation(s)
- S Lancellotti
- Center for Haemorrhagic and Thrombotic Diseases, Department of Medical Sciences, Catholic University School of Medicine, 'A. Gemelli' Hospital, Rome, Italy
| | - A Dragani
- Center for Haemorrhagic, Thrombotic and Rare Hematologic Diseases, Spirito Santo Hospital, Pescara, Italy
| | - P Ranalli
- Center for Haemorrhagic, Thrombotic and Rare Hematologic Diseases, Spirito Santo Hospital, Pescara, Italy
| | - G Petrucci
- Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - M Basso
- Center for Haemorrhagic and Thrombotic Diseases, Department of Medical Sciences, Catholic University School of Medicine, 'A. Gemelli' Hospital, Rome, Italy
| | - R Tartaglione
- Institute of Haematology, Complesso Integrato Columbus, Catholic University School of Medicine, Rome, Italy
| | - B Rocca
- Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - R De Cristofaro
- Center for Haemorrhagic and Thrombotic Diseases, Department of Medical Sciences, Catholic University School of Medicine, 'A. Gemelli' Hospital, Rome, Italy
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Bodó I, Eikenboom J, Montgomery R, Patzke J, Schneppenheim R, Di Paola J. Platelet-dependent von Willebrand factor activity. Nomenclature and methodology: communication from the SSC of the ISTH. J Thromb Haemost 2015; 13:1345-50. [PMID: 25858564 PMCID: PMC5576173 DOI: 10.1111/jth.12964] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/29/2015] [Indexed: 12/26/2022]
Affiliation(s)
- I Bodó
- Department of Hematology and Stem Cell Transplantation, St László Hospital, Budapest, Hungary
| | - J Eikenboom
- Department of Thrombosis and Hemostasis, Leiden University Medical School, Leiden, the Netherlands
| | - R Montgomery
- Department of Pediatrics - MFRC, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Patzke
- Department of Assay Development, Siemens Healthcare Diagnostic Products GmbH, Marburg, Germany
| | - R Schneppenheim
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Di Paola
- Pediatrics/Genetics, University of Colorado Denver, Aurora, CO, USA
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