von Willebrand disease and von Willebrand factor

Mental health in persons with von Willebrand disease in the United States - a large national database study

BACKGROUND

There are very few large population-based studies studying mental health in persons with von Willebrand disease (PwVWD).

OBJECTIVES

We aim to assess prevalence of depression and anxiety in PwVWD over a period of 20 years and identify bleeding symptoms that may be more likely associated with depression and anxiety in PwVWD.

METHODS

This is a retrospective cohort study using a deidentified national dataset from 1118 hospitals with 176 million patients. Cases were defined as patients aged 0-110 years, both male and female, with von Willebrand disease (VWD), without hemophilia. Controls were defined as patients aged 0-110 years, both male and female, without VWD or hemophilia. We compared rates of depression and anxiety in cases and controls and by type of bleeding symptoms.

RESULTS

We identified 66 367 PwVWD and 183 890 766 controls. The prevalence of depression (23.12% vs 8.62%; p ≤ .00093; relative risk = 2.68) and anxiety (32.90% vs 12.29%; p ≤ .00093; relative risk = 2.68) was higher in PwVWD. Most of the bleeding symptoms were associated with higher rates of depression and anxiety in PwVWD with the highest rates with abnormal uterine bleeding, hematemesis, hemoptysis, hematuria, and melena.

CONCLUSION

Our study shows that mental health disorders in PwVWD are a significant health burden, and that burden is increased with documented bleeding symptoms. It is important that primary care physicians and hematologists caring for this population recognize this increased risk and appropriately screen and refer to mental health professionals.

The diagnosis, natural history, and management of von Willebrand disease in women in the age of guidelines

INTRODUCTION

Women and girls with bleeding disorders face multiple bleeding challenges throughout their life. The most significant morbidity and mortality are due to heavy menstrual bleeding and postpartum hemorrhage in their reproductive years. The ASH/ISTH/NHF/WFH 2021 guidelines on diagnosing and managing von Willebrand disease (VWD) provide several new updates.

AREAS COVERED

Women with VWD have a higher prevalence of heavy menstrual bleeding. The subpopulation of adolescents is particularly vulnerable, as the diagnosis is often delayed with increased comorbidity of iron deficiency anemia and associated symptoms. A detailed review is done on the prevalence of bleeding-related complications, especially heavy menstrual bleeding (HMB) and post-partum hemorrhage (PPH). The management strategies are also reviewed in detail, with a specific focus on the target factor levels and the use of antifibrinolytics.

EXPERT OPINION

The 2021 ASH/ISTH/NHF/WFH diagnostic and management recommendations are reviewed with a specific focus on hormonal methods of HMB management and antifibrinolytics in this situation. The reviewed topics include neuraxial anesthesia, factor cutoff, and tranexamic acid use in the postpartum period.

Patients with von Willebrand disease in China: Results of an online survey

INTRODUCTION

Little is known about the clinical characteristics of von Willebrand disease (VWD) patients in China, the impact of Covid-19 on them and their genetic mutation.

AIM

To describe the clinical characteristics of a group of VWD patients in China, the impact of Covid-19 on them and their genetic mutation.

METHODS

An online survey using a self-designed questionnaire was conducted among patients within a WeChat group of VWD patients in China. Data were analysed using t-test, the Chi-square test, Fisher's exact test and rank sum test.

RESULTS

Data from a total of 96 patients were collected. Several important findings are yielded. Above all, type 3 patients accounted for over half of the surveyed patients. Secondly, a surprising rate (>40%) of patients had experience of being misdiagnosed. Thirdly, treatment regimens were dominated by cryoprecipitate, blood-derived FVIII and plasma, and only a small percentage of patients received prophylaxis. Fourthly, we identified 17 new von Willebrand factor (VWF) mutant genes which merit further investigation. Additionally, Covid-19 was found to pose some challenges for the patients.

CONCLUSION

In China, the high rates of type 3 patients and misdiagnosis suggest that most of the VWD patients may never be diagnosed in China. When it comes to diagnosis and treatment, there is a large gap between developing countries like China and developed countries.