1
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Laporte P, Tuffigo M, Ryman A, Fiore M, Riviere E, James C, Guy A. HemosIL VWF:GPIbR assay has a greater sensitivity than VWF:RCo technique to detect acquired von Willebrand syndrome in myeloproliferative neoplasms. Thromb Haemost 2022; 122:1673-1682. [PMID: 35322397 DOI: 10.1055/a-1806-9972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acquired von Willebrand syndrome (AVWS) is frequent in patients with myeloproliferative neoplasms (MPNs). For VWF functional evaluation, ristocetin cofactor activity by aggregometry (VWF: RCo) is considered the gold standard but have limitations, and automated activities measurement has been developed such as the HemosIl VWF:RCo Werfen® with particle agglutination (VWF:GPIbR). OBJECTIVES To evaluate the performance of VWF:GPIbR with HemosIL VWF:RCo Werfen® (VWF:GPIbR) versus VWF:RCo in patients with thrombocytosis in the context of MPNs (T-MPNs) and in patients with secondary thrombocytosis (ST). PATIENTS/METHODS MPNs patients with thrombocytosis >450 G/L (T-MPNs) were compared to patients with secondary thrombocytosis (ST) due to inflammation or iron deficiency. VWF activity (VWF:Act) was analyzed using VWF:RCo or VWF:GPIbR. VWF analysis was completed by analysis of VWF multimers and VWF collagen binding (CB) assay (VWF:CB). RESULTS 33 T-MPNs and 18 ST patients were included. Compared to aggregometry, evaluation of VWF:Act by VWF:GPIbR leaded to lower values in T-MPNs patients, but also in ST patients. Interestingly, whereas VWF:RCo/VWF:Ag ratio did not reveal differences between T-MPNs and ST patients, VWF:GPIbR/VWF:Ag ratio analysis allowed to suspect AVWS only in T-MPNs patients. Using the distribution of VWF multimers analysis and VWF:CB, we here demonstrated that VWF:GPIbR allows AVWS diagnosis in 9 T-MPNs as opposed to aggregometry. CONCLUSIONS Evaluation of VWF:Act using VWF:GPIbR has a greater sensitivity compared to aggregometry to detect AVWS in T-MPNs patients.
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Affiliation(s)
- Pierre Laporte
- Bordeaux University Hospital, Laboratory of Hematology, Pessac, France
| | - Marie Tuffigo
- Angers University Hospital, Laboratory of Hematology, Angers, France
| | - Anne Ryman
- Laboratory of Hematology, Bordeaux University Hospital, Pessac, France
| | - Mathieu Fiore
- Bordeaux University Hospital, Laboratory of Hematology, Pessac, France
| | - Etienne Riviere
- Bordeaux University Hospital, Internal Medicine, Pessac, France.,University of Bordeaux, UMR1034, Inserm, Biology of Cardiovascular Diseases,, Pessac, France
| | - Chloé James
- Bordeaux University Hospital, Laboratory of Hematology, Pessac, France.,University of Bordeaux, UMR1034, Inserm, Biology of Cardiovascular Diseases,, Pessac, France
| | - Alexandre Guy
- University of Bordeaux, UMR1034, Inserm, Biology of Cardiovascular Diseases,, Pessac, France.,Bordeaux University Hospital, Laboratory of Hematology, Pessac, France
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Colonne CK, Reardon B, Curnow J, Favaloro EJ. Why is Misdiagnosis of von Willebrand Disease Still Prevalent and How Can We Overcome It? A Focus on Clinical Considerations and Recommendations. J Blood Med 2021; 12:755-768. [PMID: 34429677 PMCID: PMC8380198 DOI: 10.2147/jbm.s266791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/31/2021] [Indexed: 12/19/2022] Open
Abstract
Despite von Willebrand disease (VWD) being the most common inherited bleeding disorder, its accurate diagnosis is frequently shrouded by diagnostic pitfalls. VWD is frequently under-diagnosed, over-diagnosed and misdiagnosed, leading to significant avoidable patient morbidity and health care system burden. At the heart of this dilemma lies the heterogeneity and complexity of von Willebrand factor (VWF) and associated defects, and the necessity of coalescing clinical and laboratory features to obtain an accurate diagnosis. Common pitfalls include poor clinical and scientific understanding and familiarity with VWD, incomplete clinical history and lack of routine use of standardised bleeding assessment tools (BAT), difficulty in accessing a comprehensive repertoire of laboratory tests, significant pre-analytical, analytical and post-analytical issues, and lack of expertise in laboratory testing and interpretation. Errors, resulting in under-diagnosis, over-diagnosis, and misdiagnosis of VWD, are presented and discussed. Strategies to minimise errors include better education of clinicians and laboratory staff on VWD, routine use of validated BAT, utilising a comprehensive gamut of laboratory investigations according to a standardised algorithm, and repeating testing to minimise pre-analytical errors. Recommendations on appropriate patient selection for VWD testing, how VWD should be investigated in the laboratory, and how to ensure test results are accurately interpreted in the correct clinical context are detailed.
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Affiliation(s)
- Chanukya K Colonne
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Sydney, NSW, Australia
| | - Benjamin Reardon
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Sydney, NSW, Australia
| | - Jennifer Curnow
- Department of Clinical Haematology, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Sydney, NSW, Australia
| | - Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Sydney, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Sydney, NSW, Australia.,School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
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3
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Castaman G, Linari S. Obstacles to Early Diagnosis and Treatment of Inherited von Willebrand Disease: Current Perspectives. J Blood Med 2021; 12:165-175. [PMID: 33790680 PMCID: PMC7997550 DOI: 10.2147/jbm.s232758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/15/2021] [Indexed: 01/02/2023] Open
Abstract
Von Willebrand disease (VWD), the most common inherited bleeding disorder, is highly heterogeneous, and its early diagnosis may be difficult, especially for mild cases and in qualitative von Willebrand factor (VWF) defects. Appropriate VWD diagnosis requires the combination of personal and/or family history of bleeding and abnormal VWF laboratory testing. The use of bleeding assessment tools has been helpful in standardizing bleeding history collection and quantification of bleeding symptoms to select patients who may benefit of further hemostatic testing. Type 1 and 3 VWD which represent quantitative VWD variants are relatively easy to diagnose. The diagnosis of type 2 VWD requires multiple assessments to evaluate the effects induced by the responsible abnormality on the heterogeneous functions of VWF. Sensitive and reproducible tests are needed to evaluate different VWF activities, starting from measuring VWF-platelet interaction. In the recent years, several increasingly sensitive, rapid and automated assays have been developed, but they are not widely available so far. Genetic testing for VWD diagnosis is not a common practice because VWF gene is very large and highly polymorphic and therefore it is used only in specific cases. It is evident that the early and correct VWD diagnosis allows optimal management of bleeding and situations at risk. Tranexamic acid, desmopressin, replacement therapy with plasma-derived concentrates with a variable content of VWF and FVIII, or the new recombinant VWF are the different therapeutic options available. Careful VWD classification guides treatment because desmopressin is widely used in type 1 while replacement therapy is the cornerstone of treatment for type 2 and 3 variants.
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Affiliation(s)
- Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Silvia Linari
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
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van der Vorm LN, Huskens D, Florin L, De Kesel P, Roest M, de Laat B, Devreese KM. Active von Willebrand Factor in patients with a bleeding diathesis. THROMBOSIS UPDATE 2020. [DOI: 10.1016/j.tru.2020.100001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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5
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Castaman G. How I treat von Willebrand disease. Thromb Res 2020; 196:618-625. [DOI: 10.1016/j.thromres.2020.07.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/17/2023]
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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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7
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Zanetto A, Rinder HM, Campello E, Saggiorato G, Deng Y, Ciarleglio M, Wilson FP, Senzolo M, Gavasso S, Bulato C, Simioni P, Garcia-Tsao G. Acute Kidney Injury in Decompensated Cirrhosis Is Associated With Both Hypo-coagulable and Hyper-coagulable Features. Hepatology 2020; 72:1327-1340. [PMID: 32614088 PMCID: PMC8672302 DOI: 10.1002/hep.31443] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Recent evidence suggests that acute kidney injury (AKI) is the main predictor of postparacentesis bleeding in patients with cirrhosis. To assess the factors responsible for bleeding tendency in AKI, we performed a prospective study comparing all three aspects of hemostasis (platelets, coagulation, and fibrinolysis) in patients with decompensated cirrhosis with and without AKI. APPROACH AND RESULTS Primary hemostasis assessment included platelet aggregation and secretion (platelet function markers) and von Willebrand factor. Secondary hemostasis assessment included pro-coagulant (factor VIII and factor XIII) and anti-coagulant (protein C, protein S, and antithrombin) factors and thrombin generation. Tertiary hemostasis assessment included fibrinolytic factors and plasmin-antiplasmin complex. Eighty patients with decompensated cirrhosis were recruited (40 each with and without AKI). Severity of cirrhosis and platelet count were comparable between groups. Median serum creatinine was 1.8 mg/dL and 0.8 mg/dL in patients with and without AKI, respectively. At baseline, patients with cirrhosis and AKI had lower platelet aggregation and secretion, indicative of impaired platelet function (increased bleeding tendency), without differences in von Willebrand factor. Regarding coagulation factors, factor VIII was higher, whereas protein C, protein S, and antithrombin were all lower, which, together with increased thrombin generation, indicate hypercoagulability. In contrast, factor XIII was lower in AKI (increased bleeding tendency). Finally, while both hypofibrinolytic and hyperfibrinolytic changes were present in AKI, a higher plasmin-antiplasmin complex indicated a hyperfibrinolytic state. After AKI resolution (n = 23 of 40), platelet function and coagulation improved to levels observed in patients with cirrhosis patients without AKI; however, fibrinolysis remained hyperactivated. CONCLUSIONS In patients with decompensated cirrhosis, AKI is associated with both hypocoagulable and hypercoagulable features that can potentially increase the risk of both bleeding and thrombosis.
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Affiliation(s)
- Alberto Zanetto
- Digestive Disease Section, Internal Medicine, Yale School of Medicine, New Haven, CT,VA-Connecticut Healthcare System, West Haven, CT,Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Henry M. Rinder
- Laboratory Medicine, Yale School of Medicine, New Haven, CT,Hematology, Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Elena Campello
- Thrombotic and Hemorrhagic Diseases Unit, General Internal Medicine, Padova University Hospital, Padova, Italy
| | - Graziella Saggiorato
- Thrombotic and Hemorrhagic Diseases Unit, General Internal Medicine, Padova University Hospital, Padova, Italy
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Maria Ciarleglio
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Francis P. Wilson
- Program of Applied Translational Research, Yale School of Medicine, New Haven, CT
| | - Marco Senzolo
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Sabrina Gavasso
- Thrombotic and Hemorrhagic Diseases Unit, General Internal Medicine, Padova University Hospital, Padova, Italy
| | - Cristiana Bulato
- Thrombotic and Hemorrhagic Diseases Unit, General Internal Medicine, Padova University Hospital, Padova, Italy
| | - Paolo Simioni
- Thrombotic and Hemorrhagic Diseases Unit, General Internal Medicine, Padova University Hospital, Padova, Italy
| | - Guadalupe Garcia-Tsao
- Digestive Disease Section, Internal Medicine, Yale School of Medicine, New Haven, CT,VA-Connecticut Healthcare System, West Haven, CT
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Huskens D, Li L, Florin L, de Kesel P, de Laat B, Roest M, Devreese KMJ. Flow cytometric analysis of platelet function to improve the recognition of thrombocytopathy. Thromb Res 2020; 194:183-189. [PMID: 32788114 DOI: 10.1016/j.thromres.2020.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Light transmission aggregometry (LTA) is the gold standard for diagnosing bleeding disorders. Although LTA is laborious, requires large volumes of blood and is relatively insensitive to small changes in platelet function, there is still no competing alternative approach to replace LTA for the diagnosis of platelet bleeding disorders. MATERIALS AND METHODS This study investigates the correlation between flow cytometry-based whole blood platelet activation test (WB-PACT) and LTA and whether WB-PACT is of additional value for the identification of bleeding disorders. In total, 161 patients with suspected bleeding diathesis were tested. RESULTS A correlation of 0.41 between LTA and WB-PACT was found, and there was agreement between tests in 62% of cases (κ = 0.23). The WB-PACT is of additional value to LTA to detect platelet function disorders (PFD) as 10 patients with elevated bleeding score (BS) were detected with WB-PACT, 4 with LTA and 7 patients were positive with both tests. Interestingly, in contrast to LTA, WB-PACT has an additional option to detect VWF disfunctions. CONCLUSION WB-PACT may have added value for the routine diagnostic work-up in patients who need to have platelet function tested.
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Affiliation(s)
- Dana Huskens
- Synapse Research Institute, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Li Li
- Synapse Research Institute, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Lisa Florin
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Pieter de Kesel
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Bas de Laat
- Synapse Research Institute, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Mark Roest
- Synapse Research Institute, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Katrien M J Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
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Peetermans M, Meyers S, Liesenborghs L, Vanhoorelbeke K, De Meyer SF, Vandenbriele C, Lox M, Hoylaerts MF, Martinod K, Jacquemin M, Vanassche T, Verhamme P. Von Willebrand factor and ADAMTS13 impact on the outcome of Staphylococcus aureus sepsis. J Thromb Haemost 2020; 18:722-731. [PMID: 31758651 DOI: 10.1111/jth.14686] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/18/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Previous clinical evidence correlates levels of von Willebrand factor (VWF) and its cleaving protease ADAMTS13 with outcome in septic patients. No previous studies addressed if VWF and ADAMTS13 affected the outcome of Staphylococcus aureus sepsis. OBJECTIVES We studied the role of VWF and ADAMTS13 in S. aureus sepsis both in patients and in mice. METHODS VWF levels and ADAMTS13 activity levels were measured in plasma samples from 89 S. aureus bacteremia patients by chemiluminescent assays and were correlated with clinical sepsis outcome parameters. In wild-type mice and mice deficient in VWF and ADAMTS13, we investigated the outcome of S. aureus sepsis and quantified bacterial clearance and organ microthrombi. RESULTS In patients with S. aureus bloodstream infections, high VWF levels and low ADAMTS13 activity levels correlated with disease severity and with parameters of inflammation and disseminated intravascular coagulation. In septic mice, VWF deficiency attenuated mortality, whereas ADAMTS13 deficiency increased mortality. Bacterial clearance was enhanced in VWF-deficient mice. The differences in mortality for the studied genotypes were associated with differential loads of organ microthrombi in both liver and kidneys. CONCLUSIONS In conclusion, this study reports the consistent relation of VWF, ADAMTS13 and their ratio to disease severity in patients and mice with S. aureus sepsis. Targeting VWF multimers and/or the relative ADAMTS13 deficiency that occurs in sepsis should be explored as a potential new therapeutic target in S. aureus endovascular infections.
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Affiliation(s)
- Marijke Peetermans
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Severien Meyers
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Laurens Liesenborghs
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, University of Leuven campus Kulak Kortrijk, Kortrijk, Belgium
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, University of Leuven campus Kulak Kortrijk, Kortrijk, Belgium
| | - Christophe Vandenbriele
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Marleen Lox
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Marc F Hoylaerts
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Kimberly Martinod
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Marc Jacquemin
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
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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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Castaman G, Linari S. Advances in diagnosis of von Willebrand disease. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1609352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology Careggi, University Hospital, Florence, Italy
| | - Silvia Linari
- Center for Bleeding Disorders and Coagulation, Department of Oncology Careggi, University Hospital, Florence, Italy
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12
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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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13
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Boender J, Eikenboom J, van der Bom JG, Meijer K, de Meris J, Fijnvandraat K, Cnossen MH, Laros-van Gorkom BAP, van Heerde WL, Mauser-Bunschoten EP, de Maat MPM, Leebeek FWG. Clinically relevant differences between assays for von Willebrand factor activity. J Thromb Haemost 2018; 16:2413-2424. [PMID: 30358069 DOI: 10.1111/jth.14319] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Indexed: 01/07/2023]
Abstract
Essentials It is unclear whether there are differences between von Willebrand factor (VWF) activity assays. We compared the four most used VWF activity assays in 661 von Willebrand disease (VWD) patients. All assays correlated excellently, but a discrepant classification was seen in 20% of patients. Differences between VWF activity assays have a large impact on the classification of VWD. SUMMARY: Background Measuring the ability of von Willebrand factor (VWF) to bind to platelets is crucial for the diagnosis and classification of von Willebrand disease (VWD). Several assays that measure this VWF activity using different principles are available, but the clinical relevance of different assay principles is unclear. Objective To compare the four most widely used VWF activity assays in a large VWD patient population. Methods We measured VWF:RCo (ristocetin to activate VWF + whole platelets), VWF:GPIbR (ristocetin + platelet glycoprotein Ib receptor [GPIb] fragments), VWF:GPIbM (gain-of-function GPIb fragments that bind VWF spontaneously without ristocetin) and VWF:Ab (monoclonal antibody directed against the GPIb binding epitope of VWF to mimic platelets) in 661 VWD patients from the nationwide 'Willebrand in the Netherlands' (WiN) Study. Results All assays correlated excellently (Pearson r > 0.9), but discrepant results led to a different classification for up to one-fifth of VWD patients. VWF:RCo was not sensitive enough to classify 18% of patients and misclassified half of genotypic 2B VWD patients, especially those with p.Arg1306Trp. VWF:GPIbR was more sensitive, accurately classified the vast majority of patients, and was unaffected by the p.Asp1472His variant that causes artificially low VWF:RCo. VWF:GPIbM was the most precise assay but misclassified over a quarter of genotypic 2A, 2B and 3 patients. VWF:Ab, often not considered an actual VWF activity assay, performed at least equally to the other assays with regard to accurate VWD classification. Conclusion Although the different VWF activity assays are often considered similar, differences between assays have a large impact on the classification of VWD.
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Affiliation(s)
- J Boender
- Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J Eikenboom
- Internal Medicine, Division, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - J G van der Bom
- Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Sanquin Research, Jon J van Rood Center for Clinical Transfusion Medicine, Leiden, the Netherlands
| | - K Meijer
- Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J de Meris
- Netherlands Hemophilia Society, Nijkerk, the Netherlands
| | - K Fijnvandraat
- Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
| | - M H Cnossen
- Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - W L van Heerde
- Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E P Mauser-Bunschoten
- University Medical Center Utrecht, van Creveld Kliniek, University Utrecht, Utrecht, the Netherlands
| | - M P M de Maat
- Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - F W G Leebeek
- Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
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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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15
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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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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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18
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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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19
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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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20
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21
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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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Costa-Pinto J, Pérez-Rodríguez A, del C Goméz-del-Castillo M, Lourés E, Rodríguez-Trillo A, Batlle J, López-Fernández MF. Diagnosis of inherited von Willebrand disease: comparison of two methodologies and analysis of the discrepancies. Haemophilia 2015; 20:559-67. [PMID: 25077350 DOI: 10.1111/hae.12380] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diagnostics of von Willebrand disease (VWD) includes assessment of factor VIII (FVIII) coagulant activity, von Willebrand factor (VWF) antigen (VWF:Ag) and VWF ristocetin cofactor activity (VWF:RCo), and more specific tests as multimeric and genetic analyses are necessary for the correct VWD classification. The ACL AcuStar analyzer introduces chemiluminescence (CL) technology in detection of VWD with automated VWF:Ag and VWF:RCo assays. Compare VWF:Ag-ELISA and VWF:RCo by aggregometry conventional assays with new CL VWF:Ag-IL and VWF:RCo-IL assays, investigate the ability to make accurate VWD diagnosis and concordance with multimeric and genetic analyses. 146 patients with congenital VWD (51 Type 1; 34 Type 2A; 16 Type 2B; 31 Type 2M; 5 Type 2N; 9 Type 3) and 30 healthy normal subjects were included. A comparison was made between CL and conventional methods. Diagnostic evaluation included: VWF:RCo/VWF:Ag ratio, multimeric distribution (sodium dodecyl sulfate [SDS]-agarose gel) of VWF and genetic analysis in 110 of 146 patients. CL and conventional methods revealed good correlation. Kappa test agreement diagnosis was >0.8. CL diagnostic sensitivity was 100% and specificity 97%. Multimeric and genetic analysis were of help in clarifying 13 discrepancies of diagnosis between methods, of which six discrepancies were explained by lack of conventional methods′ sensibility. CL methodology can detect VWD and discriminate between type 1, 3 and variant forms and offers an automated, faster, sensitive and less cumbersome method when compared to conventional assays, in particular VWF:RCo by aggregometry. In some cases, even with all phenotype and genetic analyses, discrepancies exist in the classification of VWD.
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23
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Castaman G, Hillarp A, Goodeve A. Laboratory aspects of von Willebrand disease: test repertoire and options for activity assays and genetic analysis. Haemophilia 2014; 20 Suppl 4:65-70. [PMID: 24762278 DOI: 10.1111/hae.12410] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 11/28/2022]
Abstract
The deficiency or abnormal function of von Willebrand factor (VWF) causes von Willebrand disease (VWD), the most frequent inherited bleeding disorder. The laboratory diagnosis of VWD can be difficult as the disease is heterogeneous and an array of assays is required to describe the phenotype. Basic classification of quantitative (type 1 and 3) and qualitative (type 2) VWD variants requires determination of VWF antigenic (VWF:Ag) levels and assaying of VWF ristocetin cofactor (VWF:RCo) activity, determining the capacity of VWF to interact with the platelet GPIb-receptor. Knowing the VWF:RCo activity is essential for identifying, subtyping and monitoring VWD, but the assay is poorly standardized and many protocols do not fulfil the clinical need in all situations. This has led to the development of novel activity assays, independent of ristocetin, with enhanced assay characteristics. Results from the first independent clinical evaluations are promising, showing that they are reliable and suitable for VWD diagnosis. The qualitative type 2 VWF deficiency can be further divided into four different subtypes (A, B, M and N) using specific assays that explore other activities or the size distribution of VWF multimers. These methods are discussed herein. However, in a number of patients it may be difficult to correctly classify the VWD phenotype and genetic analysis may provide the best option to clarify the disorder, through mutation identification.
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Affiliation(s)
- G Castaman
- Department of Cell Therapy and Hematology, Hemophilia and Thrombosis Center, San Bartolo Hospital, Vicenza, Italy
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24
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de Maistre E, Volot F, Mourey G, Aho LS, Ternisien C, Briquel ME, Bertrand MA, Tardy B, Frotscher B, Nguyen P, Dumont L, Vandroux D, Hézard N, Trossaërt M. Performance of two new automated assays for measuring von Willebrand activity: HemosIL AcuStar and Innovance. Thromb Haemost 2014; 112:825-30. [PMID: 25103956 DOI: 10.1160/th14-02-0108] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/30/2014] [Indexed: 11/05/2022]
Abstract
The ristocetin cofactor activity assay (VWF:RCo) is the reference method for assessing von Willebrand factor (VWF) activity but remains difficult to perform, and the coefficient of variation of the method is high (about 20-30%). This study evaluated and compared the performance for measuring the VWF activity of two newly commercialised assays [VWF:Ac Innovance (VWF:Ac) and VWF:RCo Acustar (VWF:RCo Acu)] with the reference VWF:RCo aggregation in 123 pathological plasma samples. The correlation and concordance between both new tests (VWF:RCo-Acu and VWF:Ac) and the reference VWF:RCo were good. The results of the VWF activity to VWF antigen ratio were also comparable whatever the method for the classification of VWF deficiency in all patients. Our results showed that both new tests could replace the "gold standard" VWF:RCo in aggregometry with several benefits: they are fully automated, easier and faster to perform, better adapted to emergency situations if necessary.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Trossaërt
- Dr. Marc Trossaërt, Centre Régional de Traitement de l'Hémophilie, 1 Place Alexis RICORDEAU, Centre Hospitalier Universitaire, 44093 Nantes Cedex 1, France, Tel.: +33 2 40 08 74 68, Fax: +33 2 40 08 42 59, E-mail:
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Hayward CPM, Moffat KA, Graf L. Technological advances in diagnostic testing for von Willebrand disease: new approaches and challenges. Int J Lab Hematol 2014; 36:334-40. [DOI: 10.1111/ijlh.12220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/28/2014] [Indexed: 12/25/2022]
Affiliation(s)
- C. P. M. Hayward
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton ON Canada
- Department of Medicine; McMaster University; Hamilton ON Canada
- Hamilton Regional Laboratory Medicine Program; Hamilton ON Canada
| | - K. A. Moffat
- Department of Medicine; McMaster University; Hamilton ON Canada
- Hamilton Regional Laboratory Medicine Program; Hamilton ON Canada
| | - L. Graf
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton ON Canada
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Flood VH. Perils, problems, and progress in laboratory diagnosis of von Willebrand disease. Semin Thromb Hemost 2013; 40:41-8. [PMID: 24338593 DOI: 10.1055/s-0033-1363166] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Diagnosis of von Willebrand disease (VWD) merits consideration of personal and family history of bleeding symptoms along with confirmatory laboratory testing. As the latter yields quantifiable results, overreliance on a laboratory diagnosis may occur. However, existing tests for VWD contain potential sources for error. Both intrinsic and extrinsic factors affecting these assays can contribute to either falsely normal or falsely abnormal results. This article will discuss the present available assays as well as new developments in diagnostic testing. A clear understanding of the limitations of VWD testing is helpful for ensuring the correct diagnosis of affected patients.
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Affiliation(s)
- Veronica H Flood
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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