1
|
Saadalla A, Seheult J, Pruthi RK, Chen D. Von Willebrand Factor Multimer Analysis and Classification: A Comprehensive Review and Updates. Semin Thromb Hemost 2023; 49:580-591. [PMID: 36174612 DOI: 10.1055/s-0042-1757183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Von Willebrand factor (VWF) is a multimeric glycoprotein with essential roles in primary hemostasis. Patients with von Willebrand disease (VWD), due to quantitative and/or qualitative defects of VWF usually experience mucocutaneous bleeding. Based on the laboratory results of VWF antigen, various VWF activities, factor VIII activity, and VWF multimer patterns, VWD can be categorized as type 1, 2, and 3 VWD. VWF multimer analysis by either manual or semi-automated electrophoresis and immunoblotting is a critical part of the laboratory testing to differentiate type 1, type 2 VWD, and subtypes of type 1 or 2 VWD. The multimer distribution patterns can also help to understand the underlying molecular mechanism of VWF synthesis, multimerization, and clearance defects in VWD. This review will cover VWF synthesis, multimerization, secretion, VWF multimer analysis, and VWF multimer interpretation of various types and subtypes of VWD.
Collapse
Affiliation(s)
- Abdulrahman Saadalla
- Department of Pathology, University of Utah Health Sciences Center and ARUP Laboratories, Salt Lake City, Utah
| | - Jansen Seheult
- Division of Hematopathology, Special Coagulation Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Rajiv K Pruthi
- Division of Hematopathology, Special Coagulation Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Dong Chen
- Division of Hematopathology, Special Coagulation Laboratory, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
2
|
Vangenechten I, Smejkal P, Zavrelova J, Zapletal O, Wild A, Michiels JJ, Berneman Z, Blatny J, Batorova A, Prigancova T, Penka M, Gadisseur A. Analysis of von Willebrand Disease in the "Heart of Europe". TH OPEN: COMPANION JOURNAL TO THROMBOSIS AND HAEMOSTASIS 2022; 6:e335-e346. [PMID: 36299619 PMCID: PMC9581583 DOI: 10.1055/s-0042-1757635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022]
Abstract
Background
von Willebrand disease (VWD) is a genetic bleeding disorder caused by defects of von Willebrand factor (VWF), quantitative (type 1 and 3) or qualitative (type 2). The laboratory phenotyping is heterogenic making diagnosis difficult.
Objectives
Complete laboratory analysis of VWD as an expansion of the previously reported cross-sectional family-based VWD study in the Czech Republic (BRNO-VWD) and Slovakia (BRA-VWD) under the name “Heart of Europe,” in order to improve the understanding of laboratory phenotype/genotype correlation.
Patients and Methods
In total, 227 suspected VWD patients were identified from historical records. Complete laboratory analysis was established using all available assays, including VWF multimers and genetic analysis.
Results
A total of 191 patients (from 119 families) were confirmed as having VWD. The majority was characterized as a type 1 VWD, followed by type 2. Multimeric patterns concordant with laboratory phenotypes were found in approximately 83% of all cases. A phenotype/genotype correlation was present in 84% (77% type 1, 99% type 2, and 61% type 3) of all patients. Another 45 candidate mutations (23 novel variations), not found in the initial study, could be identified (missense 75% and truncating 24%). An exon 1–3 gene deletion was identified in 14 patients where no mutation was found by direct DNA sequencing, increasing the linkage up to 92%, overall.
Conclusion
This study provides a cross-sectional overview of the VWD population in a part of Central Europe. It is an addition to the previously published BRNO-VWD study, and provides important data to the International Society of Thrombosis and Haemostasis/European Association for Haemophilia and Allied Disorders VWD mutation database with identification of novel causal mutations.
Collapse
Affiliation(s)
- Inge Vangenechten
- Haemostasis Unit, Antwerp University Hospital, Edegem, Belgium,Medicine and Health Sciences, Haemostasis Research Unit, Antwerp University, Antwerp, Belgium,Antwerp University, Antwerp, Belgium,Address for correspondence Inge Vangenechten Department of Haematology, Haemostasis Unit, Antwerp University HospitalWilrijkstraat 10, B - 2650 EdegemBelgium
| | - Petr Smejkal
- Department of Clinical Haematology, University Hospital Brno, Brno, Czech Republic,Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Zavrelova
- Department of Clinical Haematology, University Hospital Brno, Brno, Czech Republic,Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondrej Zapletal
- Department of Pediatric Haematology, University Hospital Brno, Brno, Czech Republic
| | - Alexander Wild
- Department of Haematology, University F. D. Roosevelt Hospital, Banská Bystrica, Slovakia
| | - Jan Jacques Michiels
- Blood Coagulation and Vascular Medicine Center, Goodheart Institute & Foundation in Nature Medicine, Rotterdam, The Netherlands
| | - Zwi Berneman
- Antwerp University, Antwerp, Belgium,Department of Haematology, Antwerp University Hospital, Edegem, Belgium
| | - Jan Blatny
- Department of Pediatric Haematology, University Hospital Brno, Brno, Czech Republic
| | - Angelika Batorova
- National Hemophilia Center, Department of Haematology and Blood Transfusion of the Medical School of the Comenius University, Bratislava, Slovakia
| | - Tatiana Prigancova
- National Hemophilia Center, Department of Haematology and Blood Transfusion of the Medical School of the Comenius University, Bratislava, Slovakia
| | - Miroslav Penka
- Department of Clinical Haematology, University Hospital Brno, Brno, Czech Republic,Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alain Gadisseur
- Haemostasis Unit, Antwerp University Hospital, Edegem, Belgium,Medicine and Health Sciences, Haemostasis Research Unit, Antwerp University, Antwerp, Belgium,Antwerp University, Antwerp, Belgium,Department of Haematology, Antwerp University Hospital, Edegem, Belgium
| |
Collapse
|
3
|
Pikta M, Vasse M, Smock KJ, Moser KA, van DMA, Lejniece S, Szanto T, Bautista H, Nouadje G, Banys V. Establishing reference intervals for von Willebrand factor multimers. J Med Biochem 2022; 41:115-121. [PMID: 35431650 PMCID: PMC8970582 DOI: 10.5937/jomb0-31941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background von Willebrand factor (VWF) multimers (VWF:MM) methodologies are technically difficult, laborious, time consuming, non-standardized and results vary between laboratories. A new semi automated VWF:MM assay is available for routine use (Sebia). Due to lack of reference values for VWF:MM fractions, results interpretation can be challenging in some cases. The aim of this study was to determine reference intervals for low molecular weight (LMWM), intermediate molecular weight (IMWM) and high molecular weight (HMWM) multimers. Methods By the international cooperation initiated between 4 countries (Estonia, Latvia, France, and USA) 131 samples of relatively healthy individuals were analyzed for VWF:MM (in total 51 males and 80 non-pregnant females aged 17-69 years). Reference intervals were calculated according to CLSI C28-A3 standard. Results The proposed reference intervals for VWF:MM were calculated for LMWM 10.4-22.5%, IMWM 22.6-37.6%, HMWM 45.6-66.6%. Age related differences were seen in IMWM and HMWM (p<0.001 and 0.038). There was no gender related difference observed. Geographically LMWM results of France were different from the other regions (p<0.05). Conclusions Quantification of VWF:MM fractions, in addition to qualitative assessment of VWF:MM patterns, has the potential to aid in differential diagnosis of von Willebrand disease (VWD) subtypes. The reference values calculated in this study can be used in future research to establish clinical decision limits.
Collapse
Affiliation(s)
- Marika Pikta
- North Estonia Medical Centre, Department of Laboratory Medicine, Tallinn, Estonia
| | - Marc Vasse
- Foch Hospital, Department of Biology & UMR INSERM 1176, Suresnes, France
| | - Kristi J. Smock
- University of Utah, School of Medicine, Department of Pathology, Salt Lake City, UT, USA
| | - Karen A. Moser
- University of Utah, School of Medicine, Department of Pathology, Salt Lake City, UT, USA
| | | | | | - Timea Szanto
- Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Department of Hematology, Coagulation Disorders Unit, Helsinki, Finland
| | - Hector Bautista
- Sebia, Research and Developments Department, Lisses - Evry Cedex, France
| | - George Nouadje
- Sebia, Research and Developments Department, Lisses - Evry Cedex, France
| | - Valdas Banys
- Vilnius University, Faculty of Medicine, Institute of Biomedical Sciences, Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Vilnius, Lithuania
| |
Collapse
|
4
|
Engelbrecht M, Louw S, Wiggill T. Verification of a new semi-automated Von Willebrand factor multimers assay. Int J Lab Hematol 2021; 44:e127-e131. [PMID: 34821048 DOI: 10.1111/ijlh.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Marcel Engelbrecht
- Department of Molecular Medicine and Haematology, NHLS/WITS University, Johannesburg, South Africa
| | - Susan Louw
- Department of Molecular Medicine and Haematology, NHLS/WITS University, Johannesburg, South Africa
| | - Tracey Wiggill
- Department of Molecular Medicine and Haematology, NHLS/WITS University, Johannesburg, South Africa
| |
Collapse
|
5
|
Skornova I, Simurda T, Stasko J, Zolkova J, Sokol J, Holly P, Dobrotova M, Plamenova I, Hudecek J, Brunclikova M, Stryckova A, Kubisz P. Multimer Analysis of Von Willebrand Factor in Von Willebrand Disease with a Hydrasys Semi-Automatic Analyzer-Single-Center Experience. Diagnostics (Basel) 2021; 11:2153. [PMID: 34829500 PMCID: PMC8621170 DOI: 10.3390/diagnostics11112153] [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: 10/11/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
von Willebrand disease (VWD) is reportedly the most common inherited bleeding disorder. This disorder develops as a result of defects and/or deficiency of the plasma protein von Willebrand factor (VWF). Laboratory testing for VWF-related disorders requires the assessment of both VWF level and VWF activity, the latter requiring multiple assays. As an additional step, an evaluation of VWF structural features by multimer analysis is useful in selective investigations. Multimer analysis is also important for the selection of a suitable VWF therapy preparation (desmopressin, VWF/FVIII concentrate, recombinant VWF) and the determination of the correct dose for the patient. Based on clinical and laboratory findings, including the analysis of VWF multimers, we classified our patients into individual types of VWD. Our study group included 58 patients. The study group consisted of 66% (38 patients) with VWD type 1, 5% (3 patients) with VWD type 2, 7% (4 patients) with VWD type 3, 5% (3 patients) with mixed type 1/2A VWD, and 17% (10 patients) comprising an unclassified group. In this article, we provide an overview of our practical experience using a new complementary method-the analysis of von Willebrand factor multimers with a semi-automatic analyzer Hydrasys 2 scan. We explain the principle, procedure, advantages, and pitfalls associated with the introduction of the VWF multimer analysis methodology into standard VWD diagnostics.
Collapse
Affiliation(s)
| | - Tomas Simurda
- National Center of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, 03601 Martin, Slovakia; (I.S.); (J.S.); (J.Z.); (J.S.); (P.H.); (M.D.); (I.P.); (J.H.); (M.B.); (A.S.); (P.K.)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Pikta M, Banys V, Szanto T, Joutsi-Korhonen L, Vaide I, Varik M, Lehtinen AE, Giangrande P, Laane E. Von Willebrand Factor Multimeric Assay in Acquired von Willebrand Disease Diagnosis: A Report of Experience from North Estonia Medical Centre. J Lab Physicians 2021; 13:195-201. [PMID: 34602781 PMCID: PMC8478502 DOI: 10.1055/s-0041-1730818] [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] [Indexed: 01/12/2023] Open
Abstract
Objectives
Acquired von Willebrand syndrome (AVWS) is a rare and frequently underdiagnosed bleeding disorder with an unknown prevalence. The diagnosis of AVWS is made based on laboratory investigations and the presence of clinical symptoms. Evaluation and management of affected patients are complex due to the need for multiple laboratory assays.
Materials and Methods
Here, we describe the clinical and laboratory data of seven patients with a diagnosis of AVWS. All patients met the criteria for AVWS based on laboratory findings, bleeding symptoms, and the absence of any previous history of a bleeding disorder.
Results
In all cases, the laboratory findings, lack of bleeding anamnesis, and family history suggested the presence of AVWS. Von Willebrand factor multimeric analysis showed decreased high-molecular weight (HMW) multimers in six cases. Patients with lower HMW multimers experienced more severe bleeding complications.
Conclusions
The diagnosis of AVWS is complex and requires extensive laboratory evaluation. Interdisciplinary collaboration and complex laboratory evaluations are of paramount importance for the early recognition of AVWS and optimal AVWS diagnosis as well as successful clinical management.
Collapse
Affiliation(s)
- Marika Pikta
- Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia.,Department of Laboratory Medicine, North Estonia Medical Centre, Tallinn, Estonia
| | - Valdas Banys
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Timea Szanto
- Research Program Unit of Systems Oncology, Helsinki University Hospital, Unit of Coagulation Disorders, Helsinki, Finland
| | - Lotta Joutsi-Korhonen
- Department of Clinical Chemistry, Unit of Coagulation Disorders, HUSLAB Laboratory Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ines Vaide
- Hemato-Oncology Clinic, Institute of Clinical Medicine, Tartu University, Tartu, Estonia
| | - Mirja Varik
- Hematology Department, North Estonia Medical Centre, Tallinn, Estonia
| | - Anna-Elina Lehtinen
- Department of Hematology, Unit of Coagulation Disorders, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
| | - Paul Giangrande
- Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Edward Laane
- Hemato-Oncology Clinic, Institute of Clinical Medicine, Tartu University, Tartu, Estonia
| |
Collapse
|
7
|
Von Willebrand Factor Multimer Densitometric Analysis: Validation of the Clinical Accuracy and Clinical Implications in Von Willebrand Disease. Hemasphere 2021; 5:e542. [PMID: 33623884 PMCID: PMC7892298 DOI: 10.1097/hs9.0000000000000542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022] Open
Abstract
Von Willebrand factor (VWF) multimer analysis is important in the classification of von Willebrand disease (VWD). Current visual VWF multimer analysis is time consuming and inaccurate in detecting subtle changes in multimer patterns. Although VWF multimer densitometric analysis may be useful, the accuracy needs further investigation before it can be widely applied. In this study we aimed to validate VWF multimer densitometric analysis in a large cohort of VWD patients and to identify patient characteristics associated with densitometric outcomes. Patients were included from the Willebrand in the Netherlands (WiN) study, in which a bleeding score (BS) was obtained, and blood was drawn. For multimer analysis, citrated blood was separated on an agarose gel and visualized by Western blotting. IMAGEJ was used to generate densitometric images and medium-large VWF multimer index was calculated. We included 560 VWD patients: 328 type 1, 211 type 2, and 21 type 3 patients. Medium-large VWF multimer index performed excellent in distinguishing visually classified normal VWF multimers from reduced high-molecular-weight (HMW) multimers (area under the curve [AUC]: 0.96 [0.94-0.98], P < 0.001), normal multimers from absence of HMW multimers (AUC 1.00 [1.00-1.00], P < 0.001), and type 2A and 2B from type 2M and 2N (AUC: 0.96 [0.94-0.99], P < 0.001). Additionally, higher medium-large VWF multimer index was associated with lower BS in type 1 VWD: β = -7.6 (-13.0 to -2.1), P = 0.007, adjusted for confounders. Densitometric analysis of VWF multimers had an excellent accuracy compared with visual multimer analysis and may contribute to a better understanding of the clinical features such as the bleeding phenotype of VWD patients.
Collapse
|
8
|
Pikta M, Szanto T, Viigimaa M, Lejniece S, Balode D, Saks K, Banys V. Evaluation of a new semi-automated Hydragel 11 von Willebrand factor multimers assay kit for routine use. J Med Biochem 2021; 40:167-172. [PMID: 33776566 PMCID: PMC7982284 DOI: 10.5937/jomb0-26008] [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: 04/08/2020] [Accepted: 08/12/2020] [Indexed: 01/10/2023] Open
Abstract
Background Accurate diagnosis and classification of von Willebrand disease (VWD) are essential for optimal management. The von Willebrand factor multimers analysis (VWF:MM) is an integral part of the diagnostic process in the phenotypic classification, especially in discrepant cases. The aim of this study was to evaluate the performance of a new Hydragel 11VWF multimer assay (H11VW). Methods Analytical performance characteristics such as repeatability (intra-assay variability, in gel between track variation), reproducibility (inter-assay variability, between gel variation), sensitivity, EQA performance and differences between two commercially available VWF:MM kits (H5VW and H11VW) were analysed in healthy volunteers' plasmas using in-house prepared reference plasma. Results Repeatability and reproducibility results of H11VW demonstrated acceptable and equivalent performance with previously verified H5VW. Participation in EQA was successful. No statistically significant difference was detected between H5VW and H11VW kits for different fractions of multimers: LMWM p=0.807; IMWM p=0.183; HMWM p=0.774. Conclusions H11VW demonstrated acceptable analytical performance characteristics. H11VW kit conveniently offers a more significant number of samples on a single gel. H5VW and H11VW kits can be used in daily practice interchangeably.
Collapse
Affiliation(s)
- Marika Pikta
- North Estonia Medical Centre, Department of Laboratory Medicine, Tallinn, Estonia
| | - Timea Szanto
- Helsinki University Hospital Comprehensive Cancer Centre and University of Helsinki, Coagulation Disorders Unit, Department of Hematology, Helsinki, Finland
| | - Margus Viigimaa
- Tallinn University of Technology, Department of Health Technologies, Tallinn, Estonia
| | | | | | - Kadri Saks
- Tallinn Children`s Hospital, Hematology Department, Tallinn, Estonia
| | - Valdas Banys
- Vilnius University, Faculty of Medicine, Institute of Biomedical Sciences, Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Vilnius, Lithuania
| |
Collapse
|
9
|
Vangenechten I, Gadisseur A. Improving diagnosis of von Willebrand disease: Reference ranges for von Willebrand factor multimer distribution. Res Pract Thromb Haemost 2020; 4:1024-1034. [PMID: 32864553 PMCID: PMC7443431 DOI: 10.1002/rth2.12408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Phenotypic von Willebrand disease (VWD) classification requires multiple tests including analysis of multimeric distributions von Willebrand factor (VWF) and evaluation of its structure. VWF multimer analysis is labor intensive, nonstandardized, and limited to specialized laboratories. A commercial semiautomatic assay, HYDRAGEL VW multimer assay (H5/11VWM, Sebia), has become available. OBJECTIVES Establishment of reference ranges for H5/11VWM to improve VWD classification. METHODS Implementation validation, establishment and validation of normal and pathological reference intervals (NRIs/PRIs), comparison with in-house method using 40 healthy volunteers and 231 VWD patients. RESULTS Qualitative and quantitative validation of NRI obtained sensitivity of 88% and 79%, respectively, for type 2. Comparison of the two methods showed an overall concordance of 86% with major conflicting results in all atypical 2B (n = 7) and 50% 2M-GPIb (n = 41) showing quantitative and qualitative multimeric loss, that was not detected with in-house method. We were able to use established PRIs, with 73% validity in type 2 cases, to distinguish individual type 2A subtypes (IIA, IIC, IID, IIE) from 2M and 2B. CONCLUSION H5/11VWM could be used for all clinical purposes because its reliability and its rapid and accurate diagnostic ability and reduced observer bias. Although H5/11VWM cannot evaluate triplet structures, we were able to define 2A subtypes by stripping back to the percentage of intermediate/high-molecular-weight multimers. H5/11HWM could be an efficient and widely available alternative for the "gold standard" technique.
Collapse
Affiliation(s)
- Inge Vangenechten
- Haemostasis UnitDepartment of HaematologyAntwerp University HospitalEdegemBelgium
- CSL Behring Chair in von Willebrand DiseaseAntwerp UniversityAntwerpBelgium
| | - Alain Gadisseur
- Haemostasis UnitDepartment of HaematologyAntwerp University HospitalEdegemBelgium
- CSL Behring Chair in von Willebrand DiseaseAntwerp UniversityAntwerpBelgium
- Haemostasis Research UnitAntwerp UniversityAntwerpBelgium
| |
Collapse
|
10
|
Favaloro EJ. Classification of von Willebrand disease in the context of modern contemporary von Willebrand factor testing methodologies. Res Pract Thromb Haemost 2020; 4:952-957. [PMID: 32864548 PMCID: PMC7443425 DOI: 10.1002/rth2.12392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/16/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Emmanuel J Favaloro
- Haematology Institute of Clinical Pathology and Medical Research (ICPMR) NSW Health Pathology Westmead Hospital Westmead NSW Australia.,Sydney Centres for Thrombosis and Haemostasis Westmead Hospital Westmead NSW Australia.,School of Biomedical Sciences Charles Sturt University Wagga Wagga NSW Australia
| |
Collapse
|
11
|
Favaloro EJ, Oliver S, Mohammed S, Vong R. Comparative assessment of von Willebrand factor multimers vs activity for von Willebrand disease using modern contemporary methodologies. Haemophilia 2020; 26:503-512. [PMID: 32159272 DOI: 10.1111/hae.13957] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Diagnosis of von Willebrand disease (VWD) is challenging due to heterogeneity of VWD and test limitations. Many von Willebrand factor (VWF) assays are utilized, including antigen (Ag), activity and multimer analysis. Activity assays include ristocetin cofactor using platelets (VWF:RCo) or other particles incorporating recombinant glycoprotein I ('VWF:GPIbR'), or other GPI binding assays using gain-of-function mutations ('VWF:GPIbM'), or collagen binding (VWF:CB). AIM To comparatively evaluate modern contemporary VWF activity assays vs VWF multimer analysis using modern contemporary methods. MATERIALS AND METHODS Several VWF activity assays (VWF:RCo, VWF:GPIbR, VWF:GPIbM, VWF:CB) assessed (typically as a ratio against VWF:Ag) against a new semi-automated procedure for different types of VWD (1, 3, 2A, 2B, 2M), plus control material (n = 580). The evaluation also focussed on relative loss of high and very high molecular weight multimers (HMWM and VHMWM) by densitometric scanning. RESULTS All evaluated VWF activity/Ag ratios showed high correlation to the presence/absence of HMWM and VHMWM, although VWF:CB/Ag and VWF:GPIbR/Ag ratios using an automated chemiluminescence method yielded highest correlation coefficients (r = .909 and .874, respectively, for HMWM). Use of the investigative procedure (VHMWM) identified fewer false positives for 'loss' in type 1 VWD. CONCLUSIONS This comparative investigation identified that new automated chemiluminescence VWF activity assays best identified relative loss or presence of HMWM and VHMWM according to activity to Ag ratios and an alternative investigative method for identifying VHMWM in multimer testing for a new commercial multimer method may lead to fewer false identifications of HMW loss in type 1 VWD.
Collapse
Affiliation(s)
- Emmanuel J Favaloro
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW, Australia
| | - Susan Oliver
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Soma Mohammed
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Ronny Vong
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| |
Collapse
|
12
|
Oliver S, Vanniasinkam T, Mohammed S, Vong R, Favaloro EJ. Semi-automated von Willebrand factor multimer assay for von Willebrand disease: Further validation, benefits and limitations. Int J Lab Hematol 2019; 41:762-771. [PMID: 31508897 DOI: 10.1111/ijlh.13107] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/31/2019] [Accepted: 08/21/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Accurate diagnosis of von Willebrand disease (VWD) enables effective patient management. von Willebrand factor (VWF) multimer analysis provides useful information regarding VWF multimer structure, thereby aiding VWD subtyping and management; however, historically technically challenging assays have had limited utility. This study evaluates the Sebia Hydrasys Hydragel-11 semi-automated VWF multimer assay and further validates the Hydragel-5 gel system, as primarily pertaining to VWD diagnostics and monitoring of therapy. METHODS Provisionally diagnosed (via a reference assay test panel) archived patient samples and prospective test patient samples, including those undergoing desmopressin trial or therapy monitoring, along with commercial and in-house control material and various external quality assessment (EQA) samples, were analysed. VWF multimers were evaluated for presence, loss or partial loss of high molecular weight (HMWM) and intermediate molecular weight (IMWM) multimers by both visual inspection and densitometric scanning, and comparison with reference assay results. RESULTS All anticipated multimer patterns were reproduced, with patients generally showing multimer profiles matching expected patterns according to VWD type based on reference test panel 'diagnosis'. Occasional discrepancies were resolved by retesting. The increase in plasma VWF following desmopressin therapy was also clearly demonstrated. Multimer profiles of EQA samples complemented reference test panel results and matched EQA targets. There were some 'technical' limitations noted. CONCLUSION This easy to use, standardised, semi-automated multimer analysis system can demonstrate the multimer profile of VWD patients, thus representing an additional laboratory tool for improved diagnosis, thereby facilitating appropriate patient management.
Collapse
Affiliation(s)
- Susan Oliver
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Thiru Vanniasinkam
- School of Biomedical Science, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Soma Mohammed
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Ronny Vong
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Emmanuel J Favaloro
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW, Australia
| |
Collapse
|