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Daniel MY, Ternisien C, Castet S, Falaise C, D'Oiron R, Volot F, Itzhar N, Pan-Petesch B, Jeanpierre E, Paris C, Zawadzki C, Desvages M, Dupont A, Veyradier A, Repessé Y, Babuty A, Trossaërt M, Boisseau P, Denis CV, Lenting PJ, Goudemand J, Rauch A, Susen S. Type 2N von Willebrand disease: genotype drives different bleeding phenotypes and treatment needs. J Thromb Haemost 2024:S1538-7836(24)00381-7. [PMID: 38992343 DOI: 10.1016/j.jtha.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Type 2 Normandy von Willebrand disease (VWD2N) is usually perceived as a mild bleeding disorder that can be treated with desmopressin (DDAVP). However, VWD2N patients can be compound heterozygous or homozygous for different variants, with p.Arg854Gln (R854Q) being the most frequent causative one. There are limited data about the impact of 2N variants on VWD2N phenotype and DDAVP response. OBJECTIVES This study aims to describe the phenotype of VWD2N, including DDAVP response, according to genotype. METHODS VWD2N patients with a complete genotype/phenotype characterization by the French reference center for VWD, including MCMDM-1VWD bleeding score, were eligible to be included in the study. Results of the DDAVP trial were also collected. RESULTS A total of 123 VWD2N patients from the French registry were included in this study. Results were stratified according to the presence (R854QPos, n = 114) or absence (R854QNeg, n = 9) of at least 1 R854Q allele. Three R854QPos subgroups were further individualized: patients homozygous (R854QHmz, n = 55), compound heterozygous for R854Q and a null allele (R854Q/3, n = 48), or compound heterozygous for R854Q and another 2N variant (R854Q/2N, n = 11). FVIII C levels were significantly lower in R854QNeg and R854Q/3 patients compared with R854QHmz ones (P < .001 and P < .0001, respectively). R854QNeg patients were diagnosed earlier due to bleeding symptoms and had a higher bleeding score than R854QPos patients (P < .001). In DDAVP trial, FVIII:C survival was lower in VWD type 2N than in type 1 patients. R854QPos patients had a heterogeneous DDAVP response, which was best predicted by baseline FVIII:C level. CONCLUSION The heterogeneous genetic background of VWD2N drives different bleeding phenotypes and response patterns to DDAVP, underlining the clinical relevance of DDAVP trial to identify patients potentially eligible to alternative therapeutic options.
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Affiliation(s)
- Mélanie Y Daniel
- Hematology and Transfusion Department, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Lille, Institut Pasteur de Lille, Université de Lille, U1011-European Genomic Institute for Diabetes, Lille, France. https://twitter.com/DanielMelanieMD
| | | | - Sabine Castet
- Bordeaux University Hospital, Hemostasis Clinical Center, Bordeaux, France
| | - Céline Falaise
- Hemostasis Clinical Center, Marseille University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Roseline D'Oiron
- Reference Center for Hemophilia and Rare Congenital Bleeding Disorders, Bicêtre Hospital Assistance Publique-Hôpitaux de Paris, University of Paris-Saclay and Unité Mixte de Recherche_S1176, Institut National de la Santé et de la Recherche Médicale, Le Kremlin-Bicêtre, France
| | - Fabienne Volot
- Hemostasis Clinical Center, Dijon University Hospital, Dijon, France
| | - Nathalie Itzhar
- Laboratory of Haemostasis, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Emmanuelle Jeanpierre
- Hematology and Transfusion Department, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Lille, Institut Pasteur de Lille, Université de Lille, U1011-European Genomic Institute for Diabetes, Lille, France
| | - Camille Paris
- Hematology and Transfusion Department, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Lille, Institut Pasteur de Lille, Université de Lille, U1011-European Genomic Institute for Diabetes, Lille, France
| | | | | | - Annabelle Dupont
- Hematology and Transfusion Department, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Lille, Institut Pasteur de Lille, Université de Lille, U1011-European Genomic Institute for Diabetes, Lille, France
| | - Agnès Veyradier
- Laboratory of Haemostasis, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yohann Repessé
- Laboratory and Clinical Hemostasis, Caen University Hospital, Caen, France
| | - Antoine Babuty
- Haemostasis Clinical Center, Nantes University Hospital, Nantes, France
| | - Marc Trossaërt
- Haemostasis Clinical Center, Nantes University Hospital, Nantes, France
| | - Pierre Boisseau
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Cécile V Denis
- Hémostase Inflammation Thrombose U1176, Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Peter J Lenting
- Hémostase Inflammation Thrombose U1176, Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jenny Goudemand
- Hematology and Transfusion, Lille University Hospital, Lille, France
| | - Antoine Rauch
- Hematology and Transfusion Department, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Lille, Institut Pasteur de Lille, Université de Lille, U1011-European Genomic Institute for Diabetes, Lille, France
| | - Sophie Susen
- Hematology and Transfusion Department, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Lille, Institut Pasteur de Lille, Université de Lille, U1011-European Genomic Institute for Diabetes, Lille, France.
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Brazilek RJ, Tovar-Lopez FJ, Wong AKT, Tran H, Davis AS, McFadyen JD, Kaplan Z, Chunilal S, Jackson SP, Nandurkar H, Mitchell A, Nesbitt WS. Application of a strain rate gradient microfluidic device to von Willebrand's disease screening. LAB ON A CHIP 2017; 17:2595-2608. [PMID: 28660968 DOI: 10.1039/c7lc00498b] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Von Willebrand's disease (VWD) is the most common inherited bleeding disorder caused by either quantitative or qualitative defects of von Willebrand factor (VWF). Current tests for VWD require relatively large blood volumes, have low throughput, are time-consuming, and do not incorporate the physiologically relevant effects of haemodynamic forces. We developed a microfluidic device incorporating micro-contractions that harnesses well-defined haemodynamic strain gradients to initiate platelet aggregation in citrated whole blood. The microchannel architecture has been specifically designed to allow for continuous real-time imaging of platelet aggregation dynamics. Subjects aged ≥18 years with previously diagnosed VWD or who presented for evaluation of a bleeding disorder, where the possible diagnosis included VWD, were tested. Samples were obtained for device characterization as well as for pathology-based testing. Platelet aggregation in the microfluidic device is independent of platelet amplification loops but dependent on low-level platelet activation, GPIb/IX/V and integrin αIIbβ3 engagement. Microfluidic output directly correlates with VWF antigen levels and is able to sensitively detect aggregation defects associated with VWD subtypes. Testing demonstrated a strong correlation with standard clinical laboratory-based tests. Head-to-head comparison with PFA100® demonstrated equivalent, if not improved, sensitivity for screening aggregation defects associated with VWD. This strain rate gradient microfluidic prototype has the potential to be a clinically useful, rapid and high throughput-screening tool for VWD as well as other strain-dependent platelet disorders. In addition, the microfluidic device represents a novel approach to examine the effects of high magnitude/short duration (ms) strain rate gradients on platelet function.
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Affiliation(s)
- Rose J Brazilek
- The Australian Centre for Blood Diseases, Monash University, Alfred Medical Research and Educational Precinct, Melbourne, Victoria, Australia
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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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Miesbach W, Berntorp E. Interaction between VWF and FVIII in treating VWD. Eur J Haematol 2015; 95:449-54. [DOI: 10.1111/ejh.12514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Wolfgang Miesbach
- Medical Clinic III; Institute of Transfusion Medicine; Goethe University; Frankfurt Germany
| | - Erik Berntorp
- Centre for Thrombosis and Haemostasis; Skane University Hospital; Lund University; Malmö Sweden
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Affiliation(s)
- M Morfini
- Agency for Haemophilia, Department of Emergency & Reception, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
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The von Willebrand factor from basic mechanisms to clinical practice. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 9 Suppl 2:s1-2. [PMID: 21839027 DOI: 10.2450/2011.001s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gresele P, Momi S. Inhibitors of the interaction between von Willebrand factor and platelet GPIb/IX/V. Handb Exp Pharmacol 2012:287-309. [PMID: 22918736 DOI: 10.1007/978-3-642-29423-5_12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The formation of platelet-rich thrombi, a critical step in the pathogenesis of atherothrombotic events, is a multistep process involving several components, among which von Willebrand Factor (VWF) plays a central role. Ruptured atherosclerotic plaques expose subendothelial matrix proteins which bind VWF that represents a bridge between the injured blood vessel and activated platelets, playing a crucial role in platelet adhesion and aggregation, especially in conditions of high-shear rate. Due to these peculiarities, the binding of VWF to GPIbα is an attractive drug target. Here we summarize the present knowledge on the different classes of drugs targeting the VWF-GPIb interaction and we give an account of their level of clinical development. In particular, the following compounds are discussed: AJW200, an IgG4 humanized monoclonal antibody against VWF-A1; 82D6A3, a monoclonal antibody against VWF-A3; ALX-0081 and ALX-0681, bivalent humanized nanobodies targeting the VWF-A1 domain; ARC1779 and its advanced formulation ARC15105, second-generation aptamers that bind the VWF-A1 domain; h6B4-Fab, a murine monoclonal antibody, and GPG-290, a recombinant chimeric protein, both directed against GPIbα.
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Affiliation(s)
- Paolo Gresele
- Division of Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Via E. dal Pozzo, 06126, Perugia, Italy.
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James AH, Kouides PA, Abdul-Kadir R, Dietrich JE, Edlund M, Federici AB, Halimeh S, Kamphuisen PW, Lee CA, Martínez-Perez O, McLintock C, Peyvandi F, Philipp C, Wilkinson J, Winikoff R. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol 2011; 158:124-34. [DOI: 10.1016/j.ejogrb.2011.04.025] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 02/25/2011] [Accepted: 04/30/2011] [Indexed: 01/21/2023]
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GRINGERI A, OFOSU FA, GRANCHA S, OLDENBURG J, EWING NP, FEDERICI AB. Understanding FVIII/VWF complex - report from a symposium of XXIX WFH meeting 2010. Haemophilia 2011; 18:469-75. [DOI: 10.1111/j.1365-2516.2011.02655.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kessler CM, Friedman K, Schwartz BA, Gill JC, Powell JS. The pharmacokinetic diversity of two von Willebrand factor (VWF)/ factor VIII (FVIII) concentrates in subjects with congenital von Willebrand disease. Results from a prospective, randomised crossover study. Thromb Haemost 2011; 106:279-88. [PMID: 21725579 DOI: 10.1160/th11-02-0057] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 04/29/2011] [Indexed: 11/05/2022]
Abstract
The pharmacokinetic (PK) profiles of von Willebrand factor (VWF) /factor VIII (FVIII) concentrates are important for treatment efficacy and safety of von Willebrand disease (VWD) patients. This prospective, head-to-head, randomised crossover study compared the PK profile of a new, high purity, human plasma-derived (pd)VWF/FVIII concentrate, Wilate, with the PK profile of an intermediate purity (pd)VWF/FVIII concentrate, Humate-P, in VWD patients. Subjects with inherited VWD were randomised to a single intravenous dose (40 IU/kg VWF ristocetin cofactor activity [VWF:RCo]) of Wilate or Humate-P in Period 1, and switched to the other study drug in Period 2. Each period was preceded by a washout time of ≥ 7 days. Coagulation factor parameters were analysed at multiple time-points. Of 22 randomised subjects, 20 had evaluable PK profiles, which indicated comparability for VWF antigen and VWF:RCo between Wilate and Humate-P. The reported VWF:RCo average and terminal t1/2 of 10.4 and 15.8 hours (h), respectively, for Wilate and 9.3 h and 12.8 h for Humate-P, were not statistically different. Also, the mean VWF:RCo in vivo recoveries (Wilate 1.89, Humate-P 1.99 IU/dl per IU/kg) were similar between the two replacement therapies. Wilate showed parallel decay curves for VWF:RCo and FVIII clotting activity (FVIII:C) over time, while FVIII:C of Humate-P displayed a plateau between 0 and 12-24 h. This study demonstrated bioequivalent PK properties for VWF between Wilate and Humate-P. The PK profile of Wilate, combined with the 1:1 VWF/FVIII ratio, theoretically should facilitate dosing and laboratory monitoring of VWF replacement to prevent bleeding in individuals with VWD.
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Affiliation(s)
- Craig M Kessler
- Hemophilia and Thrombophilia Comprehensive Treatment Center, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Road NW, Washington, DC 20007, USA.
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Nichols TC, Bellinger DA, Merricks EP, Raymer RA, Kloos MT, DeFriess N, Ragni MV, Griggs TR. Porcine and canine von Willebrand factor and von Willebrand disease: hemostasis, thrombosis, and atherosclerosis studies. THROMBOSIS 2011; 2010:461238. [PMID: 22091368 PMCID: PMC3211078 DOI: 10.1155/2010/461238] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 12/29/2010] [Indexed: 02/04/2023]
Abstract
Use of animal models of inherited and induced von Willebrand factor (VWF) deficiency continues to advance the knowledge of VWF-related diseases: von Willebrand disease (VWD), thrombotic thrombocytopenic purpura (TTP), and coronary artery thrombosis. First, in humans, pigs, and dogs, VWF is essential for normal hemostasis; without VWF bleeding events are severe and can be fatal. Second, the ADAMTS13 cleavage site is preserved in all three species suggesting all use this mechanism for normal VWF multimer processing and that all are susceptible to TTP when ADAMTS13 function is reduced. Third, while the role of VWF in atherogenesis is debated, arterial thrombosis complicating atherosclerosis appears to be VWF-dependent. The differences in the VWF gene and protein between humans, pigs, and dogs are relatively few but important to consider in the design of VWF-focused experiments. These homologies and differences are reviewed in detail and their implications for research projects are discussed. The current status of porcine and canine VWD are also reviewed as well as their potential role in future studies of VWF-related disorders of hemostasis and thrombosis.
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Affiliation(s)
- Timothy C. Nichols
- Department of Medicine, Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, NC 27516, USA
- Pathology and Laboratory Medicine, Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Dwight A. Bellinger
- Pathology and Laboratory Medicine, Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, NC 27516, USA
- Division of Laboratory Animal Medicine, Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Elizabeth P. Merricks
- Pathology and Laboratory Medicine, Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Robin A. Raymer
- Pathology and Laboratory Medicine, Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Mark T. Kloos
- Pathology and Laboratory Medicine, Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Natalie DeFriess
- Pathology and Laboratory Medicine, Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Margaret V. Ragni
- Medicine/Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
- Hemophilia Center of Western PA, Pittsburgh, PA 15213, USA
| | - Thomas R. Griggs
- Department of Medicine, Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, NC 27516, USA
- Pathology and Laboratory Medicine, Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, NC 27516, USA
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Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion management of patients in the peri-operative period. I. The pre-operative period. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:19-40. [PMID: 21235852 PMCID: PMC3021395 DOI: 10.2450/2010.0074-10] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Giancarlo Maria Liumbruno
- Units of Immunohaematology, Transfusion Medicine and Clinical Pathology, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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MANNUCCI PM, FEDERICI AB, JAMES AH, KESSLER CM. von Willebrand disease in the 21st century: current approaches and new challenges. Haemophilia 2009; 15:1154-8. [DOI: 10.1111/j.1365-2516.2008.01932.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nichols TC, Dillow AM, Franck HWG, Merricks EP, Raymer RA, Bellinger DA, Arruda VR, High KA. Protein replacement therapy and gene transfer in canine models of hemophilia A, hemophilia B, von willebrand disease, and factor VII deficiency. ILAR J 2009; 50:144-67. [PMID: 19293459 DOI: 10.1093/ilar.50.2.144] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Dogs with hemophilia A, hemophilia B, von Willebrand disease (VWD), and factor VII deficiency faithfully recapitulate the severe bleeding phenotype that occurs in humans with these disorders. The first rational approach to diagnosing these bleeding disorders became possible with the development of reliable assays in the 1940s through research that used these dogs. For the next 60 years, treatment consisted of replacement of the associated missing or dysfunctional protein, first with plasma-derived products and subsequently with recombinant products. Research has consistently shown that replacement products that are safe and efficacious in these dogs prove to be safe and efficacious in humans. But these highly effective products require repeated administration and are limited in supply and expensive; in addition, plasma-derived products have transmitted bloodborne pathogens. Recombinant proteins have all but eliminated inadvertent transmission of bloodborne pathogens, but the other limitations persist. Thus, gene therapy is an attractive alternative strategy in these monogenic disorders and has been actively pursued since the early 1990s. To date, several modalities of gene transfer in canine hemophilia have proven to be safe, produced easily detectable levels of transgene products in plasma that have persisted for years in association with reduced bleeding, and correctly predicted the vector dose required in a human hemophilia B liver-based trial. Very recently, however, researchers have identified an immune response to adeno-associated viral gene transfer vector capsid proteins in a human liver-based trial that was not present in preclinical testing in rodents, dogs, or nonhuman primates. This article provides a review of the strengths and limitations of canine hemophilia, VWD, and factor VII deficiency models and of their historical and current role in the development of improved therapy for humans with these inherited bleeding disorders.
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Affiliation(s)
- Timothy C Nichols
- Department of Pathology, Francis Owen Blood Research Laboratory, Laboratory Medicine at the University of North Carolina at Chapel Hill, NC 27516-3114, USA.
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Federici AB. The safety of plasma-derived von Willebrand/factor VIII concentrates in the management of inherited von Willebrand disease. Expert Opin Drug Saf 2009; 8:203-10. [DOI: 10.1517/14740330902719481] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Velik-Salchner C, Eschertzhuber S, Streif W, Hangler H, Budde U, Fries D. Acquired von Willebrand Syndrome in Cardiac Patients. J Cardiothorac Vasc Anesth 2008; 22:719-24. [DOI: 10.1053/j.jvca.2007.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Indexed: 11/11/2022]
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VISWABANDYA A, MATHEWS V, GEORGE B, NAIR SC, BAIDYA S, MAMMEN JJ, CHANDY M, SRIVASTAVA A. Successful surgical haemostasis in patients with von Willebrand disease with KoateDVI. Haemophilia 2008; 14:763-7. [DOI: 10.1111/j.1365-2516.2008.01755.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hanebutt FL, Rolf N, Loesel A, Kuhlisch E, Siegert G, Knoefler R. Evaluation of desmopressin effects on haemostasis in children with congenital bleeding disorders. Haemophilia 2008; 14:524-30. [PMID: 18284449 DOI: 10.1111/j.1365-2516.2008.01672.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Desmopressin (DDAVP) affects haemostasis by the release of von Willebrand factor and coagulation factor VIII from endothelium. The aim of the study was to evaluate the results of DDAVP testing in paediatric patients with congenital bleeding disorders. Forty-one patients consisting of children with von Willebrand's disease (VWD, n = 26) and platelet function defects (PFD, n = 15) received DDAVP intravenously at a dosage of 0.3 mug/kg over 30 min. FVIII activity (FVIII), von Willebrand factor antigen (VWF:Ag), collagen-binding activity (VWF:CB) and PFA 100((R)) closure times (CT) were measured before, 60, 120 and 240 min after DDAVP. In VWD, the VWF:Ag increased threefold until 60 min and then it decreased continuously. Compared with baseline, VWF:Ag was significantly higher at 60 and 120 min but not at 240 min. In contrast, in PFD, the peak of VWF:Ag was reached after 120 min. Two hundred and forty minutes after DDAVP, the mean was still significantly elevated compared with baseline values. The course of VWF:CB corresponded to that of VWF:Ag. In patients with VWD and PFD, FVIII rose two- to threefold within 2 h after DDAVP. CT in patients with VWD shortened markedly within 120 min and then rose again. In all children with PFD, except one non-responder, the CT shortened within 240 min after DDAVP. Two non-responders with VWD were identified by the failed increase of VWF:Ag, VWF:CB and by prolonged CT. Haemostatic effects of DDAVP differ interindividually and dependent on the coagulation disorder. DDAVP was effective in most, but not in all patients. DDAVP testing is recommended to determine the individual haemostatic response.
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Affiliation(s)
- F L Hanebutt
- Department of Pediatric Hematology and Oncology, University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany
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