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Álvarez Román MT, Rivas Pollmar MI, De la Corte-Rodríguez H, Gómez-Cardero P, Rodríguez-Merchán EC, Gutiérrez-Alvariño M, García-Pérez E, Martín-Salces M, Zagrean D, Butta-Coll NV, Jiménez-Yuste V. Knee replacement surgery in a patient with acquired von Willebrand disease: a case study with recommendations for patient management. Ann Med Surg (Lond) 2024; 86:1681-1686. [PMID: 38463081 PMCID: PMC10923270 DOI: 10.1097/ms9.0000000000001690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/27/2023] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Acquired von Willebrand disease (AvWD) is a rare underdiagnosed bleeding disorder caused by alterations in the levels of the major blood-clotting protein von Willebrand factor (vWF). The clinical and laboratory parameters of AvWD are similar to congenital vWD, but it is found in individuals with no positive family history with no underlying genetic basis. The disease remains multifactorial and incompletely understood. Proposed mechanisms include the development of autoantibodies to vWF, absorption of high molecular weight vWF multimers that impair normal function, shear stress induced vWF cleavage and increased proteolysis.The aetiology of the disease is variable, the most common being hematoproliferation, lymophoproliferation, myeloproliferation and autoimmune and cardiovascular disorders. Consensus and protocols for AvWD patients that require major surgery are currently lacking. Patients with AvWD can experience thrombotic events during surgery as a result of therapeutic interactions with pro-thrombotic risk factors. Case presentation Here, the authors report a patient with AvWD requiring a knee prosthesis implantation due to chronic pain, limited range of motion and functional impairment. The patient had a high risk of bleeding during surgery and was at risk of thrombosis due to age and obesity. Clinical discussion Perioperative care required a collaborative approach and the management of bleeding. The patient was administered vWF concentrate Willfact lacking Factor VIII to prevent haemorrhage and to minimize the risk of thrombosis. Conclusion The treatment was effective and well-tolerated. The authors use this information to provide recommendations for AvWD patients for whom major surgery is indicated.
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Affiliation(s)
| | | | | | | | - E. Carlos Rodríguez-Merchán
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research, IdiPAZ (La Paz University Hospital—Autonomous University of Madrid)
| | | | | | | | | | | | - Víctor Jiménez-Yuste
- Departments ofHematology
- Department of Medicine, Autonomous University of Madrid, Madrid, Spain
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2
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Roberts JC, Jesudas R, Tarantino MD. Development of an inhibitor in a child with severe hemophilia B. Blood Coagul Fibrinolysis 2019; 30:291-294. [DOI: 10.1097/mbc.0000000000000829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3
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Holm E, Carlsson KS, Lövdahl S, Lail AE, Abshire TC, Berntorp E. Bleeding-related hospitalization in patients with von Willebrand disease and the impact of prophylaxis: Results from national registers in Sweden compared with normal controls and participants in the von Willebrand Disease Prophylaxis Network. Haemophilia 2018; 24:628-633. [DOI: 10.1111/hae.13473] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 11/27/2022]
Affiliation(s)
- E. Holm
- Department of Translational Medicine; Lund University; Skåne University Hospital; Lund Sweden
| | - K. Steen Carlsson
- Health Economics Unit; Department of Clinical Sciences; Lund University; Lund Sweden
- The Swedish Institute for Health Economics; Lund Sweden
| | - S. Lövdahl
- Department of Translational Medicine; Lund University; Skåne University Hospital; Lund Sweden
| | | | - T. C. Abshire
- BloodCenter of Wisconsin and Departments of Pediatrics and Medicine; Blood Research Institute; Medical College of Wisconsin; Milwaukee WI USA
| | - E. Berntorp
- Department of Translational Medicine; Lund University; Skåne University Hospital; Lund Sweden
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4
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Wu R, Luke KH. The benefit of low dose prophylaxis in the treatment of hemophilia: a focus on China. Expert Rev Hematol 2017; 10:995-1004. [DOI: 10.1080/17474086.2017.1386096] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Runhui Wu
- Hemophilia Work Group, Hematology-Oncology Center, Beijing Children’s Hospital affiliated to Capital Medical University, Beijing, China
| | - Koon Hung Luke
- University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, Canada
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5
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Heijdra JM, Cnossen MH, Leebeek FWG. Current and Emerging Options for the Management of Inherited von Willebrand Disease. Drugs 2017; 77:1531-1547. [PMID: 28791655 PMCID: PMC5585291 DOI: 10.1007/s40265-017-0793-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Von Willebrand disease (VWD) is the most common inherited bleeding disorder with an estimated prevalence of ~1% and clinically relevant bleeding symptoms in approximately 1:10,000 individuals. VWD is caused by a deficiency and/or defect of von Willebrand factor (VWF). The most common symptoms are mucocutaneous bleeding, hematomas, and bleeding after trauma or surgery. For decades, treatment to prevent or treat bleeding has consisted of desmopressin in milder cases and of replacement therapy with plasma-derived concentrates containing VWF and Factor VIII (FVIII) in more severe cases. Both are usually combined with supportive therapy, e.g. antifibrinolytic agents, and maximal hemostatic measures. Several developments such as the first recombinant VWF concentrate, which has been recently licensed for VWD, will make a more "personalized" approach to VWD management possible. As research on new treatment strategies for established therapies, such as population pharmacokinetic-guided dosing of clotting factor concentrates, and novel treatment modalities such as aptamers and gene therapy are ongoing, it is likely that the horizon to tailor therapy to the individual patients' needs will be extended, thus, further improving the already high standard of care in VWD in most high-resource countries.
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Affiliation(s)
- Jessica M Heijdra
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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6
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Clough AM, Gilreath JA, McPherson JP, Link NC, Rodgers GM, Nance D. Implementation of a recombinant factor IX Fc fusion protein extended-infusion desensitization protocol. Haemophilia 2017; 23:e227-e230. [DOI: 10.1111/hae.13208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 01/19/2023]
Affiliation(s)
- A. M. Clough
- Department of Pharmacy; Huntsman Cancer Institute; Salt Lake City UT USA
| | - J. A. Gilreath
- Department of Pharmacy; Huntsman Cancer Institute; Salt Lake City UT USA
- Department of Pharmacotherapy; College of Pharmacy; The University of Utah; Salt Lake City UT USA
| | - J. P. McPherson
- Department of Pharmacy; Huntsman Cancer Institute; Salt Lake City UT USA
| | - N. C. Link
- Department of Pharmacy; Huntsman Cancer Institute; Salt Lake City UT USA
| | - G. M. Rodgers
- Division of Hematology and Hematologic Malignancies; Huntsman Cancer Institute; Salt Lake City UT USA
| | - D. Nance
- Division of Hematology and Hematologic Malignancies; Huntsman Cancer Institute; Salt Lake City UT USA
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7
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Franchini M, Mannucci PM. Efficacy and safety of a recombinant factor VIII produced from a human cell line (simoctocog alfa). Expert Opin Drug Saf 2017; 16:405-410. [DOI: 10.1080/14740338.2017.1285281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
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8
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van Vulpen LFD, Saccullo G, Iorio A, Makris M. The current state of adverse event reporting in hemophilia. Expert Rev Hematol 2016; 10:161-168. [PMID: 28013565 DOI: 10.1080/17474086.2017.1272410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Replacement of the missing clotting factor is the mainstay of hemophilia treatment. Whilst historically many hemophilia patients were infected with blood-borne viruses transmitted via plasma-derived products, nowadays the formation of alloantibodies against the missing clotting factor is the main adverse event of treatment. Areas covered: This paper provides an overview of the current national and international adverse event reporting systems, what these surveillance schemes taught us about side effects of the products presently in use, and elaborates on how to adapt these systems to the challenges we face with the changing treatment landscape. Expert commentary: Treatment of inherited bleeding disorders was accompanied by severe complications in the past, resulting in major morbidity and mortality. Current products are much safer, but still require monitoring via efficient safety surveillance systems. Adverse events are reported in national and international systems. With many new products entering the market, as well as non-factor replacement therapies, new safety issues may arise. It is important to identify potential adverse events early by making surveillance systems suitable to pick up unknown or unexpected effects, and to recognize and communicate patterns of adverse events rapidly.
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Affiliation(s)
- Lize F D van Vulpen
- a Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital , Sheffield , UK.,b Van Creveldkliniek, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Giorgia Saccullo
- a Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital , Sheffield , UK
| | - Alfonso Iorio
- c Department of Clinical Epidemiology and Biostatistics , McMaster University , Hamilton , ON , Canada
| | - Michael Makris
- a Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital , Sheffield , UK.,d Department of Infection , Immunity and Cardiovascular Disease, University of Sheffield , Sheffield , UK
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9
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Franchini M, Mannucci PM. The safety of pharmacologic options for the treatment of persons with hemophilia. Expert Opin Drug Saf 2016; 15:1391-400. [DOI: 10.1080/14740338.2016.1208747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
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10
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Berntorp E. Future of haemophilia outcome assessment: registries are key to optimized treatment. J Intern Med 2016; 279:498-501. [PMID: 27199237 DOI: 10.1111/joim.12504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Berntorp
- Department of Translational Medicine, Lund University and Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmö, Sweden
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Abstract
The introduction of clotting factor concentrates has transformed the lives of persons with inherited bleeding disorders. With the use of prophylactic treatment, it is now possible to prevent bleeding in these individuals. The early concentrates were contaminated with the HIV and hepatitis C viruses (HCV) and resulted in major morbidity and mortality in the recipients. Current products are much safer, especially in terms of infectious agents, but other adverse events such as alloantibodies (inhibitors), allergic reactions and thrombotic risks remain of concern. Approximately 30% of previously untreated patients with severe haemophilia A develop inhibitors, making this the most important issue in haemophilia care today. Recently, it was suggested that one of the most commonly used concentrates was associated with a higher inhibitor risk, but this was not supported by the evidence from all studies. Good safety surveillance systems are essential for all diseases and products but are particularly so in the group of individuals with inherited bleeding disorders treated with clotting factor concentrates who have suffered disproportionately from the adverse effects of their treatment. National and multinational systems are now in place to allow reporting of adverse events in patients with inherited bleeding disorders. All clinicians treating individuals with inherited bleeding disorders should prospectively report adverse events to treatment even if they are believed to be common and well recognized.
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Affiliation(s)
- R Lassila
- Helsinki University Hospital, Coagulation Disorders, Hematology and Comprehensive Cancer Center, University of Helsinki, Helsinki, Finland
| | - M Makris
- Department of Cardiovascular Science, Medical School, University of Sheffield, Sheffield, UK.,Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UK
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12
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Batty P, Chen YH, Bowles L, Hart DP, Platton S, Pasi KJ. Safety and efficacy of a von Willebrand factor/factor VIII concentrate (Wilate®): a single centre experience. Haemophilia 2014; 20:846-53. [DOI: 10.1111/hae.12496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- P. Batty
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
| | - Y. -H. Chen
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
| | - L. Bowles
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
| | - D. P. Hart
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
| | - S. Platton
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
| | - K. J. Pasi
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
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13
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14
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Franchini M, Lippi G. Pharmacotherapy of von Willebrand disease. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.801315] [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: 11/05/2022]
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Savage WJ, Tobian AAR, Savage JH, Wood RA, Schroeder JT, Ness PM. Scratching the surface of allergic transfusion reactions. Transfusion 2012; 53:1361-71. [PMID: 22998777 DOI: 10.1111/j.1537-2995.2012.03892.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Allergic transfusion reactions (ATRs) are a spectrum of hypersensitivity reactions that are the most common adverse reaction to platelets and plasma, occurring in up to 2% of transfusions. Despite the ubiquity of these reactions, little is known about their mechanism. In a small subset of severe reactions, specific antibody has been implicated as causal, although this mechanism does not explain all ATRs. Evidence suggests that donor, product, and recipient factors are involved, and it is possible that many ATRs are multifactorial. Further understanding of the mechanisms of ATRs is necessary so that rationally designed and cost-effective prevention measures can be developed.
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Affiliation(s)
- William J Savage
- Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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