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Atiq F, Saes J, Punt M, van Galen K, Schutgens R, Meijer K, Cnossen M, Laros-Van Gorkom B, Peters M, Nieuwenhuizen L, Kruip M, de Meris J, van der Bom J, van der Meer F, Fijnvandraat K, Kruis I, van Heerde W, Eikenboom H, Leebeek FW, Schols S. Major differences in clinical presentation, diagnosis and management of men and women with autosomal inherited bleeding disorders. EClinicalMedicine 2021; 32:100726. [PMID: 33554093 PMCID: PMC7848767 DOI: 10.1016/j.eclinm.2021.100726] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/23/2020] [Accepted: 01/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In recent years, more awareness is raised about sex-specific dilemmas in inherited bleeding disorders. However, no large studies have been performed to assess differences in diagnosis, bleeding phenotype and management of men and women with bleeding disorders. Therefore, we investigated sex differences in a large cohort of well-defined patients with autosomal inherited bleeding disorders (von Willebrand disease (VWD), rare bleeding disorders (RBDs) and congenital platelet defects (CPDs)). METHODS We included patients from three nationwide cross-sectional studies on VWD, RBDs and CPDs in the Netherlands, respectively the WiN, RBiN and TiN study. In all studies a bleeding score (BS) was obtained, and patients filled in an extensive questionnaire on the management and burden of their disorder. FINDINGS We included 1092 patients (834 VWD; 196 RBD; 62 CPD), of whom 665 (60.9%) were women. Women were more often referred because of a bleeding diathesis than men (47.9% vs 36.6%, p = 0.002). Age of first bleeding was similar between men and women, respectively 8.9 ± 13.6 (mean ±sd) years and 10.6 ± 11.3 years (p = 0.075). However, the diagnostic delay, which was defined as time from first bleeding to diagnosis, was longer in women (11.6 ± 16.4 years) than men (7.7 ± 16.6 years, p = 0.002). Similar results were found when patients referred for bleeding were analyzed separately. Of women aging 12 years or older, 469 (77.1%) had received treatment because of sex-specific bleeding. INTERPRETATION Women with autosomal inherited bleeding disorders are more often referred for bleeding, have a longer diagnostic delay, and often require treatment because of sex-specific bleeding. FUNDING The WiN study was supported (in part) by research funding from the Dutch Hemophilia Foundation (Stichting Haemophilia), Shire (Takeda), and CSL Behring (unrestricted grant).
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Affiliation(s)
- F. Atiq
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J.L. Saes
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M.C. Punt
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
| | - K.P.M. van Galen
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
| | - R.E.G. Schutgens
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
| | - K. Meijer
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | - M.H. Cnossen
- Department of Pediatric Hematology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - B.A.P. Laros-Van Gorkom
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M. Peters
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric-Hematology, Amsterdam, the Netherlands
| | - L. Nieuwenhuizen
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Maxima Medical Center Eindhoven, Eindhoven, the Netherlands
| | - M.J.H.A. Kruip
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J. de Meris
- Netherlands Hemophilia Society, Leiden, the Netherlands
| | - J.G. van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin Research, Leiden, the Netherlands
| | - F.J.M. van der Meer
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - K. Fijnvandraat
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric-Hematology, Amsterdam, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
| | - I.C. Kruis
- Netherlands Hemophilia Society, Leiden, the Netherlands
| | - W.L. van Heerde
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Enzyre BV, Novio Tech Campus, Nijmegen, the Netherlands
| | - H.C.J. Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank W.G. Leebeek
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S.E.M. Schols
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - For the WiN, RBiN and TiN study groups
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pediatric Hematology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric-Hematology, Amsterdam, the Netherlands
- Department of Hematology, Maxima Medical Center Eindhoven, Eindhoven, the Netherlands
- Netherlands Hemophilia Society, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin Research, Leiden, the Netherlands
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
- Enzyre BV, Novio Tech Campus, Nijmegen, the Netherlands
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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