Monocentric study of Willebrand’s disease in tunisia: assets and difficulties

##plugins.themes.academic_pro.article.main##

Fatma Ben Lakhal
Wijdene El Borgi
Emna Gouider
Balkis Meddeb
Naouel Ben Salah
Raouf Hafsia

Abstract

SUMMARY
Background: Von Willebrand’s disease (VWD) is the most commonly inherited bleeding disorder. It is characterized by clinical, biological and molecular heterogeneity. In certain types of the disease, diagnosis can be difficult.
Aim : We report the clinico-biological characteristics of VWD’s patients and analyze diagnosis difficulties.

Methods :33 cases were diagnosed in the laboratoryfrom February to May, 2011. Screening hemostasis included the measuring of FVIII: C, VWF: Ag and VWF: RCo. Blood cell count and blood group were performed in all cases.
Results : Mean age at diagnosis is 13 years [10 months -43 years]. The sex ratio M/F is 0.5. The patients are classified type 3 VWD in 52% of the cases, type 2 VWD in 30 % of the cases and type 1 VWD in 18 % of the cases. The diagnosis of type 2B VWD suspected in combination of the ratio VWF:RCo / VWF: Ag <0,7 and
thrombocytopenia in one case. Required tests for positive diagnosis and distinction between the primary categories of VWD are available. Specialized tests will allow a best characterization variants type 2 VWD for a better therapeutic approach.

Keywords:

Von Willebrand disease, Von Willebrand factor, Biological diagnosis, Difficulties.

##plugins.themes.academic_pro.article.details##

References

  1. Sadler E, Budde U, Eikenboom JCJ et al. Update on the pathophysiology and classification of von Willebrand disease: a report of the subcommittee on von willebrand factor. J Thromb and Haemost 2006; 4: 2103-14.
  2. Cherkaoui S, Laaloui A, Faiz S, Benchemsi N. Pregnancy and delivery in a patient with Willebrand's disease. Transfus Clin et Biol 2007; 14: 474- 80
  3. Majluf-Cruz A, Velez-Ruelas MA, Gonzalez-Avila AI et al. Von Willebrand's disease in Mexico: a pilot study. Haemophilia 2013; 19: 231-5.
  4. Rodeghiero F, Castaman G, Dini E. Epidemiological investigation of the prevalence of von willebrand's disease. Blood 1987; 69: 454-9.
  5. Gill JC, Endres-Brooks J, Bauer PJ, Jr Marks WJ, Montgomery RR. The effect of ABO blood group on the diagnosis of von Willebrand disease. Blood 1987; 69: 1691-95.
  6. Veyradier A, Fressinaud E, Goudemand J, Meyer D. La maladie de Willebrand. Hématologie 2011; 17: 278-88
  7. Laffan M, Brown SA, Collins PW et al. The diagnosis of von Willebrand disease: a guideline from the UK Haemophilia Centre Doctors' Organization. Haemophilia 2004; 10:199-217
  8. Nichols WL, Hultin MB, James AH et al. von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institue (NHLBI) Expert Panel report (USA). Haemophilia 2008; 14: 171-232.
  9. Tosseto A, Rodeghiero F, Castaman G et al. A quantitative analysis of bleeding symptoms in type 1 von Willebrand disease: results from a multicenter European study. J Thromb Haemost 2006; 4: 766-73.
  10. Rothschild C. Maladie de Willebrand. Transfus Clin Biol 1998; 5: 357-61.
  11. Siguret V, Ribba AS, Meyer D. Diagnostic biologique de la maladie de Willebrand. Ann Biol Clin 1997 ; 55 : 601-6.
  12. Michiels JJ, Gadisseur A, Budd U et al. Characterization, classification, and treatment of Von Willebrand disease: A critical appraisal of the literature and personal experiences. Semin Thromb Hemost 2005; 31 : 577-601
  13. Sadler JE. Von Willebrand disease type 1: a diagnosis in search of a disease. Blood 2003; 101(6): 2089-93.
  14. Mikhail S, Kouides P. von Willebrand disease in the pediatric and adolescent population. J Pediatr Adolesc Gynecol 2010; 23 (6 Suppl): S3-10.
  15. Lak M, Peyvandi F, Mannucci PM. Clinical manifestations and complications of childbirth and replacement therapy in 385 Iranian patients with type 3 von Willebrand disease. Br J Haematol 2000; 111:1236-9.
  16. Budde U, Scheppenheim R. Von Willebrand factor and Willebrand disease. Reviews in clinical and experimental hematology 2001; 5(4): 335-68.
  17. Znazin R, Guermazi S, Karoui M. Diagnostic biologique de la maladie de Willebrand et sesdifficultés. Tunis Med 2007; 85 : 445-9.
  18. Lattuada A, Preda L, Sacchi E, Gallo L, Federici AB, Rossi E. A rapid assay for ristocetin cofactor activity using an automated coagulometer (ACL9000). Blood Coag Fibrinol 2004; 15 : 505-11
  19. Redaelli R, Corno AR, Borroni L, Mostarda G, Nichelatti M, Morra E. Von Willebrand factor ristocetin cofactor (VWF : RCo) assay : implementation on an automated coagulometer (ACL). J Thromb Haemost 2005; 3 : 2684-8.
  20. Pittet JL, Barbalat V, Sanvert M, Villard C, Jorieux S, Mazurier C. Evaluation of a new automated Elisa test for Von Willebrand factor using tow monoclonal antibodies. Blood Coag Fibrinol 1997; 8 : 209-15.
  21. Fressinaud E, Meyer D. Maladie de Willebrand. Encycl Méd Chir, Hématologie, 13-021-A-50, 2001, 13p.
  22. Groupe d'Etude sur l'hémostase et la Thrombose. Annexe technique. Sang Thromb Vais 1993; 5: 37-9.
  23. Srivastava A, Rodeghiero F. Epidemiology of Von Willebrand disease in developping countries. Semin Thromb Hemost 2005; 31(5): 569-76
  24. Sadler JE. Low von Willebrand factor: sometimes a risk factor and sometimes a disease. Hematology Am Soc Hematol Educ Program 2009; 106-12.
  25. Rodeghiero F, Castaman G, Tosetto A et al. The discriminant power of bleeding history for the diagnosis of type 1 von Willebrand disease: an international, multicenter study. J Thromb Haemost 2005; 3 : 2619-26.
  26. Salder J E. Slippery criteria for von Willebrand disease type 1. J Thromb Haemost 2004; 2: 1720-3.
  27. Tosetto A, Castaman G, Rodeghiero F. Evidence-based diagnosis of type 1 von Willebrand disease: a Bayes theorem approach. Blood 2008; 111: 3998-4003.