Laboratory diagnosis of von Willebrand disorder (vWD) and monitoring of DDAVP therapy: efficacy of the PFA-100 (R) and vWF : CBA as combined diagnostic strategies
Ej. Favaloro et al., Laboratory diagnosis of von Willebrand disorder (vWD) and monitoring of DDAVP therapy: efficacy of the PFA-100 (R) and vWF : CBA as combined diagnostic strategies, HAEMOPHILIA, 7(2), 2001, pp. 180-189
We have coevaluated a combination of test processes for diagnosing von Will
ebrand disease (vWD) and monitoring deamino-delta -D-arginine vasopressin (
DDAVP) therapy. Using normal controls (n = 23), closure time (CT) ranges me
asured by PFA-100(R) were (mean +/- 2SD): (i) collagen/ADP cartridge (C/ADP
): 67-127 s (ii) collagen/epinephrine (C/Epi): 94-162 s. From a panel of 12
5 patients undergoing evaluation for clinical haemostatic defects, 29/30 sa
mples from patients with vWD [17/18 type 1, 1/1 type 3, 3/3 type 2A, 7/7 ty
pe 2B and 1/1 pseudo-vWD] gave prolonged CTs using C/Epi. The C/ADP was les
s sensitive, being normal in 7/18 of the type 1 vWD individuals, with highe
r sensitivity to more severe vWD. Individuals with haemophilia (six factor
VIII-deficient, one factor XI-deficient) gave normal CTs, while those with
clinical thrombocytopenia (n = 13) gave normal or prolonged CTs, somewhat d
ependent on platelet count. The PFA-100(R) was also evaluated as a part of
the laboratory monitoring procedure in patients with either vWD or haemophi
lia undergoing a DDAVP trial as a therapeutic management process. For vWD,
correction of an initially prolonged CT by DDAVP, accompanied by normalizat
ion of von Willebrand factor (vWF) measurable by von Willebrand factor anti
gen, vWF collagen binding activity and vWF ristocetin cofactor assays (vWF:
Ag, vWF:CBA and vWF:RCof), was achieved in type 1 vWD (n = 5). In an indivi
dual with type 2A vWD, DDAVP normalized vWF:Ag and vWF:RCof, but had no app
arent effect on the baseline maximally prolonged CT. In an individual with
type 2B vWD, factor VIII/vWF concentrate also normalized vWF:Ag and vWF:RCo
f, but similarly had no apparent effect on the baseline maximally prolonged
CT. vWF:CBA did not normalize for either of these individuals, potentially
suggesting that normalization of vWF:CBA might he required for normalizati
on of CT. This concept is supported by correlation analysis undertaken betw
een CT and various vWF parameters. Among these, vWF:CBA held the strongest
relationship in our data set, which showed an inverse progressive rise in C
T for falling vWF:CBA. Based on these results, we would conclude that the P
FA-100(R) is highly sensitive to the presence of vWD, and may thus provide
a valuable screening test for vWD. Furthermore, the combined utility of the
PFA-100(R) and vWF:CBA as markers of DDAVP responsiveness may prove to be
simple, quick but powerful, predictors for its clinical efficacy.