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Semin Thromb Hemost 2011; 37(5): 464-469
DOI: 10.1055/s-0031-1281030
© Thieme Medical Publishers

Platelet-Type Von Willebrand Disease: A Rare, Often Misdiagnosed and Underdiagnosed Bleeding Disorder

Maha Othman1
  • 1Assistant Professor, Department of Anatomy and Cell Biology, Queen's University; and Professor, Laurentian University-St. Lawrence College Collaborative Program, St. Lawrence College, Kingston, Ontario, Canada
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Publikationsdatum:
18. November 2011 (online)

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ABSTRACT

Platelet-type von Willebrand disease (PT-VWD) is an autosomal dominant rare bleeding disorder characterized by hyperresponsive platelets. This inherent platelet function defect is due to a gain-of-function mutation within the GP1BA gene coding for the platelet surface glycoprotein Ib alpha protein, the receptor for the adhesive protein von Willebrand factor (VWF). The defect results in excessive and unnecessary platelet–VWF interaction with subsequent removal of the hemostatically efficient high molecular weight VWF as well as platelets from the circulation, leading to thrombocytopenia and bleeding diathesis. Patients with PT-VWD present with mild to moderate mucocutaneous bleeding, which becomes more pronounced during pregnancy and following aspirin ingestion or drugs that have antiplatelet activity. Laboratory testing shows low VWF:ristocetin cofactor and low or normal VWF:antigen and characteristically an enhanced ristocetin-induced platelet agglutination (RIPA). These laboratory features are also indicators of the closely similar and more common bleeding disorder type 2B VWD. Simplified RIPA mixing assays, cryoprecipitate challenge, and flow cytometry can differentiate between the two disorders. However, the gold standard is to identify mutations within the VWF gene (indicating type 2B VWD) or the platelet GP1BA gene (confirming PT-VWD). Treatment is based on making a correct diagnosis of PT-VWD where platelet concentrates instead of VWF/factor VIII preparations should be administered. A recent fairly large retrospective/prospective registry-based international study showed that PT-VWD is very rare, likely to be misdiagnosed as type 2B VWD or idiopathic thrombocytopenic purpura, and represents 15% of type 2B VWD diagnoses.

KEYWORDS

Glycoprotein 1bα - type 2B VWD - registry - RIPA - PT-VWD mouse - platelet concentrate

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Maha OthmanM.D. Ph.D. 

Department of Anatomy and Cell Biology, Queen's University, Boterell Hall

Room 915, Kingston, Ontario K7L 3N6, Canada

eMail: Othman@queensu.ca

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