Semin Thromb Hemost 2011; 37(5): 511-521
DOI: 10.1055/s-0031-1281037
© Thieme Medical Publishers

Management of Inherited von Willebrand Disease in Italy: Results from the Retrospective Study on 1234 Patients

Augusto B. Federici1 , 2 , Paolo Bucciarelli2 , Giancarlo Castaman3 , Luciano Baronciani2 , Maria T. Canciani2 , Maria G. Mazzucconi4 , Massimo Morfini5 , Angiola Rocino6 , Mario Schiavoni7 , Emily Oliovecchio8 , Alfonso Iorio8 , Pier M. Mannucci9
  • 1Division of Hematology and Transfusion Medicine, L. SACCO University Hospital and Department of Internal Medicine, University of Milan, Milan, Italy
  • 2A. Bianchi BONOMI Hemophilia and Thrombosis Center, IRCCS Cà Granda Foundation, Policlinico Hospital, Milan, Italy
  • 3Division of Hematology, San BORTOLO Hospital, Vicenza, Italy
  • 4Hemophilia Center, Department of Hematology, University of Rome, Rome, Italy
  • 5Hemophilia Center, CAREGGI Hospital, Florence, Italy
  • 6Hemophilia Center, PELLEGRINI Hospital, Naples, Italy
  • 7Hemophilia Thrombosis Center, POLICLINICO Hospital, Bari, Italy
  • 8Hemophilia Center, University of Perugia, Perugia, Italy
  • 9Scientific Direction IRCCS Ca GRANDA Foundation Maggiore Policlinico Hospital, Milan, Italy
Further Information

Publication History

Publication Date:
18 November 2011 (online)

ABSTRACT

von Willebrand disease (VWD) is the most common inherited bleeding disorder and is due to quantitative and/or qualitative defects of von Willebrand factor (VWF). Despite the improved knowledge of the disease, detailed data on VWD types requiring specific treatments have not been reported thus far. To determine the number and types of VWD requiring therapy with desmopressin (DDAVP) and/or VWF/FVIII concentrates in Italy, a national registry on VWD (RENAWI) was organized. Only 16 of 48 centers included VWD in the RENAWI with diagnoses performed locally. Patients with uncertain results were retested by two expert laboratories using multimeric analysis and mutations of the VWF gene. A total of 1234 of 1529 (81%) cases satisfied the inclusion criteria and could be classified as VWD1 (63%), VWD2A (7%), VWD2B (6%), VWD2M (18%), VWD2N (1%), and VWD3 (5%). VWD types were also confirmed by DNA analyses and occur in young adults (83%), mainly in women (58%). Mucosal bleedings (32 to 57%) are more frequent than hematomas (13%) or hemarthrosis (6%). Most patients were exposed to an infusion trial with desmopressin (DDAVP) and found responsive with the following rates: VWD1 (69%), VWD2A (26%), VWD2M (29%), and VWD2N (71%). However, DDAVP was not always used to manage bleeding in all responsive patients and VWF/FVIII concentrates were given instead of or together with DDAVP in VWD1 (30%), VWD2A (84%), VWD2B (62%), VWD2M (63%), VWD2N (30%), and VWD3 (91%). Data of the RENAWI showed that correct VWD identification and classification might be difficult in many Italian centers. Therefore, evidence-based studies should be organized only in well-characterized patients tested by laboratories that are expert in the clinical, laboratory, and molecular markers of VWD.

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Augusto B FedericiM.D. 

Division of Hematology and Transfusion Medicine, Department of Internal Medicine University of Milan

L. SACCO University Hospital, Via G. B. Grassi, 76 – 20154 Milan, Italy

Email: augusto.federici@unimi.it

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