When is Willebrand factor (vWF) multimer analysis indicated?

Updated: Aug 01, 2019
  • Author: Carlos Solano Loran, MD; Chief Editor: Eric B Staros, MD  more...
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Answer

Answer

vWD is divided into 3 major categories: partial quantitative deficiency (type I), qualitative deficiency (type II), and total deficiency (type III).

Multimeric analysis of vWF is particularly important in the diagnosis of vWD type II, which is further divided into 4 variants (IIA, IIB, IIM, and IIN), based on the molecular characteristics of the dysfunctional vWF. The analysis shows the multimeric distribution of vWF, thus allowing classification based on the specific absence of large multimers (type IIB) or both intermediate and large (type IIA) multimers. The different subtypes have distinct clinical features and therapeutic requirements.

Manifestations of vWD include the following:

  • Easy bruising

  • Prolonged bleeding after minor trauma to skin or mucous membranes

  • Severe hemorrhage after major surgery or delayed bleeding up to several weeks after surgery

  • Heavy bleeding after tooth extraction or other oral surgery (eg, tonsillectomy and adenoidectomy)

  • Menorrhagia

  • Bleeding symptoms exacerbated by ingestion of aspirin and ameliorated by oral contraceptives [7]


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