von Willebrand disease: Diagnosis and treatment, treatment of women, and genomic approach to diagnosis

Authors: Laffan, M, Sathar, J, and Johnsen, JM.

Publication: Haemophilia; June 2020

Affiliations: Centre for Haematology, Imperial College London, London, UK; Department of Haematology, Ampang Hospital, Ampang, Selangor, Malaysia; Clinical Trial Unit, Clinical Research Centre, Ministry of Health, Ampang, Selangor, Malaysia; Research Institute, Bloodworks Northwest, Seattle, WA, USA; Washington Center for Bleeding Disorders, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA.

Abstract: von Willebrand disease (VWD) is the most common inherited bleeding disorder. VWD is caused by deficiencies in von Willebrand factor (VWF), a critical adhesive haemostatic protein. This review provides an overview of VWD diagnosis and treatment, special considerations in treating women with VWD, and current genomic approaches to VWD. For diagnosis and treatment in VWD, an accurate diagnosis is critical to providing effective treatments, determining appropriate laboratory monitoring and for counselling the patient and family. Diagnosis of VWD begins with the clinical assessment for the bleeding phenotype, which is usually characterized by mucocutaneous and provoked bleeding. The diagnosis of VWD is then made by laboratory investigation. Multiple assays are used to assess VWF levels and functions. The mainstays of VWD treatment are tailored by VWD type and symptoms, and can include antifibrinolytic treatment, desmopressin and VWF replacement treatment. Women with VWD are also at risk for excessive uterine bleeding, such as with menses and childbirth. In addition to standard VWD treatments, heavy menstrual bleeding can be treated with hormones. Interdisciplinary management of childbirth and prophylaxis in the postpartum period are needed to reduce the risk of postpartum haemorrhage. Genomic approaches to VWD can inform VWD diagnosis, treatment, test assay selection, reproductive planning and family counselling. Most VWD patients have an identifiable VWF gene DNA variant. Next-generation sequencing is rapidly being adopted to provide more comprehensive VWF sequence information for patients with known or suspected VWD.