Hemostatic effect of normal platelet transfusion in severe von Willebrand
disease patients
R Castillo, J Monteagudo, G Escolar, A Ordinas, M Magallon and J Martin Villar
Servicio de Hemoterapia y Hemostasia, Hospital Clinico y Provincial,
Facultad de Medicina, Barcelona, Spain.
Platelet von Willebrand factor (vWF) has been suggested to play an
important role in the hemostatic process. Clinical and experimental data
indicate that bleeding time (BT) and platelet-vessel wall interaction
cannot be normalized unless the defect of platelet vWF is also corrected.
We have examined the effect of normal platelet concentrate transfusion 1
hour after cryoprecipitate infusion in five type III von Willebrand disease
(vWD) patients. The cryoprecipitate infusion attained normal circulating
levels of ristocetin cofactor, vWF antigen, and factor VIII activity. In
two patients, cryoprecipitate infusion did not modify the BT (greater than
30 minutes), whereas in the remaining three patients BT was only partially
corrected (from greater than 30 to 12, 18, and 21 minutes). However, the
immediate platelet transfusion completely corrected the BT in four cases,
and in one case it shortened the BT to 8.30 minutes (n = 3 to 8 minutes).
In the perfusion study, cryoprecipitate infusion only resulted in a slight
increase in platelet deposition (surface coverage range: 2.4% to 11.3%),
whereas the platelet concentrate transfusion elicited a more marked
improvement (range: 8.2% to 26.4%; P less than .02 v post-
cryoprecipitate). These results suggest an important in vivo role of the
platelet vWF in supporting platelet-vessel wall interaction. They also give
support to the occasional addition of normal platelet transfusion to the
cryoprecipitate infusion for the control of serious bleeding episodes
resistant to cryoprecipitate in severe vWD patients.
Volume 77,
Issue 9,
pp. 1901-1905,
05/01/1991
Copyright © 1991 by The American Society of Hematology
