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Blood, 1 January 2007, Vol. 109, No. 1, pp. 112-121.
Prepublished online as a Blood First Edition Paper on September 19, 2006; DOI 10.1182/blood-2006-05-020784.


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HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY

Phenotype and genotype of a cohort of families historically diagnosed with type 1 von Willebrand disease in the European study, Molecular and Clinical Markers for the Diagnosis and Management of Type 1 von Willebrand Disease (MCMDM-1VWD)

Anne Goodeve1,, Jeroen Eikenboom2, Giancarlo Castaman3, Francesco Rodeghiero3, Augusto B. Federici4, Javier Batlle5, Dominique Meyer6, Claudine Mazurier7, Jenny Goudemand8, Reinhard Schneppenheim9, Ulrich Budde10, Jorgen Ingerslev11, David Habart12, Zdena Vorlova12, Lars Holmberg13, Stefan Lethagen14, John Pasi15, Frank Hill16, Mohammad Hashemi Soteh1, Luciano Baronciani4, Christer Hallden14, Andrea Guilliatt16, Will Lester16, and Ian Peake1

1 The Academic Unit of Haematology, University of Sheffield, United Kingdom; 2 Department of Hematology, Leiden University Medical Center, The Netherlands; 3 Hematology Department, San Bortolo Hospital, Vicenza, Italy; 4 Hemophilia and Thrombosis Centre, Foundation IRCCS Maggiore Policlinico Hospital, Mangiagalli Regina Elena and University of Milan, Italy; 5 Servicio de Hematologia y Hemoterapia, Hospital Teresa Herrera, La Coruna, Spain; 6 Institut National de la Santé et de la Recherche Médicale (INSERM U143), INSERM, Paris, France; 7 Laboratoire Français du Fractionnement et des Biotechnologies, Lille, France; 8 University of Lille, France; 9 University Medical Center Hamburg-Eppendorf, Department of Pediatric Hematology and Oncology, Hamburg, Germany; 10 Coagulation Laboratory, Hamburg, Germany; 11 Centre for Haemophilia and Thrombosis, University Hospital Skejby, Aarhus, Denmark; 12 Institute of Hematology and Blood Transfusion, Prague, Czech Republic; 13 Department of Paediatrics, University of Lund, Sweden; 14 Department for Coagulation Disorders, University of Lund, Malmö, Sweden; 15 Department of Pathology, Leicester Royal Infirmary, United Kingdom; and 16 Department of Haematology, Children's Hospital, Birmingham, United Kingdom

Type 1 von Willebrand disease (VWD) is characterized by a personal and family history of bleeding coincident with reduced levels of normal plasma von Willebrand factor (VWF). The molecular basis of the disorder is poorly understood. The aims of this study were to determine phenotype and genotype and their relationship in patients historically diagnosed with type 1 VWD. Families were recruited in 9 European countries based on previous type 1 VWD diagnosis. Bleeding symptoms were recorded, plasma phenotype analyzed, and VWF mutation analysis performed in all index cases (ICs). Phenotypic and molecular analysis stratified patients into those with or without phenotypes suggestive of qualitative VWF defects (abnormal multimers) and with or without mutations. A total of 105 of 150 ICs (70%) had mutations identified. A subgroup with abnormal multimers (38% of ICs, 57 of 150) showed a high prevalence of VWF gene mutations (95% of ICs, 54 of 57), whereas in those with qualitatively normal VWF, fewer mutations were identified (55% of ICs, 51 of 93). About one third of the type 1 VWD cases recruited could be reconsidered as type 2. The remaining group could be considered "true" type 1 VWD, although mutations were found in only 55%.


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