Preoperative screening for von Willebrand disease type 1: low yield and limited ability to predict bleeding

J Lab Clin Med. 1999 Dec;134(6):605-9. doi: 10.1016/s0022-2143(99)90100-2.

Abstract

Type 1 von Willebrand disease (vWd) is the most common hereditary bleeding disorder. The objective of this study was to measure the von Willebrand factor antigen (vWf:Ag) in a large cohort of patients who underwent surgery to assess the role of a new rapid immunoassay in a screening procedure for vWd in preoperative conditions. We studied 832 consecutive patients (540 children, 292 adults) referred to the surgical departments. For each patient we determined the vWf:Ag level with two different assays, an enzyme-linked immunosorbent assay (ELISA)(Asserachrom vWf:Ag; Diagnostica Stago, France) and a rapid immunoassay (Liatest vWf:Ag; Diagnostica Stago). Using the reference test, we found 30 of 832 patients with a vWf:Ag value below the lower limits (21 U/dL to 46 U/dL). The coefficient of correlation between the two tests was 0.77 (P = .001). When receiver operating characteristic curves were used, the cutoff value calculated to detect vWf:Ag defect with the rapid assay was 68.5 U/dL, leading to 0.36% false negatives and 9.7% false positives. Thus the rapid immunoassay appears to be a useful and easy method that is adaptable to urgent situations. Among the 30 patients with low values in ELISA, 8 had personal or familial bleeding history. Repeat blood samples confirmed the diagnosis of vWd in 5 cases, leading to a prevalence of vWd type 1 of 0.6%. However, in our series the absence of severe bleeding complications raises the question of the screening and the management of patients bearing a type 1 Willebrand disease during surgery.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Autoanalysis / methods
  • Child
  • Child, Preschool
  • Enzyme-Linked Immunosorbent Assay / methods
  • False Negative Reactions
  • Female
  • France / epidemiology
  • Humans
  • Infant
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Predictive Value of Tests
  • Preoperative Care*
  • Prevalence
  • ROC Curve
  • von Willebrand Diseases / blood
  • von Willebrand Diseases / complications
  • von Willebrand Diseases / diagnosis*
  • von Willebrand Diseases / epidemiology
  • von Willebrand Factor / analysis

Substances

  • von Willebrand Factor