Bleeding spectrum in children with moderate or severe von Willebrand disease: Relevance of pediatric‐specific bleeding

The bleeding phenotype of children with von Willebrand disease (VWD) needs to be characterized in detail to facilitate diagnosis during childhood and aid in the planning and assessment of treatment strategies. The objective was to evaluate the occurrence, type, and severity of bleeding in a large co...

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Bibliographic Details
Published in:American journal of hematology 2015-12, Vol.90 (12), p.1142-1148
Main Authors: Sanders, Yvonne V., Fijnvandraat, Karin, Boender, Johan, Mauser‐Bunschoten, Evelien P., van der Bom, Johanna G., de Meris, Joke, Smiers, Frans J., Granzen, Bernd, Brons, Paul, Tamminga, Rienk Y.J., Cnossen, Marjon H., Leebeek, Frank W.G.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Child
Child, Preschool
Cross-Sectional Studies
Female
Hemorrhage - genetics
Humans
Male
von Willebrand Diseases - complications
von Willebrand Diseases - diagnosis
Young Adult
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Summary:The bleeding phenotype of children with von Willebrand disease (VWD) needs to be characterized in detail to facilitate diagnosis during childhood and aid in the planning and assessment of treatment strategies. The objective was to evaluate the occurrence, type, and severity of bleeding in a large cohort of children with moderate and severe VWD. We included 113 children (aged 0–16 years) with Type 1 (n = 60), 2 (n = 44), and 3 (n = 9) VWD with von Willebrand factor (VWF) antigen and/or VWF ristocetin cofactor levels ≤ 30 U/dL from a nation‐wide cross‐sectional study (“Willebrand in the Netherlands” study). Bleeding severity and frequency were determined using the International Society on Thrombosis and Hemostasis‐Bleeding Assessment Tool (ISTH‐BAT) with supplementary pediatric‐specific bleeding symptoms (umbilical stump bleeding, cephalohematoma, cheek hematoma, conjunctival bleeding, postcircumcision and postvenipuncture bleeding). We found that all 26 postmenarche girls experienced menorrhagia. Other common bleedings were cutaneous (81%), oropharyngeal (64%), prolonged bleeding from minor wounds (58%), and epistaxis (56%). Pediatric‐specific bleeding symptoms were present in 44% of patients. ISTH‐BAT bleeding score was higher in index cases than in affected family members (median, 12.0 vs. 6.5, P 
ISSN:0361-8609
1096-8652
DOI:10.1002/ajh.24195