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

Yvonne V. Sanders, Karin Fijnvandraat, Johan Boender, Evelien P. Mauser-Bunschoten, Johanna G. van der Bom, Joke de Meris, Frans J. Smiers, Bernd Granzen, Paul Brons, Rienk Y J Tamminga, Marjon H. Cnossen, Frank W G Leebeek

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Abstract

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 
Original languageEnglish
Pages (from-to)1142-1148
Number of pages7
JournalAmerican Journal of Hematology
Volume90
Issue number12
DOIs
Publication statusPublished - 1 Dec 2015

Cite this

Sanders, Y. V., Fijnvandraat, K., Boender, J., Mauser-Bunschoten, E. P., van der Bom, J. G., de Meris, J., Smiers, F. J., Granzen, B., Brons, P., Tamminga, R. Y. J., Cnossen, M. H., & Leebeek, F. W. G. (2015). Bleeding spectrum in children with moderate or severe von Willebrand disease: Relevance of pediatric-specific bleeding. American Journal of Hematology, 90(12), 1142-1148. https://doi.org/10.1002/ajh.24195