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- Title
Recurrent Gastrointestinal Bleeding in a Middle-Aged Man.
- Authors
Gowani, Faaria; Phillips, Bonnie; Leveque, Christopher; Castillo, Brian; Chen, Jian; Chandler, Wayne; Rice, Lawrence; Salazar, Eric
- Abstract
Acquired von Willebrand disease (avWD) arises because of mechanisms that destroy, decrease, absorb, or clear von Willebrand factor (vWF). A 59-year-old man presented with a 3-year history of recurrent gastrointestinal bleeding. Laboratory workup revealed a prolonged platelet function assay-100. The vWF antigen was decreased, and a low vWF immunofunctional activity/antigen ratio, low collagen binding/antigen ratio, and decreased intermediate and high molecular weight multimers were noted. The patient had no high-shear stress conditions, and an antibody-mediated process was suspected. A vWF mixing study showed complete correction of vWF activity, suggesting no direct functional inhibitor. The patient was given a bolus of vWF concentrate with serial measurements of vWF; the vWF half-life was 2.5 hours. The vWF propeptide/antigen ratio was 4:1, supporting a diagnosis of aVWD resulting from increased antibody-mediated vWF clearance. This case study emphasizes the laboratory's role in the diagnosis and treatment of rare, overlooked acquired bleeding disorders.
- Subjects
GASTROINTESTINAL hemorrhage treatment; CLINICAL pathology; ENDOSCOPIC surgery; COLLAGEN diseases; DISEASE relapse; IMMUNOASSAY; SHEAR (Mechanics); BLOOD platelet disorders; PLATELET function tests; ENDOSCOPY; ANTIGENS; MIDDLE age
- Publication
Laboratory Medicine, 2022, Vol 53, Issue 4, pe91
- ISSN
0007-5027
- Publication type
Article
- DOI
10.1093/labmed/lmab104