Acquired von Willebrand syndrome associated with monoclonal gammopathy: a single-center study of 36 patients.
In this single-center retrospective study, we evaluated the accuracy of laboratory tests in diagnosing acquired von Willebrand syndrome associated with lymphoproliferative disorders in 36 consecutive patients diagnosed at the University Hospital of Nantes, France. We also compared hemostatic treatments in the following groups: 21 patients with Waldenström macroglobulinemia (WM), 14 with monoclonal gammopathy of undetermined significance (MGUS) (10 with IgG-MGUS and 4 with IgM-MGUS), and 1 with IgA multiple myeloma (IgA-MM). The diagnosis was made in 18 (50%) patients during systematic screening, in 6 (17%) during active mild hemorrhage, and in 12 (33%) during an active, severe bleed. Of the laboratory tests studied, only closure times measured on the Platelet Function Analyzer (PFA)-100 device reliably diagnosed the hemostatic problem. There was no relationship between the factor VIII activity (FVIII:C) or von Willebrand factor activity (VWF:RCo) levels and the previous history of hemorrhage described by patients.We studied hemostatic treatment in most patients: IgG-MGUS patients responded well to high-dose intravenous immunoglobulin (IVIg) infusions (1 g/kg per d), although patients with IgM-MGUS did not. Desmopressin infusions were effective in 3 patients with IgG-MGUS and 2 patients with IgM-MGUS when the baseline values were above 10 IU/dL, but levels soon returned to the baseline. The 7 WM patients had a good response to desmopressin. These results confirm the efficacy of IVIg in IgG-MGUS patients and the prominent role of closure time in the diagnosis of acquired von Willebrand syndrome.
From Laboratoire Hématologie (SV), Centre Hospitalier Universitaire, Hôpital Rangueil, Toulouse; Médecine Interne (MH), Hôtel Dieu, Centre Hospitalier Universitaire, Nantes; Centre Régional de Traitement de l'Hémophilie (AL, MS, MT), Centre Hospitalier Universitaire, Nantes; and Hématologie Clinique (BM), Hôtel Dieu, Centre Hospitalier Universitaire, Nantes; France.
Sophie
S
Voisin
Mohamed
M
Hamidou
Armelle
A
Lefrançois
Marianne
M
Sigaud
Béatrice
B
Mahé
Marc
M
Trossaërt
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010265:Paraproteinemias / Q000150:complications*; D012189:Retrospective Studies; D014842:von Willebrand Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014841:von Willebrand Factor / Q000627:therapeutic use
D006490:Hemostatics; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D014841:von Willebrand Factor; D003894:Deamino Arginine Vasopressin