title: Management of inherited von Willebrand disease in Italy: results from the retrospective study on 1234 patients.
abstract: Von Willebrand disease (VWD) is the most common inherited bleeding disorder and is due to quantitative and/or qualitative defects of von Willebrand factor (VWF). Despite the improved knowledge of the disease, detailed data on VWD types requiring specific treatments have not been reported thus far. To determine the number and types of VWD requiring therapy with desmopressin (DDAVP) and/or VWF/FVIII concentrates in Italy, a national registry on VWD (RENAWI) was organized. Only 16 of 48 centers included VWD in the RENAWI with diagnoses performed locally. Patients with uncertain results were retested by two expert laboratories using multimeric analysis and mutations of the  VWF gene. A total of 1234 of 1529 (81%) cases satisfied the inclusion criteria and could be classified as VWD1 (63%), VWD2A (7%), VWD2B (6%), VWD2M (18%), VWD2N (1%), and VWD3 (5%). VWD types were also confirmed by DNA analyses and occur in young adults (83%), mainly in women (58%). Mucosal bleedings (32 to 57%) are more frequent than hematomas (13%) or hemarthrosis (6%). Most patients were exposed to an infusion trial with desmopressin (DDAVP) and found responsive with the following rates: VWD1 (69%), VWD2A (26%), VWD2M (29%), and VWD2N (71%). However, DDAVP was not always used to manage bleeding in all responsive patients and VWF/FVIII concentrates were given instead of or together with DDAVP in VWD1 (30%), VWD2A (84%), VWD2B (62%), VWD2M (63%), VWD2N (30%), and VWD3 (91%). Data of the RENAWI showed that correct VWD identification and classification might be difficult in many Italian centers. Therefore, evidence-based studies should be organized only in well-characterized patients tested by laboratories that are expert in the clinical, laboratory, and molecular markers of VWD.
authors.affiliation: Division of Hematology and Transfusion Medicine, L. SACCO University Hospital and Department of Internal Medicine, University of Milan, Milan, Italy. augusto.federici@unimi.it
authors.forename: Augusto B
authors.initials: AB
authors.lastname: Federici
authors.forename: Paolo
authors.initials: P
authors.lastname: Bucciarelli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Castaman
authors.forename: Luciano
authors.initials: L
authors.lastname: Baronciani
authors.forename: Maria T
authors.initials: MT
authors.lastname: Canciani
authors.forename: Maria G
authors.initials: MG
authors.lastname: Mazzucconi
authors.forename: Massimo
authors.initials: M
authors.lastname: Morfini
authors.forename: Angiola
authors.initials: A
authors.lastname: Rocino
authors.forename: Mario
authors.initials: M
authors.lastname: Schiavoni
authors.forename: Emily
authors.initials: E
authors.lastname: Oliovecchio
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iorio
authors.forename: Pier M
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D005169:Factor VIII / Q000627:therapeutic use; D005260:Female; D005787:Gene Frequency; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D008875:Middle Aged; D009154:Mutation; D012189:Retrospective Studies; D055815:Young Adult; D014842:von Willebrand Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics*; D014841:von Willebrand Factor / Q000235:genetics* / Q000627:therapeutic use
chemical_list: D006490:Hemostatics; D014841:von Willebrand Factor; D005169:Factor VIII; D003894:Deamino Arginine Vasopressin