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Abnormal von Willebrand factor in bleeding angiodysplasias of the digestive tract.
A Veyradier1, A Balian, M Wolf
1Service d'Hématologie Biologique, Hôpital Antoine-Béclère, Clamart, France.
Gastroenterology
|February 13, 2001
View abstract on PubMed
Summary
Patients with bleeding angiodysplasia often have a deficiency in large von Willebrand factor multimers, suggesting a role for acquired von Willebrand disease in gastrointestinal bleeding.
Area of Science:
- Gastroenterology
- Hematology
- Vascular Biology
Background:
- Abnormal von Willebrand factor has been implicated in gastrointestinal bleeding from angiodysplasias.
- Previous studies lacked prospective assessment of this association.
Purpose of the Study:
- To investigate the role of von Willebrand factor abnormalities in patients with gastrointestinal angiodysplasias and bleeding.
- To assess for underlying acquired von Willebrand disease in these patients.
Main Methods:
- Prospective study of 27 patients with nonbleeding or bleeding angiodysplasias, telangiectasias, or diverticular hemorrhage.
- Analysis of von Willebrand factor multimer composition and screening for acquired von Willebrand disease.
Main Results:
- Patients with nonbleeding angiodysplasias or diverticular hemorrhage had normal von Willebrand factor.
- All but one patient with bleeding angiodysplasias showed a loss of large von Willebrand factor multimers.
- Aortic valve stenosis was present in 7 of the bleeding patients.
Conclusions:
- Bleeding angiodysplasias are frequently associated with a deficiency of large von Willebrand factor multimers.
- This deficiency is likely due to a latent acquired von Willebrand disease.
- Loss of these multimers impairs primary hemostasis, contributing to bleeding in vascular malformations.