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Acquired von Willebrand disease in children undergoing extracorporeal membrane oxygenation: a prospective

Joppe G Drop1, Enno D Wildschut2, Moniek P M de Maat3

  • 1Department of Paediatrics, Division of Paediatric Hematology, Erasmus Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Paediatrics, Division of Pediatric Intensive care and Pediatric surgery, Erasmus Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands.

Journal of Thrombosis and Haemostasis : JTH
|August 14, 2023
PubMed

Insights

Children on extracorporeal membrane oxygenation (ECMO) frequently develop acquired von Willebrand disease (AVWD). This condition develops quickly after ECMO initiation and resolves upon cessation, but it does not appear to cause major bleeding complications.

Area of Science:

  • Pediatric critical care medicine
  • Hematology
  • Cardiopulmonary support

Background:

  • Extracorporeal membrane oxygenation (ECMO) is vital for pediatric patients with severe cardiac or pulmonary failure.
  • Bleeding complications are frequent during ECMO support.
  • Acquired von Willebrand disease (AVWD) is a potential contributor to these bleeding issues.

Purpose of the Study:

  • To determine the incidence and temporal changes of AVWD in children during the first 14 days of ECMO.
  • To assess the relationship between AVWD and bleeding complications in this population.

Main Methods:

  • Prospective observational study of pediatric patients (0-17 years) on ECMO.
  • Serial blood sampling to analyze von Willebrand factor (VWF) parameters and multimer patterns.
  • AVWD defined by loss of high-molecular weight multimers or specific VWF ratio thresholds.

Main Results:

  • All 50 patients developed AVWD during ECMO.
  • VWF parameters and high-molecular weight multimers decreased early in ECMO and normalized within 24 hours of cessation.
  • AVWD incidence and profile were similar in patients with and without major bleeding.

Conclusions:

  • Pediatric patients on ECMO commonly develop AVWD.
  • AVWD onset is rapid post-ECMO initiation and resolution is quick after ECMO cessation.
  • AVWD appears to be an independent finding and not directly linked to major bleeding events.
Abstract

Keywords:
extracorporeal membrane oxygenationpediatricsvon Willebrand diseasevon Willebrand factor

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