BACKGROUND: von Willebrand disease (VWD) is an inherited bleeding disorder caused by a quantitative (type 1 and 3) or qualitative (type 2) defect of von Willebrand factor (VWF). The heterogeneity of laboratory phenotyping makes diagnosing difficult. OBJECTIVE: A cross-sectional, family-based VWD study in a collaboration between University Hospital Brno (Czech Republic) and Antwerp University Hospital (Belgium) to improve the understanding of laboratory phenotype/genotype correlation. PATIENTS AND METHODS: A total of 205 patients with suspected VWD were identified from historical records. Complete laboratory analysis was established using all available VWD assays including VWF multimers and genetic analysis. RESULTS: Based on the current International Society of Thrombosis and Haemostasis (ISTH) - Scientific and Standardization Committee VWD classification and type 2A sub-division into 2A/IIA, IID, IIC and IIE, the majority was characterized as a type 1 VWD, followed by type 2. Proposed laboratory phenotypes were confirmed by their multimeric pattern within 98% of this cohort. All type 2, 3 and 75% of type 1 VWD patients were confirmed by underlying causative mutations. Forty-six different causal mutations (117 not previously described in the literature) could be identified. Fifty per cent of all cases was represented by eight individual mutations, mainly p.Pro812ArgfsX31. Thirteen patients had a large heterozygous gene alteration. CONCLUSION: Although an extensive panel of tests was used, VWD classification and (sub)typing remains difficult and fluid. This study provides a cross-sectional overview of the VWD population in the Czech Republic and provides important data to the ISTH/European Association for Haemophilia and Allied Disorders VWD mutation database in linking causal mutations with unique VWD (sub)types. It also identifies new, as not previously described in the literature, causal mutations.

Blood Coagulation and Vascular Medicine Center Goodheart Institute and Foundation in Nature Medicine Rotterdam The Netherlands

CSL Behring Chair in von Willebrand Disease University of Antwerp Antwerp Belgium

Department of Clinical Haematology University Hospital Brno Brno Czech Republic

Department of Haematology Antwerp University Hospital Edegem Belgium

Department of Laboratory Methods Faculty of Medicine Masaryk University Brno Czech Republic

Department of Pediatric Haematology University Hospital Brno Brno Czech Republic

Haemostasis Research Unit University of Antwerp Antwerp Belgium

Haemostasis Unit Antwerp University Hospital Edegem Belgium

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Analysis of von Willebrand Disease in the "Heart of Europe"

Characterization of large in-frame von Willebrand factor deletions highlights differing pathogenic mechanisms