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      ¿Qué avances recientes hay en el entendimiento, diagnóstico y tratamiento de la enfermedad de Von Willebrand?: una revisión de la literatura Translated title: What Recent Advances are there in the Understanding, Diagnosis and Treatment of von Willebrand Disease? A Literature Review

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          Abstract

          Resumen La enfermedad de Von Willebrand (EVW) es el trastorno hemorrágico hereditario más común. En los últimos años han ocurrido grandes avances en su entendimiento, diagnóstico y tratamiento. Afecta hasta el 1 % de la población y comprende un espectro de subtipos heterogéneos. Se caracteriza por mutaciones con una disminución en el nivel o deterioro en la acción del factor de Von Willebrand (FVW). La mayoría de los casos se transmiten como un rasgo autosómico dominante. Las pruebas de diagnóstico para este trastorno son complejas y su interpretación requiere una comprensión de la fisiopatología. El arsenal terapéutico disponible incluye el uso de desmopresina y los concentrados de FVW/FVIII en procedimientos que requieran hemostasia. La aplicación rutinaria de terapia profiláctica para eventos hemorrágicos no se encuentra indicada. El objetivo de esta revisión es discutir la epidemiología, fisiopatología y los más recientes avances en el diagnóstico y tratamiento de la EVW hereditaria.

          Translated abstract

          Abstract Von Willebrand disease (vWD) is the most common hereditary bleeding disorder, affects up to 1% of the population and comprises a spectrum of heterogeneous subtypes. It is characterized by mutations that lead to a decrease in the level or deterioration in the action of von Willebrand factor (vWF). Most cases are transmitted as autosomal dominant. The diagnostic tests for this disorder are complex, and the proper interpretation requires a thorough understanding of the underlying pathophysiology by the health care group. The objective of this review is to discuss the epidemiology, pathophysiology, and the most recent advances in the diagnosis and treatment of vWD.

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          Most cited references53

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          Update on the pathophysiology and classification of von Willebrand disease: a report of the Subcommittee on von Willebrand Factor.

          von Willebrand disease (VWD) is a bleeding disorder caused by inherited defects in the concentration, structure, or function of von Willebrand factor (VWF). VWD is classified into three primary categories. Type 1 includes partial quantitative deficiency, type 2 includes qualitative defects, and type 3 includes virtually complete deficiency of VWF. VWD type 2 is divided into four secondary categories. Type 2A includes variants with decreased platelet adhesion caused by selective deficiency of high-molecular-weight VWF multimers. Type 2B includes variants with increased affinity for platelet glycoprotein Ib. Type 2M includes variants with markedly defective platelet adhesion despite a relatively normal size distribution of VWF multimers. Type 2N includes variants with markedly decreased affinity for factor VIII. These six categories of VWD correlate with important clinical features and therapeutic requirements. Some VWF gene mutations, alone or in combination, have complex effects and give rise to mixed VWD phenotypes. Certain VWD types, especially type 1 and type 2A, encompass several pathophysiologic mechanisms that sometimes can be distinguished by appropriate laboratory studies. The clinical significance of this heterogeneity is under investigation, which may support further subdivision of VWD type 1 or type 2A in the future.
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            Von Willebrand's Disease.

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              Epidemiological investigation of the prevalence of von Willebrand's disease.

              To evaluate the prevalence of von Willebrand's disease (vWd) we carried out an epidemiological investigation among school children of the Veneto region in northern Italy. A total of 1,218 of 1,281 possible children participated in the study. They were 11 to 14 years of age, and all attended secondary schools in two distinct small areas, 70 km apart, between which there is no social contact. A blood sample was taken from each subject for determination of the blood group and von Willebrand factor (vWf) level (measured as ristocetin cofactor and expressed in IU/dL after calibration of the internal pool against an international standard), and the parents were given a questionnaire concerning hemorrhagic symptoms in the members of the family in the last three generations. Separate normal ranges were calculated for blood group O and non-O subjects (1,166 children and 289 adults) with a nonparametric method because the distribution curves of the reference values did not fit the gaussian distribution. Diagnoses of vWd were considered only for children who had low vWf levels and were members of a family with a convincing bleeding history (case of "probable vWd"). A final diagnosis was assigned if, in addition to these criteria, at least one other family member on the side with hemorrhagic history had a low vWf level. Of the 1,218 children examined, ten were classified as having vWd (0.82%). Taking into account the 90% confidence interval for the lower limit of the normal range, this figure could range from 7 (0.57%) to 14 (1.15%). All these subjects were mildly to moderately affected and presented features of heterozygous classic vWd (type I). Affected subjects were distributed evenly in the two areas examined. Our results suggest that the prevalence of vWd might be much higher than previously reported and that a different screening approach might be of use for patients with mild bleeding diathesis.
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                Author and article information

                Journal
                unmed
                Universitas Medica
                Univ. Med.
                Pontificia Universidad Javeriana (Bogotá, Distrito Capital, Colombia )
                0041-9095
                2011-0839
                June 2020
                : 61
                : 2
                : 34-48
                Affiliations
                [5] Bogotá orgnamePontificia Universidad Javeriana Colombia
                [6] Bogotá orgnamePontificia Universidad Javeriana Colombia
                [3] Bogotá orgnamePontificia Universidad Javeriana Colombia
                [2] Bogotá orgnamePontificia Universidad Javeriana Colombia
                [1] Bogotá orgnamePontificia Universidad Javeriana Colombia catherin.tovar@ 123456javeriana.edu.co
                [4] Bogotá orgnamePontificia Universidad Javeriana Colombia
                Article
                S2011-08392020000200005 S2011-0839(20)06100200005
                10.11144/javeriana.umed61-2.vonw
                c92cb2a1-2e21-4a9a-b3da-c89fd2fde37d

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 03 October 2019
                : 11 August 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 74, Pages: 15
                Product

                SciELO Colombia

                Categories
                Revisión

                factor de Von Willebrand,trastornos hemorrágicos,enfermedad de Von Willebrand,desamino arginina vasopresina,deamino arginine vasopressin,hemorrhagic diathesis,von Willebrand factor,von Willebrand disease

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