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Predictors of von Willebrand disease in children

Authors

  • Robert F. Sidonio Jr. MD, MSc,

    Corresponding author
    1. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Monroe Carrell, Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
    • Division of Pediatric Hematology/Oncology, Department of Pediatrics, Monroe Carrell, Jr. Children's Hospital at Vanderrbilt, Preston Research Building 392, Nashville, TN 37232-6310.
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  • Sriya Gunawardena MD,

    1. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Hospital of Pittsburgh/UPMC, Pittsburgh, Pennsylvania
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  • Peter H. Shaw MD,

    1. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Hospital of Pittsburgh/UPMC, Pittsburgh, Pennsylvania
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  • Margaret Ragni MD, MPH

    1. Division Hematology/Oncology, University of Pittsburgh Medical Center Director, Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania
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  • Conflict of interest: Nothing to declare.

Abstract

Background

Bleeding and bruising are common symptoms for which children are referred to a pediatric hematologist. Although bleeding scores have been validated to quantify bleeding risk in adults, there are no similar definitive data in children. The aim was to describe presenting bleeding symptoms in children and evaluate if these bleeding symptoms were predictive of von Willebrand disease (VWD) or low von Willebrand factor (VWF).

Procedure

We performed a retrospective chart review of consecutive pediatric patients referred for perceived bleeding symptoms to the coagulation clinic at The Children's Hospital of Pittsburgh of UPMC. All underwent a uniform bleeding symptom inventory and hemostatic testing. Single and multiple variable logistic regression models were created to predict either VWD, low VWF, or nonspecific defective platelet aggregation, using the predictor variables of family bleeding history, mucocutaneous bleeding, cutaneous bleeding, and surgical bleeding, based on The International Society on Thrombosis and Hemostasis (ISTH) bleeding definitions.

Results

Of 298 pediatric patients evaluated, 8% had VWD (VWF:RCo and VWF:Ag ≤30 IU/dl) and 34% had low VWF (VWF:RCo and VWF:Ag 30–50 IU/dl). Further, 16% had a nonspecific platelet aggregation disorder, 41% had normal hemostatic testing, and 1% had factor VIII or IX deficiency. In single and multiple variable logistic regression analysis, neither a personal or family bleeding history at presentation, nor the presence of two or more bleeding symptoms were predictive of VWD, low VWF, or nonspecific defective platelet aggregation.

Conclusions

These findings suggest that qualitative assessment of bleeding symptoms alone is not useful in children. Pediatr Blood Cancer © 2012 Wiley Periodicals, Inc.

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