ArticleBlood advances2020
Low VWF levels in children and lack of association with bleeding in children undergoing tonsillectomy.
Article in Blood advances, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- (Un) Diagnosing von Willebrand disease.Hematology. American Society of Hematology. Education Program · 2025Review
- Effect of age on ISTH-BAT scores and low VWF diagnosis in the Zimmerman Program.Blood advances · 2025Article
- Beyond the count: platelet dysfunction profile in pediatric trauma patients.Research and practice in thrombosis and haemostasis · 2025Article
- Article
- Low von Willebrand factor-unraveling an enigma wrapped in a conundrum.Journal of thrombosis and haemostasis : JTH · 2024Review
- Type 1 VWD classification revisited: novel insights from combined analysis of the LoVIC and WiN studies.Blood · 2024Article
- Tracheal extubation under Narcotrend EEG monitoring at different depths of anesthesia after tonsillectomy in children: a prospective randomized controlled study.Frontiers in pediatrics · 2024Article
- Diagnostic pitfalls and conundrums in type 1 von Willebrand disease.Hematology. American Society of Hematology. Education Program · 2022Article
- Caplacizumab Model-Based Dosing Recommendations in Pediatric Patients With Acquired Thrombotic Thrombocytopenic Purpura.Journal of clinical pharmacology · 2022Article
- Reevaluation of von Willebrand disease diagnosis in a Croatian paediatric cohort combining bleeding scores, phenotypic laboratory assays and next generation sequencing: a pilot study.Biochemia medica · 2022Article
- Screening for von Willebrand disease does not impact posttonsillectomy bleeding in a low-risk population.Pediatric blood & cancer · 2021Article
- Von Willebrand Disease: Current Status of Diagnosis and Management.Hematology/oncology clinics of North America · 2021Review
- Low VWF: insights into pathogenesis, diagnosis, and clinical management.Blood advances · 2020Review
- The spectrum and severity of bleeding in adolescents with low von Willebrand factor-associated heavy menstrual bleeding.Blood advances · 2020Observational
- Association of Blood Type With Postsurgical Mucosal Bleeding in Pediatric Patients Undergoing Tonsillectomy With or Without Adenoidectomy.JAMA network open · 2020Article
- Assessing the Impact of the 2021 VWD Guidelines on the Diagnosis/Management of Low VWF Patients.Haemophilia : the official journal of the World Federation of HemophiliaArticle
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Authors and funding
12 authors.
Funding
Abstract
von Willebrand disease is a common bleeding disorder, but diagnosis can be difficult in young children who have not had bleeding challenges. We sought to evaluate the correlation between bleeding and von Willebrand factor (VWF) levels in children undergoing surgical challenge with tonsillectomy. Children ages 0 to 18 undergoing tonsillectomy without a personal or family history of bleeding were enrolled prospectively following informed consent and institutional review board approval. VWF levels were obtained at the time of surgery. VWF antigen (VWF:Ag) and VWF activity (VWF:GPIbM) were tested via enzyme-linked immunosorbent assay. Bleeding score was calculated using the International Society of Hematology bleeding assessment tool (BAT). Surgical and postoperative bleeding were determined using questionnaires filled out by the surgeon and patient/family. A total of 1399 subjects were enrolled with evaluable data, with a median age of 5 years. The median VWF:Ag was 85 IU/dL and the median VWF:GPIbM was 100 U/dL. Median BAT for the entire population was 0, including those with postoperative bleeding. There was no difference in VWF level between those who experienced postoperative bleeding and those who did not, with median VWF:Ag 85 vs 85 (P = .89) and mean VWF:GPIbM 98 vs 100 (P = .5). Interestingly, there was a difference in VWF levels with age, with median VWF:Ag 81 for those younger than 3 years, 82 for those 3 to 6 years, 90 for those 7 to 10 years, and 100 for those 11 to 18 years. A similar trend was noted for VWF:GPIbM. Of the 2 to 6 year olds, 5% had VWF:Ag <50, which would meet criteria for low VWF, but only 1.8% had an abnormal BAT at study entry and only 2.5% bled after surgery. Only 1 subject with low VWF had an elevated postoperative BAT >2. These data suggest that low VWF levels do not correlate with bleeding in children undergoing tonsillectomy. In addition, VWF levels outside the adult normal range in young children may be more common than previously thought and do not necessarily predict surgical bleeding.
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