Diagnostic Challenges in Acquired von Willebrand Disease: A Complex Case of Prostate Carcinoma

Abstract

We report an 80-year-old man suffering from ulcerative colitis and a prostate adenocarcinoma. Due to melena, colon biopsies were taken. Diffuse bleeding and a cardiac infarction complicated this procedure. Laboratory studies showed a normal platelet count and a prolongation of the activated partial thromboplastin time (aPTT). Von Willebrand factor (VWF) antigen level and ristocetin cofactor activity were low. Several disorders are known to be associated with acquired von Willebrand disease (AVWD), the commonest being hematoproliferative and cardiovascular disorders. Non-hematologic neoplasms causing AVWD are rarely documented. The underlying mechanisms differ among these disorders or may overlap. These include development of autoantibodies and mechanical destruction of VWF under high shear stress. Absorption of VWF on or inside malignant cells is believed to be the main mechanism in non-hematologic malignancies. In this report, we give a concise overview of the underlying disorders and the mechanisms that we encountered in this complex case.




J Hematol. 2016;5(3):110-112
doi: http://dx.doi.org/10.14740/jh284w