Factor VIII and von Willebrand factor changes during normal pregnancy and puerperium

Abstract

Gestation is a challenge to haemostasis and it is associated with significant haemostatic changes. Several studies have evaluated von Willebrand factor in normal pregnancy, but none considered the personal history of bleeding. We studied a group of healthy non-bleeding women (184 pregnant, 64 puerperium, 37 non-pregnant) to evaluate normal ranges and their relationship to blood group and parity. The von Willebrand factor increased markedly from non-pregnant values up to the end of early puerperium (P < 0.0001), while factor VIII only showed a slight increase. Factor VIII and von Willebrand factor activity remained within the normal range for non-pregnant women. The return to non-pregnant factor levels occurred in late puerperium, later than previously reported. Only factor VIII was significantly lower in the O blood group (P = 0.035). As regards parity, there were no differences in factor VIII, von Willebrand factor antigen and von Willebrand factor ristocetin cofactor between primigravidae and multigravidae for any period studied (P = 0.888, 0.999, and 0.237, respectively). Our results provide reference ranges that may help to design a study in von Willebrand factor disease in pregnancy.

Severe reduction of free-form ADAMTS13, unbound to von Willebrand factor, in plasma of patients with HELLP syndrome

“…[2][3][4] Several groups reported that patients with HELLP syndrome showed a marked increase of plasma VWF antigen (VWF:Ag) (200%-500%) with a full set of VWF multimers (VWFMs) as compared with normal pregnant women (;180%). 2,3,5 Inversely, patients with HELLP syndrome had low or normal ADAMTS13 activity (ADAMTS13:AC) (20%-70%). [2][3][4] These subnormal ADAMTS13:AC levels are thought to be able to eliminate preexisting unusually large VWFMs, which are responsible for platelet hyperaggregation under high shear stress.…”

Blood volume–based von Willebrand factor to prevent postpartum hemorrhage in von Willebrand disease

“…7 Postpartum blood loss in VWD At delivery, the mean estimated blood loss in women with VWD is 1.4-fold greater than in controls, 615 vs 448 mL, despite VWF concentrate treatment, and continues over the next 6 weeks postpartum, accompanied by a significantly lower hematocrit, 28.6% 7 ( Figure 1B). These findings, confirmed in retrospective studies, [8][9][10][11] remain poorly understood. Why do women with VWD experience excessive postpartum blood loss despite treatment?…”

“…[9][10][11] In women with VWD, a recent prospective study indicates the trajectories of VWF:RCo, VWF:Ag, and FVIII:C, although parallel to those in control women without VWD, do not increase to the same degree and fall more rapidly than controls.…”

Spinal anesthesia for a cesarean delivery in a woman with type-2M von Willebrand disease: case report and mini-review

“…In healthy pregnant women, the vWF and FVIII return to pre-pregnancy levels within a month of delivery. 1,[10][11][12] Type-2 vWD is sub-classified in four subtypes (A, B, M, N), 9 although recent evidence indicates the existence of at least three more subtypes (C, D, E). Patients with type-1 vWD have reduced levels of vWF and a RCo/Ag ratio higher than 0.7.…”