Acquired von Willebrand Disease Associated with Mantle Cell Lymphoma

Abstract EN

We present a rare case of acquired von Willebrand syndrome (AVWS) caused by a mantle cell lymphoma.

A 61-year-old male suffered from recurrent bleeding symptoms since a few months.

Initially, physical examination was normal.

von Willebrand factor antigen (VWF:Ag) level and factor VIII activity (FVIII:C) were low (0.31 IU/ml and 0.43 IU/ml, resp.).

Ristocetin cofactor activity (VWF:RCo) was 0.09 IU/ml, and collagen binding activity (VWF:CB) was 0.10 IU/ml.

VWF:RCo/VWF:Ag ratio was 0.29, and RIPA value was normal.

Highest molecular weight VWF multimers were absent.

A diagnosis of von Willebrand Disease (VWD) type 2A was made.

However, no genetic mutation was found.

No inhibitory antibodies against VWF or factor VIII were detected.

A few months later, cervical, axillary, and inguinal lymphadenopathy was found on physical examination.

A CT scan confirmed multiple enlarged lymph nodes, and a clonal B-cell population matching a mantle cell lymphoma was detected in the bone marrow.

Chemoimmunotherapy resulted in a very good partial remission and concomitantly in a rapid decrease of bleeding problems and complete normalization of FVIII:C and VWF:Ag.

The diagnosis of AVWS cannot be rejected by negative mixing studies due to difficulties in the detection of autoantibodies and because of a highly heterogeneous pathogenesis of AVWS.

When the suspicion of AVWS is high, an extensive investigation should be performed to find the underlying cause.