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Hamostaseologie 2011; 31(02): 118-122
DOI: 10.5482/ha-1129
Fallbericht
Schattauer GmbH

Erworbenes von-Willebrand-Syndrom Typ 2A als Begleiterscheinung eines Dialyseshunts?

Acquired von Willebrand’s disease type 2A following arteriovenous fistula for haemodialysis?
K. Leimkühler
1   Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld
,
F. Bach
1   Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld
,
S. Kuhlmann
1   Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld
,
B. Feidicker
2   Klinik für Gefäßmedizin, Evangelisches Krankenhaus Bielefeld
,
M. U. Heim
3   Institut für Transfusionsmedizin und Immun hämatologie mit Blutbank,Universitätsklinikum Otto-von-Guericke, Magdeburg
,
C. Susemihl
1   Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld
,
B. Schmidt
1   Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld
,
F. Mertzlufft
1   Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld
› Author Affiliations
Further Information

Publication History



09 December 2010

Publication Date:
28 December 2017 (online)

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Summary

Acquired von Willebrand’s disease (aVWD) is considered to be an underestimated cause of unexplained bleeding. Adsorption of von Willebrand factor (VWF) to tumour cells or hydroxyethyl starch and elimination of VWF by autoantibodies as well as shear stress-induced mechanical alteration of VWF with concomitant cleavage by enzymes may lead to an acquired deficiency of VWF and a bleeding disorder.

We report a 39-year-old woman who developed spontaneous bleeding five years after surgical creation of an arteriovenous fistula (AVF) for haemodialysis treatment. AVWD type 2A was diagnosed after successful renal transplantation. One year after surgical closure of the AVF, the aVWD could not be verified again. Thus, the aVWD may have developed because of altered blood flow and shear stress inside the arteriovenous fistula.

Zusammenfassung

Das erworbene von-Willebrand-Syndrom (VWS) gilt als unterschätzte Ursache vermeintlich unerklärlicher Blutungsneigungen. Neben der Adsorption des von-Willebrand-Faktors (VWF) an Tumorzellen oder Hydroxyethylstärke sowie der Elimination von VWF durch Autoantikörper kann eine Scherkraft-induzierte mechanische Alterierung des VWF mit nachfolgender enzymatischer Spaltung zu einem erworbenen VWF-Mangel und einer entsprechenden Blutungsneigung führen.

Wir berichten über eine 39-jährige ehemals dialysepflichtige Patientin, bei der es fünf Jahre nach Anlage eines Dialyseshunts zu spontanen Blutungen kam. Die Diagnose eines erworbenen VWS Typ 2A wurde nach erfolgreicher Nierentransplantation gestellt. Ein Jahr nach operativem Shuntverschluss war das VWS nicht mehr nachweisbar. Es kann somit vermutet werden, dass das VWS durch veränderte Strömungsverhältnisse und Scherkräfte im Bereich des Dialyseshunts entstanden war.

Keywords

Acquired von Willebrand’s disease - arteriovenous fistula - bleeding - shear stress

Schlüsselwörter

Blutung - Dialyseshunt - erworbenes von-Willebrand-Syndrom - Scherkräfte
 

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