{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T14:34:24Z","timestamp":1771684464183,"version":"3.50.1"},"reference-count":57,"publisher":"Georg Thieme Verlag KG","issue":"08","funder":[{"name":"Japanese Ministry of Health, Labor, and Welfare","award":["21FC1008"],"award-info":[{"award-number":["21FC1008"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Thromb Hemost"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>von Willebrand factor (VWF) forms high-molecular-weight multimers and plays an essential role in hemostasis, and thus its deficiency leads to bleeding symptoms. Acquired von Willebrand syndrome (AVWS) is rare, but potentially underdiagnosed, and develops in various underlying disorders. AVWS caused by anti-VWF autoantibodies is a rare subcategory of AVWS that can also be referred to as autoimmune VWF deficiency (AiVWFD). We performed a search of patients with autoimmune coagulation factor deficiencies in our nationwide survey in Japan. Among these, suspected cases of AiVWFD were extremely few, with only 11 case consultations in the last 10 years. Of these, three and five were respectively positive for anti-VWF autoantibodies (anti-VWF-Ab) and VWF inhibitor (VWF-inh). We also performed an extensive literature search of other cases from Japan, and in total, 40 cases were finally identified to have AiVWFD, with mean age of 55.0 years. Most underlying disorders were lympho- or myeloproliferative diseases, followed by autoimmune diseases. The major bleeding sites were subcutaneous and mucosal, the bleeding severity was moderate, and there were no hemorrhagic deaths. Bleeding time was prolonged; factor VIII activity, VWF antigen, and VWF activity were decreased, and high-molecular-weight VWF multimers were absent or decreased. These are similar to the common abnormal laboratory findings observed among general AVWS cases. Hemostatic therapy often involved VWF concentrates and vasopressin, and antibody eradication therapy often included corticosteroids and achieved remission. Notably, of all cases, 68% had anti-VWF-Abs, and 83% of anti-VWF-Ab-positive patients were also VWF-inh positive. To accumulate precise clinical information on AiVWFD, it is necessary to verify and improve the measurement methods for both anti-VWF-Ab and anti-VWF-inh. These findings from Japan should be confirmed in other geographic localities.<\/jats:p>","DOI":"10.1055\/s-0042-1749088","type":"journal-article","created":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T22:39:41Z","timestamp":1657319981000},"page":"911-925","source":"Crossref","is-referenced-by-count":12,"title":["A Review of Autoimmune Acquired von Willebrand Factor Deficiency in Japan"],"prefix":"10.1055","volume":"48","author":[{"given":"Akitada","family":"Ichinose","sequence":"additional","affiliation":[{"name":"Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan"},{"name":"The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsukasa","family":"Osaki","sequence":"additional","affiliation":[{"name":"Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan"},{"name":"The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan"},{"name":"Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Iida-Nishi, Yamagata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayoshi","family":"Souri","sequence":"additional","affiliation":[{"name":"Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan"},{"name":"The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan"},{"name":"Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Iida-Nishi, Yamagata, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2103-1661","authenticated-orcid":false,"given":"Emmanuel J.","family":"Favaloro","sequence":"additional","affiliation":[{"name":"Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead, New South Wales, Australia"},{"name":"Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,7,8]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1146\/annurev.biochem.67.1.395","article-title":"Biochemistry and genetics of von Willebrand factor","volume":"67","author":"J E Sadler","year":"1998","journal-title":"Annu Rev 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Hemost"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1055\/s-0031-1281028","article-title":"Von Willebrand disease: local diagnosis and management of a globally distributed bleeding disorder","volume":"37","author":"E J Favaloro","year":"2011","journal-title":"Semin Thromb Hemost"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"755","DOI":"10.2147\/JBM.S266791","article-title":"Why is misdiagnosis of von Willebrand disease still prevalent and how can we overcome it? A focus on clinical considerations and recommendations","volume":"12","author":"C K Colonne","year":"2021","journal-title":"J Blood Med"},{"issue":"10","key":"ref10","first-page":"2110","article-title":"Diagnosis and treatment of acquired factor XIII\/13 deficiencies: for all doctors treating the MHLW's designated intractable diseases [in Japanese]","volume":"56","author":"A Ichinose","year":"2015","journal-title":"Rinsho Ketsueki"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"251","DOI":"10.2491\/jjsth.29.251","article-title":"The present condition of and clinical guidance for autoimmune coagulation factor deficiencies in Japan","volume":"29","author":"A Ichinose","year":"2018","journal-title":"Jap J Thromb Hemost."},{"issue":"07","key":"ref13","first-page":"901","article-title":"Acquired von Willebrand syndrome in a patient with immune thrombocytopenic purpura [in Japanese]","volume":"56","author":"A Ihara","year":"2015","journal-title":"Rinsho 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Ieko","year":"1997","journal-title":"East Japan Dental Magazine"},{"issue":"23","key":"ref18","doi-asserted-by":"crossref","first-page":"2661","DOI":"10.2169\/internalmedicine.52.0825","article-title":"Acquired von Willebrand syndrome associated with Hashimoto's thyroiditis and subcutaneous mucosa-associated lymphoid tissue lymphoma","volume":"52","author":"T Koyama","year":"2013","journal-title":"Intern Med"},{"issue":"12","key":"ref19","first-page":"1672","article-title":"A case of acquired von Willebrand's syndrome with gastrointestinal bleeding (author's transl) [in Japanese]","volume":"19","author":"M Aihara","year":"1978","journal-title":"Rinsho Ketsueki"},{"issue":"07","key":"ref20","doi-asserted-by":"crossref","first-page":"459","DOI":"10.5794\/jjoms.67.459","article-title":"A case involving tooth extraction in a patient with acquired von Willebrand syndrome","volume":"67","author":"T Sawaki","year":"2021","journal-title":"Jap J Oral Maxillofacial Surg."},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/00043426-198921000-00008","article-title":"Acquired von Willebrand's syndrome with lupus-like serology","volume":"11","author":"N Igarashi","year":"1989","journal-title":"Am J Pediatr Hematol Oncol"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1159\/000205889","article-title":"Acquired von Willebrand's syndrome due to an inhibitor of IgG specific for von Willebrand's factor in polycythemia rubra vera","volume":"78","author":"H Mohri","year":"1987","journal-title":"Acta Haematol"},{"issue":"05","key":"ref23","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1182\/blood-2013-01-479527","article-title":"Pharmacokinetics and safety of a novel recombinant human von Willebrand factor manufactured with a plasma-free method: a prospective clinical trial","volume":"122","author":"P M 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Leebeek","year":"2021","journal-title":"HemaSphere"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1055\/s-0041-1740149","article-title":"A review of coagulation abnormalities of autoimmune acquired factor V deficiency with a focus on Japan","volume":"48","author":"A Ichinose","year":"2022","journal-title":"Semin Thromb Hemost"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1055\/a-1496-8527","article-title":"Autoimmune coagulation factor X deficiency as a rare acquired hemorrhagic disorder: a literature review","volume":"122","author":"A Ichinose","year":"2022","journal-title":"Thromb Haemost"},{"issue":"05","key":"ref29","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1182\/blood-2006-06-029850","article-title":"Acquired hemophilia A in the United Kingdom: a 2-year national surveillance study by the United Kingdom Haemophilia Centre Doctors' Organisation","volume":"109","author":"P W Collins","year":"2007","journal-title":"Blood"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.blre.2016.08.002","article-title":"Autoimmune acquired factor XIII deficiency due to anti-factor XIII\/13 antibodies: a summary of 93 patients","volume":"31","author":"A Ichinose","year":"2017","journal-title":"Blood Rev"},{"issue":"12","key":"ref31","first-page":"2183","article-title":"IgA RIPA inhibitor in a case of acquired von Willebrand syndrome [Japanese]","volume":"30","author":"Y Takai","year":"1989","journal-title":"Rinsho Ketsueki"},{"issue":"04","key":"ref32","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1111\/j.1538-7836.2012.04653.x","article-title":"Coagulation factor activity and clinical bleeding severity in rare bleeding disorders: results from the European Network of Rare Bleeding Disorders","volume":"10","author":"F Peyvandi","year":"2012","journal-title":"J Thromb 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association with risk of thrombosis","volume":"124","author":"E J Favaloro","year":"2005","journal-title":"Am J Clin Pathol"},{"issue":"08","key":"ref36","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1182\/blood-2009-01-195461","article-title":"Leukocyte proteases cleave von Willebrand factor at or near the ADAMTS13 cleavage site","volume":"114","author":"T J Raife","year":"2009","journal-title":"Blood"},{"issue":"04","key":"ref37","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1016\/j.thromres.2011.11.021","article-title":"Modulation of the von Willebrand factor-dependent platelet adhesion through alternative proteolytic pathways","volume":"129","author":"N Wohner","year":"2012","journal-title":"Thromb Res"},{"issue":"06","key":"ref38","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1172\/JCI112736","article-title":"Involvement of large plasma von Willebrand factor (vWF) multimers and unusually large vWF forms derived from endothelial cells in shear stress-induced platelet aggregation","volume":"78","author":"J L Moake","year":"1986","journal-title":"J Clin Invest"},{"issue":"06","key":"ref39","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1055\/s-2006-949668","article-title":"Comparative analysis and classification of von Willebrand factor\/factor VIII concentrates: impact on treatment of patients with von Willebrand disease","volume":"32","author":"U Budde","year":"2006","journal-title":"Semin Thromb Hemost"},{"issue":"08","key":"ref40","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1111\/jth.14545","article-title":"Phase 3 study of recombinant von Willebrand factor in patients with severe von Willebrand disease who are undergoing elective surgery: Reply","volume":"17","author":"F Peyvandi","year":"2019","journal-title":"J Thromb Haemost"},{"issue":"17","key":"ref41","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1182\/blood-2015-02-629873","article-title":"Hemostatic efficacy, safety, and pharmacokinetics of a recombinant von Willebrand factor in severe von Willebrand disease","volume":"126","author":"J C Gill","year":"2015","journal-title":"Blood"},{"issue":"05","key":"ref42","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1182\/blood-2012-10-462085","article-title":"Alloantibodies in von Willebrand disease","volume":"122","author":"P D James","year":"2013","journal-title":"Blood"},{"issue":"08","key":"ref43","doi-asserted-by":"crossref","first-page":"2707","DOI":"10.1182\/blood.V92.8.2707","article-title":"Treatment of acquired von Willebrand syndrome in patients with monoclonal gammopathy of uncertain significance: comparison of three different therapeutic approaches","volume":"92","author":"A B Federici","year":"1998","journal-title":"Blood"},{"issue":"04","key":"ref44","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.humimm.2005.01.031","article-title":"Use of intravenous immunoglobulin in patients with acquired von Willebrand syndrome","volume":"66","author":"A B Federici","year":"2005","journal-title":"Hum Immunol"},{"issue":"03","key":"ref45","first-page":"379","article-title":"A case of inhibitor-positive acquired von Willebrand syndrome that developed during treatment for cancer of esophagogastric junction","volume":"67","author":"R Nakata","year":"2018","journal-title":"Jap J Med Technol"},{"key":"ref46","doi-asserted-by":"crossref","first-page":"1179547618763371","DOI":"10.1177\/1179547618763371","article-title":"Acquired von Willebrand syndrome complicating nephrotic syndrome: a case of a patient with membranous nephropathy","volume":"11","author":"T Sugase","year":"2018","journal-title":"Clin Med Insights Case Rep"},{"issue":"S 05","key":"ref47","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1111\/hae.12984","article-title":"State of the art: von Willebrand disease","volume":"22","author":"A H James","year":"2016","journal-title":"Haemophilia"},{"issue":"10","key":"ref48","doi-asserted-by":"crossref","first-page":"3623","DOI":"10.1182\/blood.V91.10.3623","article-title":"Clinical significance of inhibitors in acquired von Willebrand syndrome","volume":"91","author":"H Mohri","year":"1998","journal-title":"Blood"},{"issue":"03","key":"ref49","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1046\/j.1365-2516.2003.00750.x","article-title":"A new ELISA assay for diagnosis of acquired von Willebrand syndrome","volume":"9","author":"C Siaka","year":"2003","journal-title":"Haemophilia"},{"issue":"06","key":"ref50","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1016\/j.thromres.2014.09.020","article-title":"A two-step approach (Enzyme-linked immunosorbent assay and confirmation assay) to detect antibodies against von Willebrand factor in patients with Acquired von Willebrand Syndrome","volume":"134","author":"F Franchi","year":"2014","journal-title":"Thromb 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