Test Id : VWFMS
von Willebrand Factor Multimer Analysis, Plasma
Useful For
Suggests clinical disorders or settings where the test may be helpful
Resolving discrepancies when results of complementary laboratory tests (eg, F8A / Coagulation Factor VIII Activity Assay, Plasma; VWACT / von Willebrand Factor Activity, Plasma; and VWAG / von Willebrand Factor Antigen, Plasma) are abnormally low or discordant
Subtyping von Willebrand disease (VWD) (primarily identify variants of type 2 VWD)
Aiding in determining appropriate treatment
Identifying variants of type 2 VWD that have fewer of the largest multimers, have unusually large multimers, or have qualitatively abnormal "bands" that indicate an abnormal von Willebrand factor structure
Method Name
A short description of the method used to perform the test
Agarose Gel Electrophoresis/Infrared Dye-Labeled Antibody Detection
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Polymers, Von Willebrand Factor
VWF Mult Anal
Von Willebrand Protein Polymers SDS Gel, Plasma
Specimen Type
Describes the specimen type validated for testing
Plasma Na Cit
Ordering Guidance
Coagulation testing is highly complex, often requiring the performance of multiple assays and correlation with clinical information. For that reason, we suggest ordering AVWPR / von Willebrand Disease Profile, Plasma.
Additional Testing Requirements
VWACT / von Willebrand Factor Activity, Plasma and VWAG / von Willebrand Factor Antigen, Plasma are requested but not required before performing this test. If already assayed, submit results. If no results are included, submit separate specimens for the above assays following specimen requirements for each test.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Specimen Type: Platelet-poor plasma
Patient Preparation:
1. Fasting is preferred.
2. Specimen should be collected prior to coagulation factor replacement therapy.
Collection Container/Tube: Light-blue top (3.2% sodium citrate)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing.
2. Centrifuge, transfer all plasma into a plastic vial, and centrifuge plasma again.
3. Aliquot plasma into a plastic vial leaving 0.25 mL in the bottom of centrifuged vial.
4. Freeze plasma immediately (no longer than 4 hours after collection) at -20 degrees C or, ideally, -40 degrees C or below.
Additional Information:
1. Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.
2. Each coagulation assay requested should have its own vial.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
1. Coagulation Patient Information (T675)
2. If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
0.5 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Plasma Na Cit | Frozen | 42 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Resolving discrepancies when results of complementary laboratory tests (eg, F8A / Coagulation Factor VIII Activity Assay, Plasma; VWACT / von Willebrand Factor Activity, Plasma; and VWAG / von Willebrand Factor Antigen, Plasma) are abnormally low or discordant
Subtyping von Willebrand disease (VWD) (primarily identify variants of type 2 VWD)
Aiding in determining appropriate treatment
Identifying variants of type 2 VWD that have fewer of the largest multimers, have unusually large multimers, or have qualitatively abnormal "bands" that indicate an abnormal von Willebrand factor structure
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
von Willebrand factor (VWF) is a large multimeric plasma glycoprotein that has essential roles in primary hemostasis. Wild-type VWF molecules are series of multimers varying in size from dimers to multimers over 40 subunits (>10 million Da). The largest multimers provide multiple binding sites that can interact with both platelet receptors and subendothelial matrix sites of injury and are the most hemostatically active form of VWF. The biological functions of VWF are as follows:
1. VWF is a ligand and mediates platelet adhesion to the subendothelial collagen at the site of vessel wall injury by binding to the platelet receptor glycoprotein (GP)-Ib, V, IX complex, and subendothelial collagen
2. VWF binds and stabilizes procoagulant factor VIII in the circulation
3. Under conditions of high shear, VWF also mediates platelet-platelet cohesion by binding to the platelet receptor GP-IIb/IIIa (integrin alpha IIb beta3)
von Willebrand disease (VWD) is the most common hereditary bleeding disorder that is caused by quantitative or qualitative VWF defect. VWD manifests clinically as easy bruising, mucocutaneous bleeding (eg, epistaxis, menorrhagia), and bleeding after trauma or surgery.
VWD has been classified into 3 major types:
-Type 1, typically an autosomal dominant disease, is the most common, accounting for approximately 70% of VWD patients. It represents a quantitative deficiency of VWF of variable severity.
-Type 2, which is usually an autosomal dominant disease, is characterized by several qualitative abnormalities of VWF. Four subtypes have been identified: 2A, 2B, 2M, and 2N.
-Type 3, an autosomal recessive disorder, leads to severe disease with virtually undetectable levels of VWF, as well as very low levels of factor VIII.
Acquired von Willebrand syndrome (AVWS) is associated with a number of different disease states and is caused by several different pathophysiological mechanisms, including antibody formation, proteolysis, binding to tumor cells with increased clearance, and decreased synthesis. AVWS is most frequently described in patients with dysproteinemias (including monoclonal gammopathy of undetermined significance, multiple myeloma, and macroglobulinemia), lymphoproliferative disorders, myeloproliferative disorders (eg, essential thrombocythemia), autoimmune diseases (eg, systemic lupus erythematosus), high-shear stress cardiovascular conditions such as severe aortic stenosis, gastrointestinal angiodysplasia, and hypothyroidism.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
An interpretive report will be provided.
Interpretation
Provides information to assist in interpretation of the test results
The plasma von Willebrand factor (VWF) multimer analysis is a qualitative visual assessment of the size spectrum and the banding pattern of VWF multimers.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Von Willebrand factor (VWF) multimer analysis is not useful if the following tests are normal:
-F8A / Coagulation Factor VIII Activity Assay, Plasma
-RIST / Ristocetin Cofactor, Plasma
-VWACT / von Willebrand Factor Activity, Plasma
-VWAG / von Willebrand Factor Antigen, Plasma
Or when:
-The VWF ristocetin cofactor:vWF antigen ratio is greater than or equal to 0.7
-The vWF activity:vWF antigen ratio is greater than or equal to 0.8
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Budde U, Schneppenheim R. von Willebrand Factor and von Willebrand Disease. Rev Clin Exp Hematol. 2001 Dec;5.(4):335-368
2. Ruggeri ZM. Structure and function of von Willebrand factor: Relationship to von Willebrand's disease. Mayo Clinic Proc. 1991;66(8):847-861
3. Sadler JE. A revised classification of von Willebrand disease. Thromb Haemost. 1994;71:520-525
4. Laffan M, Brown SA, Collins PW, et al. The diagnosis of von Willebrand disease: a guideline from the UK Haemophilia Centre Doctors Organization. Haemophilia. 2004;10(3):199-217
5. Mannucci PM. Treatment of von Willebrand's disease. N Engl J Med. 2004;351(7):683-694
6. Pruthi RKl, Daniels TM, Heit JA, et al. Plasma von Willebrand factor multimer quantitative analysis by in-gel immunostaining and infrared fluorescent imaging. Thromb Res. 2010;126(6):543-549
7. Ng C, Motto DG, Di Paola J. Diagnostic approach to von Willebrand disease. Blood. 2015;125(13):2029-2037
Method Description
Describes how the test is performed and provides a method-specific reference
Platelet-poor plasma proteins are denatured using heat and an anionic detergent, sodium dodecyl sulfate. The sample is then electrophoresed through a discontinuous agarose gel on a cooled horizontal electrophoresis unit overnight to separate the von Willebrand factor (VWF) multimers by size. The gel is fixed in acid and isopropanol, washed in water, and incubated with dilute rabbit-antihuman VWF. After washing away unbound antibody, the gel is incubated with dilute goat-antirabbit IgG antibody tagged with an infrared dye. Excess secondary antibody is washed away, and the gel is scanned using an infrared imaging system. The digitized image of the electrophoretic distribution of the VWF multimers is interpreted by a coagulation consultant and a written report is provided.(Favaloro EJ, Koutts J: Diagnosis of von Willebrand disease. In: Kottke-Marchant K, ed. Laboratory Hematology Practice. Wiley Blackwell; 2012:447-459; Favaloro EJ and Lippi G. eds. Hemostasis and Thrombosis, Methods and Protocols. Humana Press 2017)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Thursday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
85247
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| VWFMS | von Willebrand Factor Multimer, P | 48595-3 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 603851 | von Willebrand Factor Multimer, P | No LOINC Needed |
| 603855 | VWF Multimer Interpretation | 48595-3 |