Abdul Mannan – VWF:RCo for Diagnosing von Willebrand Disease: That Test Might Be Failing Your Patients
Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board, shared on LinkedIn:
“Are you still using VWF:RCo to diagnose von Willebrand Disease (vWD)?
That test might be failing your patients.
Here’s the problem: VWF:RCo uses ristocetin, an antibiotic, to force an artificial interaction between VWF and platelets. It doesn’t measure how VWF actually works in the body. And it has a serious blind spot.
The D1472H gene variant is present in 63% of African Americans. This variant causes VWF:RCo to give falsely low results. Same patient. Same blood. Wrong answer. This leads to misdiagnosis based purely on genetics.
Why VWF:GPIbM is the better choice:
- It uses engineered GPIb receptors that bind VWF directly, mimicking what happens in real life
- It measures true physiological function, not an artificial reaction
- It’s unaffected by the D1472H variant
- It shows better reproducibility, especially at low VWF levels
- It’s now recommended in ASH/ISTH/NHF/WFH guidelines (Blood Advances, 2021)
Think of it this way. VWF:RCo is like checking if a key fits by looking at scratches on the keyhole. VWF:GPIbM actually turns the door handle to see if the lock works.
If your lab still reports only VWF:RCo, it might be time for a conversation with your laboratory team. Equitable diagnosis shouldn’t depend on a patient’s ethnic background.
What assay does your lab use for VWF activity?”
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