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Open Access

Quantification of von Willebrand factor and ADAMTS-13 after traumatic injury: a pilot study

Taleen A MacArthur, Julie Goswami, Laurie Moon Tasson, Alexander Tischer, Kent R Bailey, Grant M Spears, Jing-Fei Dong, Matthew Auton, Rosemary Kozar, Myung S Park
DOI: 10.1136/tsaco-2021-000703 Published 5 April 2021
Taleen A MacArthur
1Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Julie Goswami
1Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Laurie Moon Tasson
2Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Alexander Tischer
2Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Kent R Bailey
3Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Grant M Spears
3Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Jing-Fei Dong
4Department of Hematology, University of Washington School of Medicine, Seattle, Washington, USA
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Matthew Auton
5Biochemistry and Molecular Biology, Mayo Clinic, Rochester, New York, USA
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Rosemary Kozar
6Department of Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
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Myung S Park
7Surgery, Mayo Clinic, Rochester, Minnesota, USA
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  • Figure 1
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    Figure 1

    Mechanistic description of VWF release after trauma. This schematic describes VWF synthesis and release under physiological circumstances and after trauma, as well as the potential role of VWF in clot formation after trauma. ULVWF, ultra-large von Willebrand factor; VTE, venous thromboembolism; VWF, von Willebrand factor.

  • Figure 2
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    Figure 2

    Individual values for trauma patients and healthy volunteers. Individual values plotted for (A) 22 samples from trauma patients at 0–2 hours from TOI vs. 21 healthy volunteers and (B) 28 samples from trauma patients at 6 hours from TOI vs. 21 healthy volunteers. Values for the REAADS assay (%), VWF:Ag level (µg/mL), and ADAMTS-13:Ag level (µg/mL) are shown. Solid lines represent median. Kruskal-Wallis test for significance: *p<0.05, **p<0.01, ***p<0.001. ADAMTS-3:Ag, ADAMTS-3 antigen; REAADS, Rapid Enzyme Assays for Autoimmune Diseases; TOI, time of injury; VWF:Ag, von Willebrand factor antigen.

Tables

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  • Table 1

    Detailed clinical characteristics of all 30 trauma patients

    Patient identificationTime points of samplesAdditional injuriesTransfusion (Y/N)ISSABO blood type
    10–2 hours, 6 hoursTBIN26B+
    26 hoursFacial fractures, TBIN24A+
    30–2 hours, 6 hoursRib fractures, scapula fracture, clavicle fracture, pelvic fracture, spine fractures, TBIY50O+
    40–2 hours, 6 hoursSkull fracture, TBIN26O+
    56 hoursSkull base fracture, spine fractures, TBIN17O+
    66 hoursTBIY29B−
    76 hoursTBIN29O+
    80–2 hours, 6 hoursLB Fx (femur) with vascular injury, facial degloving injury, TBIN38A+
    96 hoursSkull fractures, LB Fx (humerus, ulna, radius), TBIN24O+
    100–2 hours, 6 hoursOpen ankle fracture, TBIY27B+
    110–2 hours, 6 hoursTBIY26AB+
    126 hoursSkull fracture, spine, fractures, LB Fx (tibia/fibula), TBIY33A+
    130–2 hours, 6 hoursSkull base fractures, spine fractures, TBIY33A+
    140–2 hours, 6 hoursLB Fx, TBIN9AB+
    150–2 hours, 6 hoursLB FxN14A+
    160–2 hours, 6 hoursSplenic laceration, LB FxN22O+
    170–2 hours, 6 hoursLB FxY9A−
    186 hoursLB FxN4O+
    196 hoursLB FxN17O+
    200–2 hours, 6 hoursCardiac injury from stab woundY26O+
    210–2 hours, 6 hoursTBI, spine fractures with cord injury, splenic/hepatic/renal lacerationsY50O+
    220–2 hours, 6 hoursTBI, spine fractures, LB Fx (femoral neck), ankle fracture, rib fracturesY22A+
    230–2 hours, 6 hoursSuperficial lacerations from stab woundsY5O+
    240–2 hours, 6 hoursTBI, subgaleal hematoma, splenic laceration, mesenteric injury, spine fractures, rib fracturesY22B+
    250–2 hours, 6 hoursLB Fx (tibia and fibula), thigh hematoma, wrist fracture, scapular fracture, rib fracturesY14A+
    260–2 hours, 6 hoursSpine fractures with cord injury, rib fracturesY25A+
    270–2 hours, 6 hoursTBI, LB Fx (bilateral femur)Y34A−
    280–2 hoursTBI, aortic injury, LB Fx (femur and humerus), ankle fracture, pelvic fracture, spinal fractures, rib fracturesY34AB+
    290–2 hoursLiver lacerationY21O+
    300–2 hours, 6 hoursTBI, spine fractures with cord injury, rib fracturesY75A+
    • The table shows individual descriptions (de-identified) of the clinical characteristics of the 30 trauma patients in this study including time points of sample acquisition and all clinically relevant injuries.

    • ISS, Injury Severity Score; LB Fx, long bone fracture; N, no; TBI, traumatic brain injury; Y, yes.

  • Table 2

    VWF activity and thrombin generation kinetics in trauma patients versus healthy volunteers*

    Including only samples obtained from trauma patients at 0–2 hours from TOIHealthy volunteers
    (n=21 samples)
    Trauma
    (n=22 samples)
    P value
    REAADS activity (%)92.0 (71.0–114.0)190.0 (132.0–264.0)<0.001
    ADAMTS-13:Ag (µg/mL)1.00 (0.89–1.09)0.84 (0.51–0.94)0.010
    VWF:Ag (µg/mL)13.4 (7.30–35.94)22.7 (15.8–28.4)0.224
    REAADS activity (%) × 21/VWF:Ag (µg/mL)0.193 (0.033–0.243)0.170 (0.120–0.241)0.627
    ADAMTS-13:Ag/VWF:Ag0.061 (0.027–0.150)0.038 (0.024–0.055)0.068
    LT (min)4.00 (3.33–4.70)3.67 (3.29–4.67)0.336
    PH (nM)184.0 (142.6–224.0)277.8 (206.7–299.8)0.006
    ttPeak (min)8.33 (7.00–9.30)6.56 5.67–7.83)0.003
    Including only samples obtained from trauma patients at 6 hours from TOITrauma
    (n=28 samples)
    REAADS activity (%)92.0 (71.0–114.0)167.5 (108.0–312.5.0)<0.001
    ADAMTS-13:Ag (µg/mL)1.00 (0.89–1.09)0.653 (0.531–0.821)<0.001
    VWF:Ag (µg/mL)13.4 (7.30–35.9)18.5 (14.1–37.5)0.063
    REAADS activity (%) × 21/VWF:Ag (µg/mL)0.193 (0.033–0.243)0.147 (0.089–0.302)0.531
    ADAMTS-13:Ag/VWF:Ag0.061 (0.027–0.150)0.034 (0.013–0.044)0.006
    LT (min)4.00 (3.33–4.67)4.34 (3.61–4.97)0.715
    PH (nM)184.0 (142.6–224.0)226.1 (201.3–254.9)0.008
    ttPeak (min)8.33 (7.00–9.33)7.33 (6.34–8.49)0.035
    • Analyses were performed on all samples that were 0–2 hours from the TOI (top half of the table) and all samples that were 6 hours from the TOI (bottom half of the table), separately.

    • Plasma thrombin generation parameters (calibrated automated thrombogram) including LT, PH, and ttPeak are viewed against REAADS activity, ADAMSTS13:Ag level and VWF:Ag level for the same patient samples.

    • The ratio of REAADS activity (%) to VWF:Ag level is also presented and was calculated using the REAADS 21% value. Additionally, the ratio of ADAMTS-13:Ag level to VWF:Ag level was calculated for both trauma patients and volunteers and is presented.

    • *Kruskal-Wallis test for statistical significance. Results are presented as median values with IQR, with p<0.05 (bolded) are considered statistically significant.

    • ADAMTS-13:Ag, ADAMTS-13 antigen; LT, lagtime; PH, peak height; REAADS, Rapid Enzyme Assays for Autoimmune Diseases; TOI, time of injury; ttPeak, time to peak; VWF, von Willebrand factor; VWF:Ag, VWF antigen.

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Quantification of von Willebrand factor and ADAMTS-13 after traumatic injury: a pilot study
Taleen A MacArthur, Julie Goswami, Laurie Moon Tasson, Alexander Tischer, Kent R Bailey, Grant M Spears, Jing-Fei Dong, Matthew Auton, Rosemary Kozar, Myung S Park
Trauma Surg Acute Care Open Apr 2021, 6 (1) e000703; DOI: 10.1136/tsaco-2021-000703

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Quantification of von Willebrand factor and ADAMTS-13 after traumatic injury: a pilot study
Taleen A MacArthur, Julie Goswami, Laurie Moon Tasson, Alexander Tischer, Kent R Bailey, Grant M Spears, Jing-Fei Dong, Matthew Auton, Rosemary Kozar, Myung S Park
Trauma Surg Acute Care Open Apr 2021, 6 (1) e000703; DOI: 10.1136/tsaco-2021-000703
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Quantification of von Willebrand factor and ADAMTS-13 after traumatic injury: a pilot study
Taleen A MacArthur, Julie Goswami, Laurie Moon Tasson, Alexander Tischer, Kent R Bailey, Grant M Spears, Jing-Fei Dong, Matthew Auton, Rosemary Kozar, Myung S Park
Trauma Surgery & Acute Care Open Apr 2021, 6 (1) e000703; DOI: 10.1136/tsaco-2021-000703
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