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Coronary artery bypass surgery in a patient with Haemophilia A: a case report

laboratory because of improved precision, specificity and speed of assay [3]. However, it is important that laboratories recognize the limitations of their assay of choice including the interference from a number of substance including icterus, lipaemia and certain antibodies. The Siemens and Werfen VWF:Ag both use polyclonal rabbit anti-human VWF antibodies. The BC VWF:RCo, Werfen VWF:RCo and manual assay do not contain any antibodies whereas mouse monoclonal antibodies are present in the Innovance VWF Ac and Werfen VWF Act reagents. The chemiluminescent VWF:RCo does contains mouse monoclonal antibodies but includes a blocking agent for HAMA up to 1 lg mL . The Werfen VWF Act assay also contains a blocking agent against HAMA, but it is likely that the level in our patient swamps this agent. Acquired Von Willebrand Syndrome with a bleeding diathesis is a rare disorder [8], however, AVWS in the absence of bleeding appears to be more prevalent, particularly in patients secondary to lymphoor myelo-proliferative or cardiovascular diseases [9]. At present it is unknown how many humans develop anti-animal antibodies that interfere with assays employed in coagulation laboratories. The results presented in this report clearly demonstrate that some automated VWF activity assays may misdiagnose patients with AVWS and VWD. When using these VWF activity assays, which do not include ristocetin and platelets, in the initial diagnosis of acquired haemophilia and VWS, it is imperative that a VWF antigen should be tested at the same time. Where a discrepancy between a low VWF:Ag and higher VWF activity is found then an alternative, ristocetin-based assay, should be performed to exclude an erroneously high result and monitor subsequent replacement therapy.