The detection of even tiny amounts of von Willebrand factor (VWF):antigen after desmopressin treatment or in hidden sites like platelets allows the differentiation between patients with recessive von Willebrand disease (VWD) type 3, severe type 1, and 2C (2A subtype IIC). Recessive VWD 2C of various severity displays a characteristic multimeric pattern with pronounced dimer band, absence of triplet structure and lack of large multimers not due to increased proteolysis. Recessive VWD type 2C (2A subtype IIC) is caused by homozygosity or double heterozygosity of missense mutations in the D1 and D2 domains of the VWF propeptide (pp) that catalyzes the multimerization in the D3 domain at the N terminus of mature VWF. In expression studies of recombinant mutant VWF, secretion of VWF mainly consisted of dimers which failed to form intermediate- and high-molecular-weight multimers consistent with the clinical diagnosis of VWD 2C (2A subtype IIC). Carriers of a heterozygous missense mutation in the VWFpp region (D1–D2 domain) of the VWF gene may present mild VWD type 1 and show a typical multimeric pattern with a heavy predominance of VWF dimers.

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