Von Willebrand disease: Difference between revisions
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**Epistaxis, gingival bleeding, menorrhagia | **Epistaxis, gingival bleeding, menorrhagia | ||
*Hemarthrosis is unusual | *Hemarthrosis is unusual | ||
==Differential Diagnosis== | |||
==Diagnosis== | ==Diagnosis== | ||
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**Increased risk of thrombosis, especially in patients with coronary artery disease | **Increased risk of thrombosis, especially in patients with coronary artery disease | ||
== | ==References== | ||
Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e (2010), Chapter 230. Hemophilias and Von Willebrand Disease | *Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e (2010), Chapter 230. Hemophilias and Von Willebrand Disease | ||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] |
Revision as of 12:34, 10 June 2015
Background
- Most common inherited bleeding disorder
- vWF has two roles:
- 1. Acts as cofactor for platelet adhesion
- 2. Acts as carrier protein for factor VIII extending its half life
- vWD results from quantitative or qualitative dysfunction of Von Willebrand factor
Clinical Features
- Skin and mucosal bleeding
- Epistaxis, gingival bleeding, menorrhagia
- Hemarthrosis is unusual
Differential Diagnosis
Diagnosis
- Bleeding time: prolonged
- PT: normal
- PTT: normal-mildly prolonged
- vWF activity level: low
Treatment
- Avoid ASA, NSAIDs, heparin
- Intermediate purity factor VIII
- Goal to increase VWF activity by 50-100%
- Initial infusion of 20-40 IU/Kg
- High replacement doses may be indicated in more severe disease
- Platelet transfusion
- consider if replacement therapy instituted and persistent bleeding
- Desmopressin
- Induces release of vWF from endothelial storage sites
- 0.3mcg/kg IV (max 20mcg) over 30min
- Aminocaproic acid
- Recombinant Factor VIIa
- Consider in type 3 VWD patients who have developed antibodies to VWF replacement
- Increased risk of thrombosis, especially in patients with coronary artery disease
References
- Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e (2010), Chapter 230. Hemophilias and Von Willebrand Disease