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Introduction
Very Sociable
Guy
Chest Pain
Girl with a Rash
England 1944
Trouble Healing
Morning Stiffness
Bruises Easily
Shortness of
Breath
Drug Interactions
Review
Thanks to
Quiz
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She's got a bleeding
disorder, she's pregnant and scared.
- We can follow her factor VIII levels.
- Pregnancy causes an elevation in plasma
factor VIII.
- History shows that patients with VIII levels near 100% should
do fine with:
- Aggressive surgical hemostasis and
- Efficient uterine contraction (give oxytocin).
- If normal levels of VIII are not achieved
prior to delivery, we can give desamino-D-arginine vasopressin (DDAVP)
immediately postpartum.
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- DDAVP is known to cause an increase in vWF
protein in many patients.
- If DDAVP doesn't have the desired effect,
sterile factor VIII concentrate containing vWF will be necessary.
- The important thing is that her doctor now knows she has type I von Willebrand disease, and
she can be prepared
for the delivery.
- Here's an interesting tidbit. People with
blood type O naturally have lower levels of vWF. You
have to use a different reference range for them.
- Her blood type is A, Rh+, so this isn't an
issue here.
Wow, this can get tricky.
What's next?
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