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vWD Diagnosis & Treatment

The first indications of vWD may be noticed after a minor surgical procedure (such as a tooth extraction), where prolonged bleeding might be observed. Other symptoms may include frequent nosebleeds, heavy menstruation, and bleeding after invasive surgery.

If vWD is suspected, your doctor can arrange tests to determine how long you bleed before your blood clots and blood tests to measure your level of von Willebrand factor. Your doctor will also take into consideration your personal and family medical history.

The type of treatment depends on the individual, their type of vWD and the severity of the bleeding. Treatments may have side effects and the right course of action should be decided on in consultation with a doctor.

People with mild forms of VWD often do not require treatment for the disorder except for surgery or dental work. Minor bleeds can often be treated with the P.R.I.C.E. regimen (Protection. Rest. Ice. Compression. Elevation)

For those with more serious bleeds or who need further treatment there are several options, depending on individual circumstances and the severity of the disorder. Desmopressin is a synthetic drug which copies a natural hormone that acts by releasing von Willebrand factor stored in the lining of the blood vessels. People react to desmopressin is different ways and a doctor will need to test an individual’s response to the drug before trhere is an urgent need for the drug, such as surgery. A sufficient amount of time, usually 24 hours, must pass between doses to allow the body to rebuild its stores of von Willebrand factor. Desmopressin can also have mild side effects such as facial flushing, headache, nausea, and water retention.

People with Type 3 vWD and some forms of Type 2 vWD often need factor replacement with factor concentrates. Plasma-derived Factor VIII concentrate also contains vWF. Recombinant vWF is currently under development but not yet available in New Zealand. Factor concentrates are also used when desmopressin is not effective or when there is a high risk of major bleeding, such as for major surgery.

Bleeding in mucous membranes (inside the nose, mouth, intestines or womb) can be controlled by drugs such as tranexamic acid, aminocaproic acid, or by fibrin glue. However, these products are used to maintain a clot and do not actually help form a clot.

Hormone treatment, such as oral contraceptives (birth control pills), helps increase VWF and Factor VIII levels and control menstrual bleeding. If hormone treatment is not prescribed, antifibrinolytic agents may be effective for treating heavy menstruation. Women who suffer from anemia (low levels of iron in the blood, causing weakness and fatigue) due to excessive menstrual bleeding may need to take iron supplements.

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