Next Dr Caroline Millar on von Willebrand disease - starting with does the pt require treatment? #BSH2017
When does low vwF become type1 vWD? polymorphisms& mutatns in vWF gene, ABO gp &other genetic &non genetic factors all pay a role #BSH2017
Levels may be low but ?do they contribute to bleeding risk &/or explain bleeding phenotype? #BSH2017
Treatment may be the same whether called 'vWD' or not but may be more important when desmopressin contraindicated e.g. older age #BSH2017
As always history is key, as emphasised in the guidelines b-s-h.org.uk/guidelines/gui… #BSH2017
Bleeding Assessment Tools standardise bleeding hx. But haemostatic challenges required to accrue points bleedingscore.certe.nl #BSH2017
Ricof <0.30 cut off for vW disease but 0.3-0.5 is low &may be risk factor for bleeding in setting of bleeding hx #BSH2017
What is a "failed" desmopressin response? Desmo may still be useful in some situations. Challenge can also be diagnostic #BSH2017
Remember w high purity vWF &recomb vWF need to give FVIII simultaneously for immediate effect #BSH2017
Little evidence base for treatment decisions in vWF inc freq of monitoring, target levels, duration of rx, VTE prophylaxis.... #BSH2017
FVIII accumulation causes concern but is it a real problem esp now target Ricof levels are lower? #BSH2017
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