15. Women with von Willebrand Disease

  1. Augusto B. Federici MD3,
  2. Christine A. Lee MA, MD, DSc (Med), FRCP, FRCPath, FRCOGad eundem4,
  3. Erik E. Berntorp MD, PhD5,
  4. David Lillicrap MD6 and
  5. Robert R. Montgomery MD7,8
  1. Christine A. Lee MA, MD, DSc (Med), FRCP, FRCPath, FRCOGad eundem4,
  2. Rezan A. Kadir MD, FRCS (ed), MRCOG, MD1 and
  3. Peter A. Kouides MD2

Published Online: 21 MAR 2011

DOI: 10.1002/9781444329926.ch15

Von Willebrand Disease: Basic and Clinical Aspects

Von Willebrand Disease: Basic and Clinical Aspects

How to Cite

Lee, C. A., Kadir, R. A. and Kouides, P. A. (2011) Women with von Willebrand Disease, in Von Willebrand Disease: Basic and Clinical Aspects (eds A. B. Federici, C. A. Lee, E. E. Berntorp, D. Lillicrap and R. R. Montgomery), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444329926.ch15

Editor Information

  1. 3

    Division of Hematology and Transfusion Medicine, L. Sacco University Hospital, Department of Internal Medicine, University of Milan, Milan, Italy

  2. 4

    University of London, London, UK

  3. 5

    Malmö Centre for Thrombosis and Haemostasis, Lund University, Skåne University Hospital, Malmö, Sweden

  4. 6

    Department of Pathology and Molecular Medicine, Richardson Laboratory, Queen's University, Kingston, ON, Canada

  5. 7

    Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA

  6. 8

    Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA

Author Information

  1. 1

    The Royal Free Hospital, London, UK

  2. 2

    Mary M Gooley Hemophilia Center, Rochester General Hospital, Rochester, NY, USA

  3. 4

    University of London, London, UK

Publication History

  1. Published Online: 21 MAR 2011
  2. Published Print: 25 MAR 2011

ISBN Information

Print ISBN: 9781405195126

Online ISBN: 9781444329926

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Keywords:

  • menorrhagia;
  • pictorial bleeding assessment chart;
  • adolescent;
  • Mirena coil;
  • pregnancy;
  • miscarriage;
  • postpartum hemorrhage;
  • DDAVP;
  • tranexamic acid

Summary

Epidemiologic studies have shown an approximately 11–16% prevalence of laboratory diagnoses of von Willebrand disease (VWD) in women who present with menorrhagia. There is a variation of von Willebrand factor (VWF) during the menstrual cycle and testing in the early follicular stage is recommended. VWD may present as acute menorrhagia in adolescents. Treatment includes tranexamic acid, DDAVP, and clotting factor concentrates. A good response has been achieved using the Mirena intrauterine system. There is usually a progressive rise in VWF in type 1 VWD during pregnancy, but treatment with clotting factor concentrates may be required to cover delivery in type 3 and some subtypes of type 2 VWD where the VWF is < 15 IU/dL at the beginning of pregnancy. Women with VWD are at increased risk of postpartum hemorrhage because the VWF falls to pre-pregnancy levels after delivery.