15. Treatment of vWD
Treatment of vWD
- Congenital von Willebrand disease
- Cryoprecipitate (risk of TTD)
- Factor replacement
- Humate P [virally inactivated]
- DDAVP
- Acquired von Willebrand disease
- Treat underlying condition or d/c drugs
- IV immunoglobulin (IVIG) for lymphoproliferative disease or monoclonal gammopathy (blockade of FcR prevents clearance)
- Treat with DDAVP to further increase vWF levels
- Consultation for this patient with laboratory medicine
- IVIG (1gm/kg) trial
- 80 gm IV- 5 days before surgery
- cost $1663
- Trial of DDAVP given 2 days before surgery
- DDAVP also given day of surgery
- 80 gm IV- 5 days before surgery
Pre-op Laboratory Studies
| vWF Antigen | Ristocetin | Bleeding time | |
| 2/25/02 | 28% | <12% | >30 mins |
| 3/22/02 IVIG given | |||
| 3/25/02 | 138% | 113% | 10 mins |
| DDAVP | 182% | 228% | 6 mins |
| 3/27/02 | |||
| DDAVP | 7.5 mins | ||
Outcome
- Surgery (3/27) went smoothly, with minimal bleeding
- No further therapy needed; patient d/c'ed to home and no problems on follow-up
- Approximate cost savings with laboratory consult: $28,000
