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Semin Thromb Hemost 2011; 37(5): 587-594
DOI: 10.1055/s-0031-1281047
© Thieme Medical Publishers

Diagnosis and Management of von Willebrand Disease: A Developing Country Perspective

Sukesh Chandran Nair1 , Auro Viswabandya2 , Alok Srivastava2
  • 1Department of Clinical Pathology and Blood Bank, Vellore, India
  • 2Department of Haematology at Christian Medical College, Vellore, India
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Publication History

Publication Date:
18 November 2011 (online)

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ABSTRACT

Special challenges exist in the management of patients with von Willebrand disease (VWD) because of limitations in diagnostic facilities and therapeutic options. However, even within these limitations, it is possible to establish comprehensive services for this condition. Our data show that among 202 patients with VWD, 107 were type 3, 62 were type 1, and the others different categories of type 2. Basic tests such as bleeding time and activated partial thromboplastin time with factor (F)VIII coagulant are able to diagnose most of those with severe disease. We have been able to adapt the specific tests such as von Willebrand factor (VWF) ristocetin cofactor and VWF antigen from the tedious batched manual methods to cost-effective automated methods on advanced coagulometers. Discriminatory tests such as VWF collagen binding, VWF:FVIIIB, ristocetin-induced platelet agglutination (RIPA) are done in batches. Therapeutic options and for the treatment of bleeding include desmopressin, cryoprecipitate, and intermediate purity VWF-containing clotting factor concentrates. Tranexamic acid is also widely used as well as hormonal therapy for menorrhagia. We have also shown that modest doses of intermediate purity FVIII (Koate DVI; Talecris Biotherapeutics, Raleigh, NC, USA) at 35 IU/kg preoperatively and 10 to 20 IU/kg after that are sufficient for surgical hemostasis in these patients.

KEYWORDS

von Willebrand disease - developing countries - diagnosis - therapy

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Alok SrivastavaM.D. F.R.A.C.P. F.R.C.P.A. F.R.C.P. 

Department of Haematology

Christian Medical College, Vellore 632004, India

Email: aloks@cmcvellore.ac.in