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Old 03-02-2012
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Default vWF thearpy...do give ur reason along

A 17-year-old adolescent comes to your office seeking help for “heavy”
menses. Your review of systems also reveals weekly epistaxis. Her only sig-
nificant past history includes a tonsillectomy at age 6 after which she required
blood transfusion for excessive bleeding. Her family history includes several
people who seem to bleed and bruise more easily than others. The patient’s
mother required a hysterectomy after child birth for excessive hemorrhage.
You order a variety of laboratory tests. The patient has a hemoglobin of
6.5 mg/dL with an MCV of 60%; her platelet count is 350,000/μL. Her von
Willebrand antigen and her von Willebrand factor (vWF) activity (risto-
cetin cofactor activity) are decreased. Her vWF is reported as normal but in
decreased amounts. You have been unable to reach her to report the findings,
but when she calls about 1 week later she reports she is having a mild to
moderate nosebleed. You initiate therapy with which of the following?

a. Aminocaproic acid (Amicar)
b. vWF concentrate alone
c. vWF with factor VIII
d. Desmopressin (DDAVP)
e. Intravenous immunoglobulin (IVIG)
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Old 03-02-2012
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D) desmopressin, acts on the V2 receptor and it stimulates the release of vWF, which are in the endothelial cells.
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Old 03-02-2012
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D is the ans . Desmopressin will cause release of subendothelial stores of VWF and factor V111 ,which will stop the bleeding. if this fails she can go for factor V111 replacement that has both VWF and factor V111
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