• Treatment
• What is…

Many people with Von Willebrand disease (VWD) have few or no symptoms. People with more serious VWD may have more bleeding problems. Symptoms can also change over time. Sometimes VWD is discovered only when there is heavy bleeding after a serious accident or a dental or surgical procedure.

The main symptoms of VWD are:

• easy bruising
• frequent or prolonged nose bleeds
• bleeding from gums
• prolonged bleeding from minor cuts
• heavy or prolonged menstrual bleeding
• bleeding in the upper and lower gastrointestinal tract
• prolonged bleeding following injury, surgery, dental work, or childbirth

More women than men show symptoms of VWD. Women with VWD often bleed more or longer than normal with menstruation and following childbirth. Some women with VWD have a lot of menstrual pain or irregular menstruation.

Blood type can play a role. People with Type O blood often have lower levels of Von

Willebrand factor (VWF) than people with Types A, B, and AB. This means people with VWD and Type O blood may have more problems with bleeding.

VWD is not easy to diagnose. People who think they have a bleeding problem should see a haematologist who specializes in bleeding disorders. Proper tests can be done at a bleeding disorders treatment centre. Since the VWF protein has more than one function, more than one lab test should be used to diagnose VWD.

Testing involves measuring a person’s level and activity of VWF, and that of another blood clotting protein, factor VIII (FVIII). Testing is often repeated because a person’s VWF and FVIII levels can vary at different times.

Some of the tests that may be performed include:

Menstruation

Women with VWD tend to have more symptoms than men because of menstruation and childbirth. Girls may have especially heavy bleeding when they begin to menstruate. Women with VWD often have heavier and/or longer menstrual flow. This heavier menstrual flow can cause anaemia (low levels of iron in the blood, causing weakness and fatigue).

Women with VWD should be checked regularly for anaemia.

What is “excessive” bleeding?

Every woman is different, and what is considered “normal” for one woman may be “excessive” for another. The average amount of blood lost during a “normal” period is 30-40 mL. Blood loss of 80 mL or more is considered heavy.

Of course, the amount of blood lost can be difficult to measure. If you believe you may suffer from excessive bleeding, complete the assessment chart during your next period. This is only a guide, but it can be a useful tool for you and your doctor to use when assessing your menstrual flow.

Pregnancy / childbirth

A woman with VWD should see an obstetrician as soon as she suspects she is pregnant. The obstetrician should work with a bleeding disorders treatment centre to provide the best care during the pregnancy and childbirth. During pregnancy, women experience an increase in VWF and FVIII levels. This provides better protection from bleeding during delivery. However, after delivery, these clotting factor levels fall quickly and bleeding can continue for longer than normal.

Menopause

Women with VWD entering menopause (end of menstruation, usually between the ages of 45 and 50) are at increased risk of unpredictable and heavy bleeding. It is important for a woman with VWD to maintain a strong relationship with her gynaecologist as she approaches menopause.

Adapted with permission from the Canadian Hemophilia Society http://www.hemophilia.ca/en/

Content reproduced with permission from www.wfh.org