Case history
Case history
A 24-year-old woman presents to the emergency department 8 weeks postnatal with heavy vaginal bleeding, fatigue, and light-headedness. This was her first pregnancy. She has a history of menorrhagia since menarche and iron-deficiency anaemia. She had no bleeding symptoms during her pregnancy, and her vaginal bleeding was not excessive in the first few days after delivery, but it has continued since the delivery and in the past week has increased in flow. Her past medical history is remarkable for an appendectomy at age 14 years without bleeding complications, but she had to return to the oral surgeon for suturing after wisdom tooth extraction at age 16 years. Her family history is remarkable for a sister with heavy menses. Her father had recurrent nosebleeds as a child and had several cauterisations as therapy.
Other presentations
Patients with type 2 or type 3 VWD usually present with more severe bleeding symptoms. Severity of bleeding symptoms correlates with the reduction of von Willebrand factor functional activity. In type 3 disease, factor VIII is also severely decreased and may be low enough to put the patient at risk for joint bleeding and other symptoms more commonly seen in haemophilia A (factor VIII deficiency). Recurrent gastrointestinal bleeding may be a significant medical problem, particularly in older patients. Patients with type 2N disease have symptoms more common to mild and moderate haemophilia A, with fewer mucosal bleeding symptoms than other patients with VWD. The diagnosis of type 2B VWD may follow an incidental finding of thrombocytopenia, particularly in pregnancy, which tends to make the platelet count fall further. [2]
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