Despite popular belief, there is a rare type of hemophilia that affects women of child-bearing age. Von Willebrand disease is the most common of the hereditary bleeding dis-orders and can affect males and females alike
It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks after delivery as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the patient with von Willebrand disease who experiences a postpartum hemorrhage is: a. Cryoprecipitate.
b. Factor VIII and vWf.
c. Desmopressin.
d. Hemabate.
C
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A Cryoprecipitate may be used; however, because of the risk of possible donor viruses, other modalities are considered safer.
B Treatment with plasma products such as factor VIII and vWf are an acceptable option for this patient. Because of the repeated exposure to donor blood prod-ucts and possible viruses, this is not the initial treatment of choice.
C Desmopressin is the primary treatment of choice. This hormone can be admi-nistered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage.
D Although the administration of this prostaglandin is known to promote contrac-tion of the uterus during postpartum hemorrhage, it is not effective for the pa-tient who presents with a bleeding disorder.
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