title: Painless urethral bleeding: an unusual presentation of Von Willebrand disease.
abstract: Von Willebrand disease (vWD) is the most common bleeding disorder, and usually presents with either easy bruising or mucus membrane bleeding. Many patients are also diagnosed as a result of abnormal pre-operative laboratory tests. In this report, we describe two patients presenting with painless, persistent urethral bleeding as their initial manifestation of vWD. The first patient began bleeding after a Foley catheter was placed during a hospital admission for status epilepticus. A urologic examination demonstrated a wound in the posterior urethra. Despite repeated attempts at controlling the bleeding with cautery, the bleeding persisted. The second patient presented with spontaneous urethral bleeding and a normal urologic examination. Due to persistent bleeding, both patients underwent a coagulation evaluation that demonstrated the presence of type 1 vWD. The first patient had resolution of his bleeding following 5 weeks of Alphanate, a von Willebrand factor containing factor VIII concentrate, and aminocaproic acid. The second patient initially responded to desmopressin, but subsequently required Humate-P to achieve complete resolution. These cases illustrate the importance of an evaluation for bleeding disorders in patients with persistent bleeding from any site.
authors.affiliation: Division of Hematology, Children's Hospital of Orange County, Orange, CA 92868, USA.
authors.forename: S
authors.initials: S
authors.lastname: Armenian
authors.forename: J L
authors.initials: JL
authors.lastname: Raffel
authors.forename: D J
authors.initials: DJ
authors.lastname: Nugent
authors.forename: G
authors.initials: G
authors.lastname: Young
mesh_terms: D000293:Adolescent; D002648:Child; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D014522:Urethral Diseases / Q000209:etiology*; D014546:Urinary Catheterization / Q000009:adverse effects; D014842:von Willebrand Diseases / Q000150:complications* / Q000175:diagnosis