title: Diagnosis and management of von Willebrand disease: a developing country perspective.
abstract: Special challenges exist in the management of patients with von Willebrand disease (VWD) because of limitations in diagnostic facilities and therapeutic options. However, even within these limitations, it is possible to establish comprehensive services for this condition. Our data show that among 202 patients with VWD, 107 were type 3, 62 were type 1, and the others different categories of type 2. Basic tests such as bleeding time and activated partial thromboplastin time with factor (F)VIII coagulant are able to diagnose most of those with severe disease. We have been able to adapt the specific tests such as von Willebrand factor (VWF) ristocetin cofactor and VWF antigen from the tedious batched manual methods to cost-effective automated methods on advanced coagulometers. Discriminatory tests such as VWF collagen binding, VWF:FVIIIB, ristocetin-induced platelet agglutination (RIPA) are done in batches. Therapeutic options and for the treatment of bleeding include desmopressin, cryoprecipitate, and intermediate purity VWF-containing clotting factor concentrates. Tranexamic acid is also widely used as well as hormonal therapy for menorrhagia. We have also shown that modest doses of intermediate purity FVIII (Koate DVI; Talecris Biotherapeutics, Raleigh, NC, USA) at 35 IU/kg preoperatively and 10 to 20 IU/kg after that are sufficient for surgical hemostasis in these patients.
authors.affiliation: Department of Clinical Pathology and Blood Bank, Vellore, India.
authors.forename: Sukesh Chandran
authors.initials: SC
authors.lastname: Nair
authors.forename: Auro
authors.initials: A
authors.lastname: Viswabandya
authors.forename: Alok
authors.initials: A
authors.lastname: Srivastava
mesh_terms: D019411:Clinical Laboratory Techniques / Q000379:methods*; D003029:Coagulants / Q000627:therapeutic use*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D003906:Developing Countries; D005169:Factor VIII / Q000627:therapeutic use; D006801:Humans; D014148:Tranexamic Acid / Q000627:therapeutic use; D014842:von Willebrand Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D014841:von Willebrand Factor / Q000627:therapeutic use
chemical_list: D003029:Coagulants; D014841:von Willebrand Factor; D014148:Tranexamic Acid; D005169:Factor VIII; D003894:Deamino Arginine Vasopressin