von Willebrand's Disease (vWD)

00:01 In von Willebrand disease our focus is going to be on, once again, how much of my von Willebrand factor I have present? The combination of platelet function and also what clotting factor? Which one? VIII.

00:16 The combination of the two is going to give you what test? Good.

00:21 An increase in bleeding time and an increase in PTT.

00:25 And here we go.

00:26 The types.

00:27 We have type I, mild decrease in von Willebrand factor.

00:31 Mild.

00:33 Type II , a defect in von Willebrand factor function but more commonly is the one you?re gonna be looking for with complete absense of complete von Willebrand factor.

00:45 And not only that but you also have lack of stabilization of factor VIII activity.

00:52 Signs and symptoms include bruising.

00:56 Remember we talked about that lady who may have inserted a tampon, had a pad on, woke up in the morning and still during her menses are soaking the sheets with blood.

01:07 Lots of blood everywhere.

01:09 Bleeding, especially mucous membrane?menorrhagia, unfortunately.

01:12 At the same time you can also expect there to be iron deficiency, right? Obviously, lots of bleeding taking place.

01:18 Laboratory test include the following.

01:21 Predict what?s gonna happen first, please? Increase in PTT and increase in bleeding time and especially for type III, abnormal ristocetin cofactor assay.

01:32 In other words, the ristocetin is then going to cause what?s known as aggregation and decreased von Willebrand factor and factor VIII.

01:42 While here you?re looking at and focusing on type I and type III.

01:47 Ultimately, if you?ve been following me, you come to this table and everything should speak to you.

01:54 Laboratory testing for bleeding diathesis.

01:57 I wanna point out what?s important for each one.

01:59 Pay attention.

02:01 Aspirin increase in bleeding time, lack of thromboxane, no aggregation, platelet count perfectly normal, no petechia.

02:11 Thrombocytopenia whatever the cause may be, obviously, decrease in platelet count, increase in bleeding time only.

02:20 Von Willebrand disease either class or type I and type III.

02:24 You?d expect there to be an increase in bleeding time because the von Willebrand factor is not functioning properly, a bind to glycoprotein Ib and PTT is elevated due to lack of stabilization of factor VIII.

02:37 Hemophilia A, let's talk about severe.

02:40 Not much activity going on with your factor VIII so therefore resulting in increase in PTT.

02:49 DIC everything?s elevated except for platelet count and that?ll be decreased.

02:56 Warfarin and heparin, well you tell me.

02:59 Warfarin which test are you gonna use? Remember WEPT? Warfarin Extrinsic PT.

03:06 If it?s not warfarin, it?s heparin.

03:08 If it?s not extrinsic, it?s intrinsic.

03:11 If it?s not PT, PTT.

03:13 Welcome to heparin.