Quality of Life of Women With Bleeding Disorders - Essay Example

? Quality of Life among Women with Bleeding Disorders Von Willebrand disease (vWD An Overview Von Willebrand disease (vWD) is a most common type ofhereditary bleeding disorder which prevails in 1% of the world’s population. Majority of people suffering from vWD are not diagnosed because its symptoms are usually mild. However, severe bleeding may occur and necessitate treatment, specifically before and after surgical and dental procedures. The medical diagnoses and treatment of vWD are complex and should be done by medical practitioners who specialize in the treatment of bleeding disorders. However, health care physicians play a significant role in detecting signs and symptoms of vWD and in the ensuring that proper management is given to patients suffering from the disease (Lillicrap and James 2009). Von Willebrand Disease (VWD) is named after Dr. Erik von Willebrand (1870-1949) who first described the condition in 1926. He became famous for his description of bleeding among inhabitants of the island of Foglo in the Aaland archipelago in the Baltic Sea. In 1925, he examined a 5-year old patient whose four siblings died of bleeding disorders. In his report, he presented this as an unidentified type of hemophilia. He initially called the disorder “pseudohemophilia” because of lengthened bleeding time. During the course of his study, he noted that platelets were involved so he renamed it “constitutional thrombopathy” (Owens 2007). The ability of blood to clot is usually affected by vWD and can cause excessive bleeding. In rare cases, such bleeding may harm the internal organs or may even be fatal. VWD manifests in a deficiency in protein in the blood which is called von Willebrand factor (vWF) found in the linings of the blood vessels. Bleeding occurs when blood vessels are injured. Blood cells called platelets cluster together to block the hole in the blood vessel and control the bleeding. vWF serves as adhesion to help the platelets bond together to form a blood clot. Another vital protein that helps the blood clot is factor VIII (FVIII) found in vWF. FVIII is normally inactive in hemophilia which is another clotting disorder. In comparison with hemophilia, vWD more common and less serious among inherited bleeding disorders. It affects 1 out of 100 to 1000 people. Unlike hemophilia which mostly affects males, vWD has effects in both males and females (NHLBI 2008). vWD Disease Forms or Types Just like in many health conditions, vWD is classified into different forms. Type 1 is the most prevalent and is the mildest form, wherein vWF in the blood is decreased. The symptoms manifested are mild and may not even be detected. However, use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can aggravate the condition. People with Type 1 (partial quantitative deficiency), vWD do not have spontaneous bleeding but may bleed considerably with trauma, medical and dental procedures. In Type 2 (qualitative deficiency) vWD, there is an abnormality in vWF. This type is further subdivided into Type 2A and Type 2B. In Type 2A, the multimer which are the building blocks in VWF are smaller than the normal size and rupture easily. In Type 2B, vWF glues to the platelets too well resulting to the clustering of the platelets which can cause reduced platelet number. There are 2 more subtypes (2M and 2N) but these are much rarer. In Type 3 (total deficiency) vWD, there is severe bleeding with vWF and FVIII in the blood at very low levels. Pseudo or platelet type of vWD is comparable to Type 2B but in this case, there is a deficiency in the platelets instead of vWF (Griffin 2010). Prevalence of vWD VWD is prevalent worldwide and can also manifest in animal classes including canine and hogs. Its occurrence in people differs depending on the method applied to identify medical findings. It has been reported in two extensive epidemiologic researches that symptoms and signs of vWd were evident in up to 1% of children and infant population (Werner, Broxson, Tucker, Giroux, Schults, and Abshire 1993). Type 3 vWD which is the most severe has been found to occur in between 1 and 3 million in various countries Moreover, those who have been manifesting symptoms of vWD and have been diagnose by health care practitioners were estimated to be just about 1 in 1000. All researches conducted show that vWD prevail in women twice as that recorded in men most probably because of the possibility of menorrhagia in females (Rodeghiero, Castaman and Dini 1987). Severe vWD patients present a life long history of continuous symptoms of bleeding. They may have medical symptoms including arthropathy, hemophilia A & B and may have extensive bleeding even after trauma or surgical procedures (Rodeghiero, Castaman and Tosetto 2009). Intermediate vWD patients normally have less severe bleeding. Differentiating severe from intermediate patients may be pertinent for clinical analysis. In relation to treatment, severe and intermediate patients may be teamed together with the prominent distinction that prophylaxis should be reserved to patients with severe vWD and recurring heavy bleeding (Berntorp 2008). Severe and intermediate vWD patient must always be administered with anti-hemorrhagic prophylaxis before surgical and invasive procedures. Any bleeding that can be alarming and deterrent to one’s activity should be addressed immediately. Desmopressin is the first treatment option in all patients who prove to be receptive to this medication and patients who do not positively respond to desmopressin should be given vWF/FVIII containing products (Rodeghiero et al 2009). Patients with mild vWD which is primarily Type 1 seldom experience uninterrupted bleedings that are remarkable. A history of uneventful surgical procedure is common even without previous hemorrhagic prophylaxis. Patients with mild vWD should be handled conventionally. Appropriate warnings should be given to these patients on improper use of anti-platelets medicines, advising them about usage of anti-fibrinolytic medications for invasive or surgical procedures on mucous tissues such as dental extraction. Patients with mild vWD can be prescribed with desmopressin (Rodeghiero et al 2009). Symptoms of vWD Von Willebrand Disease is generally distinguished by different mucosal bleeding mainly in the mouth, nose, throat, gastrointestinal tract and outside of the skin. Symptoms of vWd which are evident and most severe are mennorhagia and post partum hemorrhage. Five remarkable signs of bleeding connected with vWD are easy bruising or contusion; menorrhagia which is heavy and prolonged menstrual period; epistaxis or nosebleed; post partum hemorrhage which is heavy bleeding after childbirth and recurring bleeding after surgical and dental procedures. Bleeding may often be due to injury but in other cases, there are no evident causes. VWd manifests rather few signs which is mainly the reason why this disease is hard to diagnose. Many people are not aware that they have vWD not until a member of the family has medical findings of this disease; undergo surgical procedure; or experience physical injury (CSL Behring, 2008). People affected with Type 1 or Type 2 vWD may not manifest major bleeding problems thus they may not be diagnosed until they experience profuse bleeding after an injury or surgical procedure. Furthermore, Type 3 vWD may result to major bleeding problems during early childhood. Thus, Type 3 vWD among children is detected in their formative years. Important information about personal and family history should be taken by the doctor doing the diagnosis. Among these are occurrences of bleeding that last more than 15 minutes or recur within the first 7 days following a trauma; prolonged heavy bleeding after surgical or dental procedures; contusion with little or no evident trauma especially if lumps are felt under; nosebleed with no obvious cause that occurs for more than 10 minutes; blood in the stool with no evident reason; heavy bleeding during menstrual period and usually lasting longer than 7 to 10 days; and muscle or joint bleeding (NHLBI 2008). The preliminary medical evaluation of a person being assessed for vWD should center on the occurrence of excessive bleeding throughout his life and bleeding disorders that run in the family. The history of bleeding should cover the identification of severity, length of time, spot where bleeding occurs, type of injury or issues related with bleeding, alleviation of bleeding and medications used at the start of bleeding such as aspirin, other non-steroidal anti-inflammatory drugs (NSAIDs), clopidogrel, warfarin or heparin. If medical procedures are to be performed, inquiries should be made if the person is taking the said medicines and if there is any history of diseases in liver, kidney, blood, bone marrow or platelet counts. Further assessments should be done if there any history of these medical conditions (NHLBI, 2006). Treatment Plans for vWD There are various recommended treatment plans for each type of vWD that can be organized after proper diagnosis. One of the treatments that can be applied to Type 1 vWD is Desmopressin which is an artificial drug resembling natural hormones and is responsible for releasing VWF in the lining of the blood vessels. This can be taken in three ways such as injecting in the veins, injecting in the skin or through nasal spray. However, there are different reactions to this drug; thus, tests should be conducted by medical practitioners to find a person’s response to this drug especially before surgical procedures. An adequate period of time preferably 24 hours should elapse before the next dosage of desmopressin is prescribed. However, this medication should be given together with VWF and FVIII to control bleeding especially in major surgical operations. Mild side effects are noted in this drug but in rare cases, serious side effects were manifested. Drugs such as Cyklokapron (tranexamic acid) and Amicar (aminocaproic acid) can be used also in Type 1 vWD and this help in securing blood clot in place and in stopping plasmin from dissolving this blood clot. In the process by which blood forms clots (coagulation), fibrin glue can be extracted from the blood and serve as a natural clotting agent that can be used directly to the spot where bleeding occurred. Factor VIII/von Willebrand factor concentrate (FVIII/VWF concentrate) is used in the treatment of Type 3 VWD and in most forms of Type 2 vWD. This is made from collected human plasma that has been processed to take out FVIII and VWF. In this process, different parts of the blood are taken apart so much so that the person receives the needed parts (Lillicrap 2004). Diagnosis of vWD Diagnostic testing is necessary to determine vWD in women. It is very difficult to diagnose this condition because of the symptoms manifested are usually mild. Some people have been afflicted with this disease for years before it has been determined. Many people suffering from vWD have mild symptoms or manifest symptoms that can be associated with other bleeding disorders thus making it hard to diagnose vWD base on medical symptoms. Tests conducted on a person with supposed vWD often include the measurement of bleeding time, vWF antigen, ristocetin co-factor activity, factor VIII antigen and activity of factor VIII (Rrodhe 2008). Women suffering from Type 1 vWD have increased duration of bleeding but intermittent normal bleeding time. There is reduction in the amount of vWF; reduced activity of vWF; and insignificant reduction in the level of factor VIII and activity. Women with type 2 vWD have extended bleeding time; reduced activity of vWF; reduced amount of vWF and factor VIII; and reduced factor VIII activity. Women with type 3 vWD have undetermined vWF levels; insignificant vWF activity; less than 5-10% levels of factor VIII; and considerable reduction of factor VIII activity. There is a reduction of the activity of vWF for all types of vWD, making it the most responsive means of determining all three types of vWD. Patients with average results should undergo examination two to three times over a three month period (Rrodhe 2008). Mennorrhagia or prolonged and serious menstrual bleeding is the most widespread symptom and is reported by 80% of women diagnosed with vWD. Mortality rate is very low; however, there is considerable morbidity. This condition affects approximately between 10% and 30% of women at their reproductive age. Quality of life is significantly affected since this medical condition has found to be related to anemia, fatigue, shunning away from work and family activities and sexual dysfunction. Women diagnosed with vWD usually undergo more medical procedures. It was reported in two extensive researches conducted by Kadir (2008) in England and by Kouide, Burkhart, Phatak, Porter, Peacock, Braggins, Cox, Belling, Michalovic and Howard (2000) in the US respectively, that 25% of women said to be suffering vWD have undergone dilation and curettage (D & C) as part of the assessment of menorrhagia. It was also reported in Kouide et al’s study that among 99 women suffering from vWD, 7% undergo hysterectomy before the diagnosis of vWD (Kouide, et. al, 2000). In the previous years, proofs have come out that 13% of healthy women with heavy menstruations may possibly have mild vWD which is not diagnosed (Shankar, Sabin, Economides, and Kadir 2004). Menstrual cycles that extend for a long duration or heavy flow (menorrhagia) has been associated to blood loss, reduction of iron in the blood and finally deficiency in iron or anemia. Menorrhagia has not been given much attention by the public or medical practitioners. The reason is that open discussions about bleeding associated with menstruation is considered as traditional social “taboo”. Moreover, although researches have been done to quantify the normal volume of blood lost during a menstrual cycle, the methodology used are trials, are without proper management and are not available to clinicians (Hallberg and Nilsson 1964). The medical profession does not have standards in quantifying abnormal bleeding in the menstrual cycle that are clinically practical and widely accepted either by history of physical and laboratory assessments. Generally, women have no idea what is considered as normal blood flow in menstruation and they just depend on comparisons made with close relatives and friends or more often, totally avoid the issue. Women suffering from menorrhagia usually experience ‘awkwardness’ and ‘embarrassment’ as a result of prolonged and heavy menstrual bleeding which often leads to fatigue and absences from school/work. Upon manifestation of symptoms of anemia, women will finally take it upon themselves to seek medical attention and are likely to be diagnosed with severe case of anemia. In such cases, pharmacological therapy such as oral contraceptive pills or invasive procedures such as D & C, hysteroscopy, endometrial ablation, myomectomy or uterine artery embolization are necessary and if not found to be successful , hysterectomy can be conducted although heavy menstrual bleeding is not caused by uterine pathology (Oehler, and Rees 2003). Effects of Heavy Bleeding on Quality of Life: Ethical, Economic and Social Implications Guidelines on heavy menstrual bleeding were issued by the National Institute for Health and Clinical Excellence (NICE) in 2007 (NICE Guideline 44 2007). Heavy Menstrual Bleeding or HMB was classified as too much loss of blood that impedes the psychological, physical, emotional and social quality of life of a women which can happen alone or in combination with other symptoms. The present definition of HMB varies from the definition used by previous study that calculates 80 ml blood loss per menstrual cycle (Blood Center of Wisconsin 2008). In the early 1990s, it was shown that 60% of women with heavy menstrual bleeding have undergone hysterectomy as a treatment. Since then new methods of treatment such as hormonal intra-uterine devices and different procedures for endometrial ablation have been presented and found to be effective replacements. In evaluating patients with HMB, historical and physical assessments can present information in classifying the nature of bleeding, pathology and related concerns and needs. A diagnostic study conducted among 2500 women in UK showed that 50% had no histological defects that can be considered as causes. Findings revealed that uterine fibroids (30%) and polyps (10%) are the general causes (Greer, Lowe, Walker, and Forbes 1991). Treatment of women suffering from bleeding disorders may be classified as either medical or surgical. Most of these treatments are particularly carried out to address health related issues of women with bleeding disorders. There are significant disparities in methods used which are based on the personal choices of the patient. Future researches should be conducted to identify specifically the corresponding focus of therapies. Management should be done in coordination with the physician, hematologist and gynecologist with the intention of significantly lessening hysterectomies and improving the quality of life of women suffering from bleeding disorder (Irvine & Cameron 1999). Hormonal therapy is commonly used as a treatment for women who present menorrhagia. All hormonal therapies are considered to be safe in the management of conditions associated with bleeding disorders. Combined oral contraceptives (COCs) are proven to be a successful and safe therapies for menorrhagia which can abate blood loss by roughly 50% (Irvine & Cameron 1999). Hormones help normalize the menstrual cycle by reducing the amount of endometrial lining. It can be used with any form of bleeding disorder and while hematologists can prescribed hormone therapy, the service of gynecologist is also needed. Stimate is responsible for releasing VWF from the stored supply. The existence of more VWF in the blood will help platelets to clump; thus clots will be formed easily. This can be applied only in the treatment of vWF, deficiency in the function of platelets or in hemophilia A. This medicine is costly and pharmacy benefits should be provided to the person needing this medication. Another treatment that can be prescribed is Amicar which is an oral medication that maintains a clot by averting ruptures. It is also costly and pharmacy benefits should be considered in its use (Blood Center of Wisconsin 2008). Depending on the type and severity of vWD, a person suffering from this disorder may get treatments that enhance production of vWF. These are usually done by taking or using a drug called desmopressin taken as nasal spray or as an injection. Detailed information regarding the use of this medication is provided by clinicians including its side effects. DDAVP can be used but it is important to know how to use this because it can cause adverse side effects. This medication will help in the replacement of vWF. This is done through direct injections of the protein to the blood. It also used to prevent dissolving of clots. This can be done by taking medications such as amicar or tranexamic acid in tablet form, as a mouth wash or as an injection to the vein. This is usually helpful in managing nose bleeds or bleeding after dental procedures. Medications that activate the formation of clots can also be used and are available in foam strip and gel that may be applied to the bleeding spot (Rick 2009). Although hormone therapy that is used for the treatment of menorrhagia can obstruct conception, there are still a big possibility for women with vWD to get pregnant. However, pregnancy can cause few bleeding problems. Fortunately, during pregnancy and childbirth there is an increase of VWF in the blood for women diagnosed with Type 1 VWD. Nevertheless, there is a significant decrease of VWF after child delivery, thus, treatment should be administered for prevention and control of excessive bleeding. Breastfeeding is one way of increasing the level of VWF after childbirth among women with Type 1 VWD. Pregnancy is also possible among women with Type 2 and 3 vWD; however, more preventive measures are needed (Canadian Hemophilia Society 2011). Women diagnosed with Type 3 vWD were found to experience repeated miscarriages specifically on the first trimester. This spontaneous abortion aside from being frequent is also associated with heavy bleeding. The threat of abortion can be minimized through factor replacement therapy. On the other hand, the risk of acquiring and being exposed to parvovirus is possible. Parvovirus can cause abortion. Preventive treatment should be administered to women who are likely to suffer heavy bleeding prior and after childbirth. This may include desmopressin if consider effective, anti-fibrinolytics like cyklokapron and amicar; and FVIII/VWF concentrate. During conception, the fetus is presumed to be affected with the bleeding condition unless otherwise indicated by prenatal assessment. Post partum hemorrhage in women suffering with vWD is more common. Hence, these women should be carefully observed during the period following delivery. Laboratory tests should be done on VWF/FVIII and hemoglobin or the level of iron in the blood (Canadian Hemophilia Society 2011). Breastfeeding among women suffering with Type 1 keeps the hormones in high level during pregnancy and this may protect her from excessive bleeding after childbirth. In the occurrence of bleeding disorder after delivery, factor concentrates or even red blood cells should be transfused (Canadian Hemophilia Society 2011). Deficiency of the clotting factor can be attributed to women with bleeding disorders such menorrhagia, methrorrhagia, bleeding at ovulation or after miscarriage, abortion or childbirth (Greer et al 1991). Safety measures must be conducted in women with vWD because they are in danger of experiencing extensive bleeding when they undergo surgical procedures. Repeated miscarriage can also be expected among women with severe vWD. Complications brought about by bleeding can be prevented by adhering to general principles and treatment (Demers, Derzko, David, and Douglas 2005). Pregnant women with a inherited bleeding disorder may be in need of multidisciplinary approach and they ought to have their delivery in a hospital with an obstetrician, anaesthesiology, hematologist and pediatrician. Pregnant women with bleeding disorders should be managed by therapy dealing with replacement of clotting factor when available, desmopressin, platelet transfusion, tranexamix acid and other effective ways. Caesarian sections should be done for obstetrical manifestations. Epidural and spinal anesthesia should be discouraged unless 40% of plasma level of the deficient factor is not required. Regional anesthesia is not contraindicated if coagulation is normal. The danger of early and late post partum hemorrhage is increased in women suffering from bleeding disorders and this may occur after childbirth. This necessitates immediate reporting; forceps, vacuum extractions and fetal scalp blood sampling should not be used if the fetus is at risk of bleeding. Unless sufficient diagnosis and treatment are available, intramuscular injections, surgery and circumcision should be avoided in women with severe hereditary bleeding disorder (Demers et al 2005). Congenital bleeding disorder can put to risk the success of pregnancy unless the effective services of hemostasis experts are obtained (Demers et al 2005). Women’s quality of life is adversely affected by bleeding disorders. Many women impose restrictions on the time allocated for work while others alter their chosen careers. Heavy bleeding during menstrual period restrain women from going to work. Due to recurring problems of bleeding and continually seeking medical attention, many women have lost their trust in the medical profession. One other outcome of vWD is anemia, which is an iron deficiency brought about by excessive blood loss and women experience constant fatigue. Women have the tendency to suffer from depression because of the stress they go through because of their bleeding disorder. Pain during menstrual period and ovulation are most likely experienced by women. Many women have painful sexual intercourse. They must also continuously cope up from embarrassment especially during incidence of staining as a result of heavy bleeding (Lima 2010). Women suffering with bleeding disorders may have different reactions. Some may take it as an obstacle to hurdle while others may find it hard to adjust in the situation. There are some common issues related to bleeding disorders. One of these is the sense of denial that comes from those women who have recent findings of bleeding disorder. Some women have a hard time accepting that they are suffering from life long and chronic medical disorder. This denial can lead to further complication of treatment plan to a significant level. Another issue that may come out from women affected by bleeding condition is self blame. This holds true in pregnant women wherein she blame herself for passing the disorder to her child. Women afflicted with the condition may feel overpowered and not able to come to their child’s rescue during series of bleedings thus making the feeling of guilt possible. It is very hard to live in guilt because it complicates their lives and make it dull. The diagnosis of the bleeding disorder may result to shock among women with bleeding conditions. The most significant action that women may do is to recover from shock and try to think of means by which they can be assisted and supported throughout their lives (Lillicrap 2004). Another negative reaction brought about by bleeding disorders are frustration and helplessness having considered that they are in a complex situation. Women find it difficult to fathom the essence of this situation and accept that they are the suffering from this condition. This reaction may upset these women, deterring them from widening their outlook towards the situation they are in. Women’s attitudes toward their medical condition is characterized by fear. Recognizing that a bleeding disorder is life long, women may fear about their profession, relationships and related burdens of the situation. Fear associated with this condition may affect women’s options, doing specific things and affecting the overall quality of life of women with bleeding disorders (Lillicrap 2004). Women in this medical condition might find it hard to plan for their future thus giving rise to anxiety. It is may be difficult for them to have specific plan according to what they really desire to do because of the considerable effects of the severity of bleeding that hinder them to function well. Realizing that doing all things they want is not possible because of their life long condition, women become less productive in various ways. Women suffering from bleeding disorders have lessened anticipation of positive things to happen. They have lost their optimism and hope in leading a quality life. They believe that effective treatment for their condition is not available thus reducing their chance to be treated. Moreover, they believe that they will have to bear the pain all their life (Lillicrap 2004). Women may show hopelessness in various ways. Some women believe that nothing can be done to alleviate their condition and that nobody understands their situation including the pain they are going through. Such issues should be properly addressed to correct the wrong perceptions of women about their medical condition. If left uncorrected, this precludes effective management, depriving them of the opportunity to lead a normal life (Lima 2010). While von Willebrand disease (vWD) is the most commonly known inherited bleeding disorder that affects a major population, few people including medical practitioners have thorough knowledge of this condition. This has primarily lead to low rate of diagnosis. Appropriate diagnosis may provide explanations on the notion that people with vWD are different. The symptoms manifested are real and being aware of the cause would those who suffer from the condition to accept and take control of the situation (Society for the Advancement of Education 2003). Unlike hemophilia, which can be found rarely in women, vWD affects equal number of men and women. Women suffering from vWD present unusually heavy bleeding during menstrual period often lasting for more than 7 days and presents a need to change pads or tampons within less than 2 hours. If not properly diagnosed, this can result to surgical procedures such as hysterectomy, dilation and curettage, endometrial ablation as well as extended bleeding after child delivery. Aside from health implications, vWD also has a deep effect on women’s quality of life, causing decreased self esteem to aversion with intimacy. This is usually true in women suffering from prolonged menstrual bleeding. This condition usually hampers regular activities of women related to school or work and cause fear and anxiety (Society for the Advancement of Education 2003). There is also the possibility of medical procedures such as hysterectomy though there may be no apparent need for it because medical practitioners usually misdiagnose menorrhagia. This frequently ensues among women in their early 20s or 30s to control menorrhagia. A research conducted shows that 7% of those who undergo hysterectomy for menstrual bleeding were later diagnosed with vWD. Thus, the disease can be treated without any surgical procedures. Aside from physical and psychological trauma that women suffering from vWD experience as a result of hysterectomy, it also poses a threat to their life. Women should consider the effects of hysterectomy on their personality and future plans of having a child (Society for the Advancement of Education 2003). VWD can affect women physically and psychologically in connection with intimate relationships and sexuality. Adolescents with VWD may lack the interest and confidence to enjoy going out on date. As they mature and commit into an intimate relationships, there may be a need to reveal their symptoms or diagnosis to their partners. This may cause misinterpretation or even rejection. This problem can be complicated by physiology. In most women with vWD penetrative sexual intercourse may lead to profuse bleeding as a result of vaginal tearing. Thus, vWD may result to relationship problems (Society for the Advancement of Education 2003). Summary and Conclusions As a summary of this paper about vonWillebrand Disease, key points have been noted. Von Willebrand is considered a bleeding disorder that affects the functions of blood to clot. This can result to excessive bleeding after an injury. In vWd , a protein in the blood called von Willebrand factor are either in low levels or do not function. VWD is classified into Type 1, Type 2 and Type 3. VWD is almost always inherited. Genes of this disorder are passed on to children by their parents afflicted by vWD. The signs and symptoms manifested in vWD relies on the type and severity of the disorders. Primary symptoms include bruises from bumps and injuries, excessive nose bleeding, heavy bleeding after surgical and dental procedures, lengthened menstrual bleedings in women, blood in stools and urine and internal hemorrhage and joints. VWD is sometimes difficult to diagnose. Many people do not experience major bleeding problems until they have heavy bleeding after surgical procedures or some other trauma. VWD can be diagnosed by medical practitioners based on family and medical history or medical analysis of the person’s physical condition. It is important to have early diagnosis to ensure appropriate treatment and normal active lives despite the condition. VWD can be treated through medicines and therapies for replacement or increasing the amount of VWF in the blood, stopping the breakdown of clots and controlling heavy menstrual bleeding in women. Women suffering from vWD may also be treated with oral contraceptives , intrauterine devices or a procedure that destroys the lining of the uterus that may cause reduction of menstrual blood loss. Pregnancy can be a test for women who have vWD. The professional services of an hematologist and obstetrician who specializes in high risk pregnancy is needed. VWD cannot be cured but it can be treated. Efficient supervision of von Willebrand Disease is considered a life-long endeavor that entails wide ranging care from experts. Specialty pharmacy and home infusion providers are put in place to educate the families to ensure that people suffering from vWD religiously comply with the medications and treatment plans required. Such also cover s treatment before the individual engages in sports, medical and dental procedures, where bleeding is most likely. Additionally, specialty infusion pharmacies are certified to enhance the training provided to caregivers and patients to enable them to conduct self infusion. Once properly managed, people suffering from vWD can lead normal, active and productive lifestyles. References American Home Care Federation 2010, Von Willebrand disease. [Online] Available at: [Accessed 29 May 2011]. Berntorp E 2008, Prophylaxis in von Willebrand disease. Haemophilia, vol. 14, no. 5, pp. 47–53. 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