Managing Anesthesia for a Patient With Von Willebrand Disease: A Case Report

Von Willebrand disease (vWD) is a common inherited bleeding disorder caused by a deficiency of von Willebrand factor (vWF), a glycoprotein involved in hemostasis. The two major roles of vWF are platelet adhesion and the stabilization of factor VIII in the coagulation cascade. The patient discussed in this case report was an eight-month-old male with diagnosed Type 1 vWD scheduled for circumcision due to phimosis. The preoperative evaluation showed no abnormalities. vWD was managed with the administration of a tranexamic acid bolus dose of 80 mg, followed by a continuous infusion throughout the case. The surgical course was uneventful; the patient maintained normal sinus rhythm and stable vital signs. Upon emergence, the patient had an episode of laryngospasm that was treated successfully with succinylcholine 20 mg. In the post-anesthesia care unit (PACU), the patient's vital signs were stable, and there were no signs of postoperative hemorrhage or bleeding difficulties. It is important for anesthesiologists to learn from this case because it highlights the complexity and heightened attention required when managing pediatric patients with underlying coagulation disorders. This case demonstrates the potential for significant morbidity associated with inadequate perioperative care and the need for coordination among a multidisciplinary team.