Preoperative Hemostatic Management for Refractory Abnormal Uterine Bleeding in Patients With von Willebrand Disease:...

von Willebrand disease (VWD) is the most frequent inherited bleeding disorder in women, characterized by quantitative or qualitative deficiency in von Willebrand factor (VWF). This deficiency in functional VWF has a dual effect on hemostasis, resulting in impaired coagulation; thus, it may cause unstoppable abnormal uterine bleeding (AUB).

A 44-year-old female complained of AUB for 4 years before admission. She was diagnosed with adenomyosis and had been taking dienogest 1 × 2 mg; however, the bleeding still continued. She was hospitalized due to her heavy bleeding, with her lowest hemoglobin level (7.0 g/dL) and received recurrent blood transfusion. As coagulation disorder was suspected, the laboratory result revealed a low level of Factor VIII (52.0%) and Factor von Willebrand (37.0%), suggestive of Type 2 VWD. She also had generalized anxiety disorder related to her refractory AUB. She then underwent laparoscopy total hysterectomy, right salpingo-oophorectomy, and left salpingectomy for source control. Preoperatively, 2 units of cryoprecipitate and intranasal desmopressin (DDAVP) 300 mcg were given. The medication continued up to 7 days after surgery, with no massive bleeding reported afterwards.

Coagulopathies, including VWD, should always be suspected in patients with refractory AUB. Preoperative medication such as cryoprecipitate products and DDAVP could be given to provide an immediate hemostatic response in preventing excessive bleeding during surgery. Laparoscopy is considered the best surgical approach to ensure less blood loss and lower risk of hemorrhage. A multidisciplinary approach is essential to ensure both effective hemostatic control and comprehensive patient care.