Patient with von Willebrand Disease for Gynaecologic Surgery - Perianaesthetic Concerns

Abstract

We report a case of von Willebrand (vWD) disease and highlight the relevance of this condition to the perianaesthetic management.A 23-year-old female, known case of vWD diagnosed at 3 years of age, was posted for laparoscopic ovarian cystectomy. Pre-induction, patient was transfused with cryoprecipitate 10units. Standard tech-nique of anaesthesia was followed with intraoperative cryoprecipitate administration. Surgery was uneventful with adequate hemostasis. Post-operatively analgesia was maintained with morphine patient controlled analgesia(PCA). All intra-muscular injections were avoided. She was transfused with cryoprecipitate/ fresh frozen plasma(FFP) till 5th day and injection tranexamic acid was administered. Postoperative serum coagulation studies were within normal limits. Patients with vWD do not carry an increased operative risk during elective procedures if appropriate prophylac-tic and corrective therapy is administered. Although the administration of cryoprecipitate and other blood products has traditionally been the cornerstone of treatment for vWD, the recent development of desmopressin(DDAVP) for clinical use may provide an effective alternative to replacement therapy with blood products. Further laparaoscopic procedures, taking care during ryle′s tube and foley′s catheter insertion, in such patients are the safer alternative for all kind of gynecologic surgeries.

Keywords

• von Willebrand disease
• von Willebrand factor
• Coagulopathy.