von Willebrands Disease and Gynae Surgery

60-year-old lady for laparoscopic BSO – Preventative surgery


  • Family history of Ovarian Cancer
  • Mild Asthma – No admissions or steroids. 
  • Hypertension – single agent


  • Bleeding Disorder – Patient unsure of name of condition, knows it is a platelet problem.
  • Normal FBC and Coagulation Screen
  • VWD most likely diagnosis
  • First diagnosed 30 years ago – presented with epistaxis
  • PPH after all births
  • Life-threatening intraoperative haemorrhage requiring massive transfusion and ICU admission following elective D&C/Cone Biopsy
  • Brother died following post-tonsillectomy bleed
  • Telehealth Consult with haematologist recently – No letter available. Patient states they recommended Tranexamic acid and platelet cover preoperatively and oral tranexamic acid for 10 days postoperatively
  • Concern about possible transfusion reaction – describes dyspnoea and lip swelling during massive transfusion episode
  • Undergone 2 subsequent orthopaedic procedures with no bleeding – femoral nail in Japan and revision of femoral nail in Sydney. Both procedures performed under platelet cover.


Coagulation Screening in Perioperative Clinic


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Transfusion reaction

  • Most likely scenario is symptoms were attributable to massive transfusion
  • Early Group and screen for antibodies to identify any specific blood requirements preoperatively

Role for Thromboelastography?

  • Evolving research in this area, especially in the acute and perioperative settings.
  • TEG parameters of K-time and MRTG have been found to be effective in detecting patients with vWF:Rco < 30IU/dL (Diagnostic value <60)
  • See attached article on bleeding disorders and anaesthesia


  • Chase Haematologist letter and inform local team preoperatively to ensure we have all possible products required
  • Postpone surgery for shortest possible time until haematology review occurs.