Question

A 14-year-old female is brought to the Family Medicine Clinic presenting with heavy menses and occasional epistaxis. The mother reports that this is common among the women in their extended family but not investigated until now.

Lab values in the preliminary workup include:
-Set of abnormal closure times in the PFA-100 bleeding test device (but not indicative of aspirin effect)
-Normal PT
-Slightly prolonged aPTT
-Normal platelet count
-Normal fibrinogen
-Hematocrit=32%
von Willebrand's workup reveals:
30% antigen level, 25% Ristocetin cofactor activity level, and 40% Factor VIII clotting activity.

The patient states that she wants analgesic relief from the discomfort accompanying menstruation and desires an intervention to reduce the episodic bleeding.

What is the best set of recommendations you can make to this patient?

Answer 1

Providing analgesic relief with acetaminophen, avoiding aspirin, managing bleeding with desmopressin (DDAVP), and oral contraceptive pills to regulate menses are recommended for a 14-year-old female with von Willebrand disease presenting with heavy menses and occasional epistaxis.

Step-by-step explanation:

The best set of recommendations for a 14-year-old female with heavy menses, occasional epistaxis, and a von Willebrand's workup indicating reduced levels of von Willebrand factor and Factor VIII would include medications to manage bleeding and relieve pain. Regarding analgesic relief, it's important to avoid aspirin as it can interfere with platelet function and exacerbate bleeding. Instead, non-steroidal anti-inflammatory drugs (NSAIDs) that do not affect platelet function as much, such as acetaminophen, may be used for pain relief during menstruation.For the management of her bleeding symptoms, treatment options include desmopressin (DDAVP), which can raise the levels of von Willebrand factor and factor VIII for a period of time, and oral contraceptive pills to regulate menses and potentially reduce the flow. Educating the patient on the importance of avoiding certain medications that can worsen bleeding and implementing iron supplementation if necessary due to heavy menstrual bleeding leading to anemia are also recommended.