A 28-year-old woman comes to her physician concerned about an excessive amount of bleeding from her gums when she brushes her teeth. Laboratory results show an increased partial thromboplastin time and increased bleeding time, but are otherwise unremarkable. Which of the following treatments is the least risky and will most likely alleviate this patient's symptoms?
2. factor VIII concentrate
3. vit K
4. LMW heparin
5. protamine sulfate
vit K and protamine- antidotes to warfarin and heparin- not given as coagulants on their own, pt has von Willebrand so need to give cryoprecipitate
The correct answer is A. This woman suffers from von Willebrand's disease, the most common inherited bleeding disorder; it results from a defective form or overall deficiency of vWF. vWF has two functions: it serves as the ligand for platelet adhesion to a damaged vessel wall, and it also is the plasma carrier of factor VIII. Due to platelet dysfunction and lack of a carrier for factor VIII, the unique lab finding in this disease consists of an increased bleeding time and an increased partial thromboplastin time. Cryoprecipitate is the precipitate that remains when fresh frozen plasma is thawed. It contains sufficient normal vWF to correct the bleeding dyscrasia. In addition to prolonged bleeding from mucosal surfaces as in this patient, other symptoms include easy bleeding and skin bleeding. While some clinicians do not use cryoprecipitate because of the possible risk of virus transmission, cryoprecipitate obtained from a well-screened donor may be a viable treatment option.
Answer B is incorrect. Factor VIII concentrate is used to treat individuals with hemophilia A, an inherited condition that results in factor VIII deficiency.
Answer C is incorrect. Vitamin K can be used to reverse the effects of warfarin, a vitamin K antagonist that inhibits vitamin K-dependent clotting factors. It will not correct a vWF deficiency.
Answer D is incorrect. LMWH is an anticoagulant that acts predominantly on factor Xa. This patient is in need of a procoagulant rather than an anticoagulant. LMWH can be administered subcutaneously. One advantage of LMWH over heparin is that the partial thromboplastin time does not need to be routinely monitored with this drug.
Answer E is incorrect. Protamine sulfate is used for reversal of heparinization. It is a positively charged molecule that acts by binding to heparin, a negatively charged molecule. Protamine would have no therapeutic benefit for this patient.