How Is von Willebrand Disease Diagnosed?
Early diagnosis of von Willebrand disease (VWD) is
important to make sure that youre treated and can live a normal, active
life.
VWD is sometimes difficult to diagnose. People with
type 1 or type 2 VWD may not have major bleeding problems. As a result, they
may not be diagnosed until they have heavy bleeding after surgery or some other
trauma.
On the other hand, type 3 VWD can cause major
bleeding problems during infancy and childhood. As a result, children with type
3 VWD are usually diagnosed during their first year of life.
To find out if you have VWD, your doctor will review
your medical history and the results from a physical exam and tests.
Medical History
Your doctor will likely ask questions about your
medical history and your familys medical history. He or she may ask
about:
- Any bleeding from a small wound that lasted more
than 15 minutes or started up again within the first 7 days following the
injury.
- Any extended, heavy, or repeated bleeding that
required medical attention after surgery or dental extractions.
- Any bruising with little or no apparent trauma,
especially if you could feel a lump under the bruise.
- Any nosebleeds that occurred for no apparent
reason and lasted more than 10 minutes despite pressure on the nose, or any
nosebleeds that needed medical attention.
- Any blood in your stools for no apparent
reason.
- Any heavy menstrual bleeding (for women). This
bleeding usually involves clots or lasts longer than 7 to 10 days.
- Any history of muscle or joint bleeding.
- Any medicines you've taken that might cause
bleeding or increase the risk of bleeding. For example, aspirin and other
nonsteroidal anti-inflammatory drugs (NSAIDs), clopidogrel
(Plavix®), warfarin, or heparin.
- Any history of liver or kidney disease, blood or
bone marrow disease, or high or low blood platelet counts.
Physical Exam
The doctor also will do a physical exam to look for
unusual bruising or other signs of recent bleeding. He or she also will look
for evidence of liver disease or
anemia.
Diagnostic Tests
No single test can diagnose VWD. Your doctor will
order a combination of blood tests to diagnose the disease. These tests may
include:
- Von Willebrand factor antigen. This test measures
the amount of von Willebrand factor in your blood.
- Von Willebrand factor ristocetin
(ris-toe-SEE-tin) cofactor activity. This test shows how well the von
Willebrand factor works.
- Factor VIII clotting activity. Some people with
VWD have low levels of factor VIII activity, while others have normal levels.
- Von Willebrand factor multimers. This test is
done if one or more of the first three tests are abnormal. It shows the makeup
or structure of the von Willebrand factor. It helps your doctor diagnose what
type of VWD you have.
- Platelet function test. This test measures how
well your platelets are working.
Your doctor may order these tests more than once to
confirm the diagnosis. He or she may also refer you to a hematologist (a doctor
who specializes in treating blood diseases) to confirm the diagnosis and for
followup care. |