All parents deal with their child's bruises and bloody noses from time to time. For most kids, a bandage and a sympathetic hug are all it takes to get them back in the game.
But a small number of kids have frequent nosebleeds, unexplained bruising, or prolonged bleeding after a tooth is pulled. Such excessive or prolonged bleeding could be a sign of a genetic disorder known as von Willebrand disease.
For many kids with this disorder, the symptoms are so mild that they never know they have it. Those with a more severe form of the disease, though, need proper diagnosis and a treatment plan to help them lead normal, active lives.
Von Willebrand disease, or vWD, is an inherited disorder that affects the blood's ability to clot properly. It takes its name from Dr. Erik von Willebrand, who first described the condition in 1926. As a group, bleeding disorders (including hemophilia) are rare. Von Willebrand disease is the most common inherited bleeding disorder, affecting about 1% of the population.
Normally, bleeding occurs when a blood vessel is cut or torn. The blood's ability to clot (to plug the hole in the blood vessel and stop the flow of blood) is a complex process involving platelets and proteins called clotting factors. Von Willebrand factor is involved in the early stages of blood clotting, and also carries the important clotting protein factor VIII. (Factor VIII is the protein that is missing or defective when someone has hemophilia.)
People with vWD have bleeding problems because the levels or functioning of these blood components needed for clotting are abnormal.
As with many conditions, there are various forms of vWD. Unlike hemophilia, which affects only boys, vWD affects boys and girls equally.
Like hemophilia, vWD is a genetic disorder that is usually passed from parent to child (very rarely, it can be acquired after birth). The child of a man or a woman with vWD has a 50% chance of getting the gene.
In types 1 and 2, a child can inherit the gene for the disease from one parent only. In type 3, the child usually needs to inherit the gene from both parents. In those cases, the child will likely have severe symptoms, even if the parents don't have any symptoms at all. Also, a child can inherit the gene and show no symptoms, but as a carrier can pass the gene on to any offspring.
The symptoms of von Willebrand disease can include:
Because symptoms can be mild, vWD can be difficult to diagnose and often goes undetected.
Blood tests used to diagnose vWD include:
Tests might need to be repeated because the levels they detect may rise and fall over time. Also, the doctor will take a family medical history to see if other relatives have a bleeding disorder.
The most common treatment for vWD is desmopressin, a medication that causes a temporary increase in the von Willebrand factor and factor VIII levels. It can be given intravenously (into a vein) or intranasally (into the nose), but may be ineffective in treating Type 2A or Type 2B.
People with Type 3 (and some with Type 2A and 2B) will need treatment with Humate-P, an intravenous medication derived from human plasma that contains factor VIII and von Willebrand factor. Those with Type 1 also might receive Humate-P in certain situations, such as major trauma or major surgery, although they usually can be treated with desmopressin.
Medication to inhibit the breakdown of blood clots (such as aminocaproic acid) also might be used.
Kids with vWD should avoid unnecessary trauma, including contact sports. If bleeding does occur, apply pressure to the area. During nosebleeds, pinch the soft part of the nose and have the child lean slightly forward to keep the blood from flowing down the throat.
Because of the possibility of excessive bleeding, male infants who are at risk for vWD (those with a family history of the disease) should not be circumcised without a doctor's OK.
Girls with vWD who have started their periods might want to take extra pads or a change of clothes in case of accidents. Heavy menstrual bleeding sometimes can be controlled with birth control pills.
Kids with vWD should not take aspirin and other non-steroidal anti-inflammatory drugs (such as ibuprofen) for pain or fever. These drugs interfere with platelet function and can increase the risk of bleeding. It is safe to take acetaminophen, which doesn't affect platelet function.
Call your doctor immediately if your child experiences any excessive or unexplained bleeding.