Peri-operative management of an adult patient with type 2N von Willebrand's disease scheduled for coronary artery bypass graft

A case report on the successful perioperative management of hepatectomy for hepatocellular carcinoma in a patient with von Willebrand disease

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Although von Willebrand disease (VWD) is a common inherited bleeding disease, only 1 case of hepatectomy in a patient with VWD has been described.

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Perioperative hemostatic management is important especially in patients with VWD undergoing surgery because of the dysfunction of the platelet and destabilization of the blood clotting factor VIII.

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The patient was successfully treated by administering factor VIII/von Willebrand factor concentrate and by measuring activated partial thromboplastin time as an index for perioperative hemostatic management.

Introduction

Although von Willebrand disease (VWD) is a common inherited bleeding disorder, very few cases of surgery in patients with VWD have been reported.

Presentation of case

A 77-year-old man was referred to our hospital for treatment of hepatocellular carcinoma (HCC) based on type C chronic hepatitis. He had also been treated for VWD in the hematology department of another hospital. Partial hepatectomy was performed with the administration of factor VIII/von Willebrand factor concentrate just before and after the operation. The perioperative course was uneventful, and the patient was discharged 12 days after surgery.

Discussion

VWD causes dysfunction of the platelet and destabilization of the blood clotting factor VIII. The patient was successfully treated with measurement of activated partial thromboplastin time (APTT) as an index for the management of hemostasis.

Conclusion

This report describes a rare case of a successful perioperative management of hepatectomy in a patient with VWD.

Evidence-based patient safety advisory: blood dyscrasias

Rarely, patients with blood disorders may seek to undergo plastic surgery. Although plastic surgeons are not expected to diagnose or manage blood disorders, they should be able to recognize which patients are suitable for surgery and which should be referred to a hematologist before a procedure. This practice advisory provides an overview of the perioperative steps that should be completed to ensure appropriate care for patients with blood disorders.

Redo-redo aortic root replacement with a mechanical valved conduit in a patient with von Willebrand's disease: Case report

A 40 year-old female, with a history of cardiac surgery for congenital aortic valve stenosis and von Willebrand's disease (VWD) presented with increasing shortness of breath due to mixed aortic valve dysfunction. With a paucity of such cases in the literature, we describe the successful outcome of a patient with VWD who underwent elective redo-redo aortic root replacement with a mechanical valved conduit. She was given a three-month trial of warfarin pre-operatively to evaluate the extent of bleeding risk. Her post-operative course was uneventful and she was discharged home after six days.