Brain CT noncontrastaxial view. Dietrich, and W. Strouse, and R. Preoperative paranasal sinus CT. At presentation, he was taking felodipine, ramipril, prednisolone 6 mg weaning dose, omeprazole and alendronic acid.
Recognizing and Remediating von Willebrand Disease: A Case Study in Collaborative Care - lilypaddayspa.biz
AvWD is a rare disorder with cases reported in published literature up to Abstract Von-Willebrand disease VWD is one of the platelet dysfunction disorders that results from a deficiency of Von-Willebrand factor, which is essential for hemostasis. Therefore, it is essential to take my dream job sample essay meticulous history of any bleeding event after surgical procedures.
The laboratory results corresponded to Von-Willebrand disease type IIa. Furthermore, history taking regarding coagulative disorders, anticoagulative medication history, and bleeding events after simple trauma or procedures is crucial.
The MRI with gadolinium enhancement showed a 3 cm multilobulated tumour in the left parotid gland in the anterior aspect superficially with clear boundaries and no evidence child creative writing invasion of the surrounding tissue.
View at Google Scholar M. In addition, adjunctive treatment with antifibrinolytic agents i. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Pang, J.
What is von Willebrand Disease?
This was histologically reported as an EMC. Cohen, and N.
Participants are advised to consult prescribing information for any products discussed. Introduction Epistaxis is the most common emergency in ENT departments. Conflict of Interests The authors declare that there is no conflict of interests regarding the publication of this paper.
Therefore, due to these results and the late onset of an abnormal bleeding episode without a family history of vWD a diagnosis of AvWD was made. The patient was also diagnosed with GI angiodysplasia during an evaluation for hematemesis and hematochezia.
An unknown explanation of menorrhagia in women and mucocutaneous bleeding during or after invasive procedures should raise suspicion of VWD [ 7 vwd case study, 8 ].
Suspicion of a coagulative function disorder and early consultation with a hematologist are essential if a patient has a previous bleeding history and bleeding is not controlled by nasal packing, surgical management, or embolization. At presentation, he was taking felodipine, ramipril, prednisolone 6 mg weaning dose, omeprazole and alendronic acid.
Figure 1: Even if general laboratory tests such as PT, aPTT, and platelet count show normal results, a coagulative function disorder may still be present. He was diagnosed with AvWD. He had no children, lived alone and was a non-smoker and occasional drinker.
- Von Willebrand's disease: case report and review of literature
- To prevent further bleeding, nasal packing was performed again in the right nasal cavity.
- Most cases of epistaxis can be managed with conservative techniques, but in some cases, cauterization chemical or electrical or nasal packing is required.
- This was histologically reported as an EMC.
- Kansestani et al.
The hematemesis lasted for several days, and the bleeding eventually stopped spontaneously. However, the man later visited the emergency department due to nasal bleeding.
Angiodysplasia associated with VWD has been reported for many years [ 3 ]. On the second day after surgery, the packing was removed successfully without further bleeding.
Von-Willebrand Disease Presenting as Intractable Epistaxis after Nasal Polypectomy
Disclosure of Unlabeled Use This CME activity may or may not discuss investigational, unapproved, or off-label use of drugs. References R. Case Presentation A year-old man underwent endoscopic nasal polypectomy.
Vwd case study examination of his neck, a 3—4 cm firm, round swelling was palpable in the left parotid vwd case management plan template business plan. It is predominantly a tumour of the major salivary glands but they may also arise in minor salivary glands 13—15 and rarely in extraoral sites such as the paranasal sinuses, 13 14 pharynx 14 and bronchus.
During angiography, a pseudosac was found at the distal part of the left maxillary arterial branch, but a definite bleeding focus could not be found Figure 2. Rahimi, A.
Support haymarketmedical. Subacute subdural hemorrhage was found after head trauma from a fall. He also has a congenital malformation of his right forearm. At the time of this event he visited his dentist who felt that the laceration in his oral cavity was too small to explain the extent of his bleeding.
To date, many guidelines and algorithms for epistaxis management have been reported, but consensus has not been reached [ 12 ]. VWD patients typically have normal laboratory results on screening for bleeding disorders.
Background This is the first case report of a patient with acquired von Willebrand's disease AvWD secondary to epithelial myoepithelial carcinoma EMC of the parotid salivary gland. He did not need a blood transfusion and dissertation proposal for human resource management bleeding stopped spontaneously. If you have any other questions relating to your certificate or other issues with the activity, please contact myCME.
The packing was removed the next day, but continuous bleeding from the right nasal cavity developed. Apart from this there were no other symptoms or signs on history and examination.
In this case, all parameters including PT, aPTT, and platelet count were in normal ranges; however, there was a history of bleeding events after biopsy and a simple dental procedure. Owing to his bleeding episode the ear, nose and throat ENT department felt it would be best to organise MRI of his head and neck and liaise with the haematology department regarding safely performing fine-needle aspiration FNA of the lump for cytology.
Otherwise he had been feeling well without any significant weight loss, no change in bowel habit and no rectal blood loss or nosebleeds.
This case report highlights the presentation, investigation and management of AvWD and parotid lumps as well as discussing proposed pathophysiological mechanisms for AvWD. We report a case of intractable epistaxis after endoscopic nasal polypectomy, which was later diagnosed as Von-Willebrand disease and managed by platelet transfusion.