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Von Willebrand Disease (VWD)
Part 1: NHLBI Diagnosis Guidelines

Introduction & Clinical Assessment Recommendations

VWD NHLBI Guidelines (2008)1Initial Patient Evaluation — History4

Slide 16

May 2011

Which bleeding history questions are the most useful for identifying persons with a bleeding disorder? This Table is excerpted from a larger Table in the NHLBI VWD Guidelines, and summarizes part of the information from one of the few published studies4 — that helps identify which bleeding history questions are the most informative for identifying persons with a possible bleeding disorder. The most informative questions are: 1) Family history of a bleeding disorder, especially a diagnosed bleeding disorder, demonstrating odds ratios (OR) of 50-98 vs. those without a bleeding disorder; and 2) History of abnormal bleeding with surgery or wounds or dental extractions, demonstrating OR of 6-67 for those with a bleeding disorder. Mucocutaneous bleeding symptoms, such as easy bruising (ecchymoses) or nosebleeds (epistaxis) have lower predictive power for a bleeding disorder (eg, OR 4-10), however mucocutaneous bleeding symptoms are prevalent in persons with VWD. Other bleeding symptoms such as a history of menorrhagia have limited predictive power (OR) for a bleeding disorder, however menorrhagia is a frequent manifestation of a bleeding disorder such as VWD, but may often have other causes. Information from this study, and 2 others, was used to develop the 9 recommended bleeding history questions (previous slide 16, Box 1).

Summarizing and synthesizing the clinical bleeding history assessment, persons with VWD (or other bleeding disorders) are likely to have more than 1, or several of these bleeding symptoms or a history of them — especially abnormal bleeding with surgical or invasive challenges, along with a history of mucocutaneous bleeding, as well as a family history of a bleeding disorder — and the history and types of abnormal bleeding symptoms are partially age-dependent (eg, adults vs children).

Initial Patient Evaluation History4


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