An anesthetic case report of VON willebrand's disease

A case of von Willebrand's disease with repetitive postoperative bleeding is reported. A 4-year-old boy was scheduled for tonsillectomy and sdenoidectomy under general anesthesia. Physical examination findings were within normal limits and laboratory data reve aled no abnormalities except for slight prolongation of the bleeding time (5 min by Duke's method). His past history and family history were non-contributory. Although there was no bleeding tendency during operation, nasal bleeding began after he returned to the ward. Operations for hemostasis had to be done three times over the following two weeks. After that, his past history was re-examined and it was clarified that he had had frequent epistasis and had a episode of difficulty of hemostasis after extraction of the tooth. Further laboratory examinations revealed that both he and his mother were the patients of von Willebrand's disease. This case tells us that a careful examination of history is very important. In the pre-operative preparation of a patient suffering from von Willebrand's disease, it is important to select a time for surgery and to infuse cryoprecipitate before operation. During operation fresh whole blood must be used for blood transfusion. Hypothermic anesthesia and use of aspirin should be avoided.