Wed10November0747AM 5

You are asked to provide advice on a 35-year-old woman who is admitted under the maxillo-facial surgeons for extraction of wisdom teeth.

The only concern was that she had developed prolonged bleeding following a tooth extraction 10 years previously and had required suturing. Besides this, she gave no other history of bleeding.

What is the most likely diagnosis?

(Please select 1 option)

Factor IX deficiency

Factor XII deficiency

Primary antiphospholipid syndrome

von Willebrand's disease Correct

Factor V Leiden

Explanation

Not that much is given away by this history just the issue of a prolonged bleed after prior dental extraction.

The most likely diagnosis when considering this patient is von Willebrand's disease which is an autosomal dominant condition and is one of the commonest bleeding disorders. Most cases are mild, with bleeding after only mild injury, particularly mucosal membrane injuries.

The condition is due to a reduction or structural abnormality of von Willebrand's factor, which has the dual role of promoting normal platelet function and stabilising coagulation factor VIII.

von Willebrand's disease can give normal results on screening tests and diagnosis may require specialist investigation.

Most patients with mild disease respond to desmopressin (DDAVP) but clotting factor concentrates are needed for a minority.

Answer Statistics

1

3%

2

2%

3

1%

4

87%

5

9%

Times answered: 267