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///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-05:00

Use of TEG to evaluate a term obstetric patient with presumed VWD type 2B presenting to labor and delivery

Abstract Number: T-69
Abstract Type: Case Report/Case Series

Nicole M Verdecchia MD1 ; Nicholas Schott MD2; Jonathan Waters MD3

Background:

There are several types of von Willebrands Diesease (VWD), each with different presentation, work up, and treatment. While factor VIII levels, VWF:Ag, and VWF:RCo have been used as predictors for bleeding and response to treatment in type 1 VWD, there are no guidelines to accurately predict bleeding risk and response to treatment in pregnant patients with other types of VWD (1-3). Thromboelastogram (TEG) analysis was used in the management of a patient with a presumed diagnosis of type 2B VWD.

Case Report:

The patient was a 24 year old G6P0151 female with a history of recurrent spontaneous abortions and bleeding after tonsillectomy, who presented in labor. Her sister had a history of VWD type 1, and she reported a history of VWD type 2B. There was no diagnostic labs to confirm the diagnosis. She received recombinant VWF prior to epidural placement and just following her spontaneous vaginal delivery at the request of the hematology service based on history. TEG analysis was performed prior to recombinant VWF, after recombinant VWF, and after delivery (Table 1).

Discussion.

The patient’s TEG results prior to delivery were hypercoagulable, unlike case reports of TEG evaluation during pregnancy which show a hypocoaguable TEG (1-3). This prompted further investigation into the patient’s history. She had outside hospital labwork done at 21 weeks which was normal, and not consistent with VWD, including normal PTT, Factor VIII, ristocetin cofactor, platelet count, and VWD antigen. Therefore, she likely did not have VWD. In this case, TEG helped to disprove a diagnosis of VWD. Recombinant VWF was not warranted and potentially increased her risk of thrombotic complications. More data on TEG analysis during pregnancy is needed, but it may be used as a tool to determine if a patient requires recombinant VWF during labor and delivery when the initial diagnosis is unclear.

References

1. Biguzzi E, Siboni S, Ossola M, Zaina B, Migliorini A, Peyvandi F. Management of pregnancy in type 2B von Willebrand disease: case report and literature review.Haemophilia. 2015 Jan;21(1):98-103.2014 Nov 27.

2. Güth U, Tsakiris D, Reber A, Holzgreve W, Hösli I. Management of patients with Type 2B von Willebrand's disease during delivery and puerperium. Z Geburtshilfe Neonatol. 2002 Jul-Aug;206(4):151-5.

3. Toukh M, Ozelo M, Angelillo-Scherrer A, Othman M. A novel use of thromboelastography in type 2B von Willebrand disease. Int. J Lab Hematol. 2013 Dec;35(6):11-4.



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