Unstoppable

A 2 year old boy presents with continued bleeding from his mouth, following a fall 5 hours ago.

Close questioning of his mother reveals a history of somewhat prolonged bleeding from immunisation sites, and other sites of minor injury. No medical attention was sought.

There is no history of lethargy, weakness, or pica. His drug and family histories are unremarkable.

Select Relevant Investigations
Full Blood Count

Performed

WBC: 7,900/mm3 (6,000 - 17,000)
Hb: 12.3 g/dL (10.5 -13.5)
Hct: 35.4% (33.0 - 39.0)
Platelets: 368,000/mm3 (156,000 - 369,000)
Clotting Profile

Performed

PT: 11 sec (10-13)
APTT: 37 sec (24-33)
Hemostasis Factor Assays

Performed

vWF Ag: 0.16 U/mL (0.78-1.53)
Ristocetin cofactor activity assay: <0.10 U/mL (0.50-1.50)
Blood Film

Performed

The peripheral blood film (blood picture) appears completely normal.

Select Relevant Management
Desmopressin
Tranexamic Acid
Iron + Folate
vWF Concentrates