Specialist Haemophilia Centres or Services have a team of health professionals with expertise in providing treatment and care to people with bleeding disorders including VWD. They can work with the person with VWD to make a treatment plan and advise on ways to live well with VWD.
The team includes:
- Haematologists: doctors who specialise in blood disorders
- Haemophilia nurses
- Social workers or counsellors
- Other specialist health professionals
The recommended treatment for VWD can depend on the type of VWD a person has and how severe it is. Usually people with mild VWD will only need treatment if they have surgery, dental work or an accident or injury.
For some minor bleeding problems, like bruising, treatment may not be necessary.
If people do need treatment at times, there are several treatments available. Which treatments will be used on particular occasions will depend on the person’s medical needs, what works best for them and the situation. The haematologist will consider all of this when they work with the person to decide the best treatment option.
Desmopressin (DDAVP) is a synthetic hormone. It works by releasing the body’s stored VWF and factor VIII into the bloodstream to help blood clot. These stores are limited, so a person may need to wait for the body to rebuild its stores of VWF before taking another dose, usually about 24 hours. Desmopressin can be given as a slow injection into a vein, but may also be given as an injection subcutaneously (into the fatty tissue under the skin), or in special circumstances as a nasal spray.
Desmopressin can help to prevent or treat bleeding in many people. It is not suitable for everyone. The haematologist at the Haemophilia Centre may decide to give a test dose of desmopressin and evaluate whether it will work for that particular person. This test may need to be repeated at times as people’s responses to DDAVP change at different times in their life.
Clotting factor concentrate made with von Willebrand factor (VWF) and factor VIII (FVIII) replaces the missing VWF and FVIII in the blood and helps blood to clot. This clotting factor concentrate is made from the plasma (pale yellow fluid part) in human blood and is produced from blood donations.
This clotting factor concentrate is used when DDAVP is not suitable, or when it is likely the person will need treatment for more than 2-3 days, eg after major surgery. The treatment is infused (injected) into a vein in the arm.
Tranexamic acid and aminocaproic acid are medicines that stop blood clots being dissolved once they have formed. They can be used to stop bleeding in the mouth or nosebleeds, gut bleeding, bleeding after dental work, minor surgery or an injury.
Most commonly they are taken as tablets, syrup or as a mouthwash. They may be used by themselves or together with DDAVP or a clotting factor concentrate.
Fibrin glue is a medical gel made from fibrinogen and thrombin, which are proteins in the body that help blood to clot. It can be applied directly onto a wound to stop bleeding.
Hormone treatment, such as oral contraceptives (birth control pills), can help women who have heavy menstrual bleeding. The hormones can increase VWF and factor VIII levels.