Desmopressin (DDAVP) in bleeding disorders of childhood

As in adults, desmopressin (DDAVP) can be used in children for prophylaxis of bleeding and to stop bleeding in many hereditary and acquired bleeding d isorders. DDAVP is the treatment of choice in children with mild hemophilia and type 1 von Willebrand's disease (vWD), It is effective in some variant s of vWD and in many patients with platelet function defects. It reduces th e bleeding diathesis of children with uremia and drug-induced bleeding comp lications. In any case, a test dose of DDAVP has to be given to the patient to predict the hemostatic effect before relying on this drug for treatment. The respo nse can be measured by shortening of the bleeding time (BT) and of partial thromboplastin time (PTT), indicating a rise of Factor (F) VIII or von Will ebrand factor (VWF). Side effects such as facial flushing, transient headache, increased pulse r ate, and drop in systolic blood pressure are mild and transient. They can b e minimized when the dose is not exceeding 0.3 mu g/kg body weight, and the infusion lasts at least 20 to 30 minutes. The strong antidiuretic action o f DDAVP has some potential problems that are negligible in adults and older children when water intake is restricted. In infants and small children un der the age of 18 months, however, DDAVP should be used with caution and wi th close surveillance in order to prevent water intoxication and electrolyt e imbalance. The danger is increased when the patients receive parenteral f luid substitution. The advantages of DDAVP include the reduction in the use of plasma factor c oncentrates, thereby minimizing the danger of immunological or infectious c omplications, as well as the considerable reduction of costs realized by tr eatment with this form of medication. Fortunately, it can be applied succes sfully in the most frequent hereditary bleeding disorder, namely vWD type 1 .