Haemostasis with cryoprecipitate in patients undergoing surgery for severevon Willebrand disease

Background. There are limited data on the management of haemostasis in pati ents with severe von Willebrand disease undergoing major surgery. Data on t he use of cryoprecipitate in this setting are even more limited. In many de veloping countries cryoprecipitate is often the only available source of fa ctor replacement. The minimum factor levels required for maintaining haemos tasis after surgery have never been carefully evaluated. Methods. Data from 3 patients with severe von Willebrand disease who underw ent 4 major surgical procedures at our institution, using lower than standa rd recommended doses of cryoprecipitate were analysed for adequacy of facto r replacement and complications. Results. The average preoperative cryoprecipitate infusion was 22.5 i.u, of factor VIII/kg (range: 15-25). The bleeding time done by the modified Ivy method, 30 minutes after infusion, was normal in all these patients, The av erage cryoprecipitate support for days 1-3 was 16.5 i.u. of factor VII/kg/d ay (range: 12.5-25) and for days 4-10 was 12.4 i.u. of factor VIII/kg/day ( range: 8.3-16), The mean duration of factor replacement was 12 days (range: 7-17). Two patients had delayed bleeding, one on day 3 attributed to the i nadvertent use of a non-steroidal and-inflammatory drug and the second on d ay 10 which was probably secondary to septicaemia. Bleeding resolved in bot h these patients as soon as the precipitating factors were relieved. Conclusion. The total amount of factor replaced in our patients is approxim ately half of what would have been used if the usual recommendations were f ollowed. The data suggests that lower doses of cryoprecipitate could be ade quate for major surgery and wound healing In severe von Willebrand disease. This will lead to lowering of costs and reducing the risk of transfusion-a ssociated virus infection.