.Snapshot A 30-year-old woman presents with a recurrent history of nosebleeds and heavy menses. She recently read that taking a baby aspirin was good for the heart. However, ever since she started taking aspirin, she has been experiencing more and more nosebleeds. Her father and paternal uncle similarly have histories of prolonged nosebleeds. Labs show increased PTT, normal PT, and increased bleeding time. Introduction Inherited mixed platelet and coagulation disorder from deficiency in von Willebrand factor (vWF) Epidemiology Most common inherited bleeding disorder Female to male ratio 2:1 login to view 1 more bullet More likely in Caucasians Genetics login to view 1 more bullet ETIOLOGY Pathogenesis login to view 5 more bullets Presentation Symptoms login to view 8 more bullets STUDIES Normal or ↑ PTT (like hemophilia) Normal PT ↑ bleeding time (unlike hemophilia) CBC login to view 2 more bullets ↓ von Willebrand factor antigen Differential Diagnosis Bernard-Soulier syndrome Glanzmann thrombasthenia Hemophilia DIAGNOSIS Diagnosis by ristocetin cofactor assay login to view 2 more bullets Repeat testing may be required as vWF is an acute phase reactant login to view 1 more bullet Treatment Prevention login to view 1 more bullet DDAVP (desmopressin acetate) login to view 1 more bullet Factor VIII replacement if refractory to DDAVP login to view 1 more bullet Cryoprecipitate no longer used Complications Excessive bleeding, especially during childbirth Prognosis Most are mild or moderate in severity Variable prognosis