pubertal AUB

Question 1

what is ddx?

Answer 1

• anovulatory bleeding (HPO axis immaturity)
• bleeding disorders
• vaginitis
• pregnancy
• endocrine

Question 2

what is the work-up?

Answer 2

• pregnancy test
• vaginal/cervical cultures
• TSH
• CBC, fibrinogen, ptt, pt/inr

Question 3

what does VWF do?

Answer 3

• aids in plt aggregation

- carries and releases factor 8

Question 4

what are types and inheritance patterns of VWD? what testing do you do for VWD?

Answer 4

type I: mild deficiency, autosomal dominant
type II: qualitative issue with VWF, AR
type III: severe/complete absent VWF, AR

Testing:

• ristocetin factor activity level for vwf
• vwf Ag
• factor VIII

Question 5

treatment for vwd

Answer 5

• desmopressin acetate (ADH analogue that causes release of VWF from endothelium)
• 50% fetal risk if type I; avoid vacuum delivery, FSE. delay circumcision