On June 1 I provided two hemostasis lectures for Dr. Ingrid Oakley’s Nurse Anesthesia course at the University of Alabama at Birmingham. I particularly like doing these lectures because I admire and respect Dr. Oakley; UAB’s remote online real-time technology is cool, and the students are serious, bright, and engaging. These are experienced nurses working on an advanced degree, and they like to get things right because they always see that patient in the foreground. They also motivate me to cover questions I may otherwise not think about.
Anyway, I received a couple of questions from grad student Ben Tomlin, and will answer them here…
Ben asks, what is the preferred treatment for von Willebrand disease (VWD) patients when their bleeding is not resolved by DDAVP?
Ben, in the US there are two approved formulations, Humate P and Alphanate, and most practitioners prefer Humate P because the concentration of von Willebrand factor is about 4X the level of factor VIII. When administering Humate P, ensure regular laboratory monitoring. This avoids overdosing, which exposes the patient to thrombotic risk and wastes resources. Also, you want to confirm efficacy, as there are occasional (rare, actually), VWF inhibitors that shorten the half-life. Geo