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Volume 351:2345-2346 November 25, 2004 Number 22
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Treatment of von Willebrand's Disease

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by Mannucci, P. M.
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To the Editor: In his scholarly review of the treatment of von Willebrand's disease, Mannucci (Aug. 12 issue)1 omits a discussion of hypothyroidism as a cause of acquired von Willebrand's disease. Hypothyroid patients may have bleeding symptoms such as easy bruising, menorrhagia, or prolonged bleeding after tooth extraction. The most frequent defects in hemostasis are a prolonged bleeding time, decreased platelet adhesiveness, and low plasma concentrations of factor VIII and von Willebrand factor.2 Desmopressin rapidly ameliorates these abnormalities3 and is of value for the acute treatment of bleeding or when surgery is necessary. Long-term thyroxine replacement reverses these abnormalities.3,4 Acquired . . . [Full Text of this Article]



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