Cancer and cancer surgery

The patients with VWD should be treated for cancer in the same way as the patients without bleeding diathesis, but the specifics of hemostasis need to be delineated. In case of invasive procedures or surgery, the need for factor concentrate or desmopressin in combination with tranexamic acid should be evaluated and a written plan and laboratory follow-up are to be provided. Since some types of chemotherapy can cause thrombocytopenia, the bleeding tendency could increase in patients with VWD. With good clinical planning together with the oncologist, anesthesiologist and surgeon regarding management of cancer and hematological treatment, the hemostatic routines can be established.

Some types of cancer, for instance myeloproliferative disorders, multiple myeloma, and sometimes solid tumors can be associated with acquired von Willebrand syndrome. It is therefore important to check blood samples on a regular basis, and on demand upon increased bleeding symptoms.

Since women with VWD often have menorrhagia, bleeding symptoms due to a gynecologic cancer, may be overlooked and the diagnosis may be delayed. It is therefore important to have regular appointments with gynecologists, and acutely in case of changing bleeding patterns.

Cancer patients may become thrombogenic, and therefore high VWF/FVIII levels (above 150 IU/dL) should be avoided in association with replacement therapy and surgical settings. Pure VWF concentrates are often preferred under these circumstances. In some extreme cases with high thrombotic burden, thromboprophylaxis with low-molecular weight heparin can be considered. Some types of cancer, for instance myeloproliferative disorders, multiple myeloma, and sometimes solid tumors can be associated with acquired von Willebrand syndrome. It is therefore important to check blood samples on a regular basis, and on demand upon increased bleeding symptoms.