Haematology: von Willebrand disease: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Haematology: von Willebrand disease

Sample item

A 20-year-old woman has heavy menstrual bleeding and recurrent nosebleeds since childhood. Platelet count and PT are normal, the aPTT is mildly prolonged, and the bleeding time is prolonged. Factor VIII activity is 30%, von Willebrand factor antigen is 28% and ristocetin cofactor activity is low in proportion. What is the most appropriate treatment for a heavy menstrual bleed?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Desmopressin with tranexamic acid

Type 1 von Willebrand disease is a quantitative partial deficiency of von Willebrand factor, which carries factor VIII and mediates platelet adhesion. Desmopressin releases stored von Willebrand factor from endothelial Weibel-Palade bodies and raises factor VIII, and tranexamic acid stabilises clots in mucosal bleeding. Von Willebrand factor concentrates are used for severe bleeding or non-responders.

Option by option

  • A. Desmopressin with tranexamic acid (correct)

    Correct. Desmopressin releases endogenous von Willebrand factor and tranexamic acid reduces mucosal bleeding.

  • B. Platelet transfusion

    Platelet counts are normal and the defect is in von Willebrand factor, so platelet transfusion is not needed.

  • C. Vitamin K

    Vitamin K corrects deficiency of factors II, VII, IX and X, which is not present here.

  • D. Fresh frozen plasma

    Plasma carries a risk of volume overload and is not the preferred source of von Willebrand factor when concentrates are available.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Desmopressin with tranexamic acid. Type 1 von Willebrand disease is a quantitative partial deficiency of von Willebrand factor, which carries factor VIII and mediates platelet adhesion.

Why is "Platelet transfusion" not the answer?

Platelet counts are normal and the defect is in von Willebrand factor, so platelet transfusion is not needed.

Why is "Vitamin K" not the answer?

Vitamin K corrects deficiency of factors II, VII, IX and X, which is not present here.

Why is "Fresh frozen plasma" not the answer?

Plasma carries a risk of volume overload and is not the preferred source of von Willebrand factor when concentrates are available.

What concept does this question test?

It tests Haematology: von Willebrand disease in General Medicine. Desmopressin releases stored von Willebrand factor from endothelial Weibel-Palade bodies and raises factor VIII, and tranexamic acid stabilises clots in mucosal bleeding. Von Willebrand factor concentrates are used for severe bleeding or non-responders.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: von Willebrand disease?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.