1. Chapter 10 Discussion: Von Willebrand disease
Chapter 10 Discussion: Von Willebrand diseaseChapter 10 Discussion: Von Willebrand
diseaseVon Willebrand disease (VWD) is the most common inherited bleeding disorder
with 1in 20,000 people being affected (Favaloro, 2017). The disease is caused by a lack of
the VonWillebrandfactor (VWF), a clotting factor that has multiple to functions: being a
carrier for coagulation factor 8 (FVIII) andallowing platelets to clump and aggregate
(Hubert, & VanMeter, 2018).The disease three subtypes, one to three with three being most
severe. Type one is indicated by VWF levels less than 50IU/dL and type 3 with undetectable
VWF levels (Echahdiet al., 2017).Men and women are both equally affected by VWD
however women can be faced with additional complications due tomenstruationand
childbirth (Govorovet al., 2016).PurposePost-partum hemorrhage (PPH)can be a major
complication of childbirth.Studies have shown a significant increase in the incidence of PPH
in women with VWD compared to those without the disease (Govorovet al., 2016).The
major purpose of the article was to investigate theincidenceof PPH in women with VWD and
examinehow PPH incidence correlates to each subtype of VWD. The levels of VWF and FVIII
during pregnancy and hemostatic drug treatment before and after delivery are also
examined in this study.ORDER NOW FOR ORIGINAL, PLAGIARISM-FREE PAPERSThe
discipline of the literature reviewThe article discipline can be classified underclinical
hematology. The researchers studied the lab results of patients to verify the existence of a
deficiency in the Von Willebrand factor. The research explores the ifhematologictreatments
help individuals affected with VWD decrease the incidence of PPH,
allhematologicissues,further exemplifyingthat this study is under thehematologic
discipline.Gaps and issuesGovorovet al. (2016) noted that collected data from the study
were insufficient in makingcomparisonsof different subgroups within the study. To make
comparisons getting more people of each VDW subtype would have been beneficial. With a
rare disease like VWD, amulti-centerstudy could have provided more information.
Obtaining information on maternal blood loss accurately also proved to be an issue in this
study due to differences in procedure between the facilities incorporated in the
study.Design and methodsStudy participants were recruited from the Coagulation Unit at
Karolinska University Hospital in Sweden.Deliveries from 14 different obstetric units were
examined.Researchers focused on women who delivered during1995-2012. The inclusion
criteria for participants were: a VWD diagnosis (all subtypes), female gender, age 18–50
years, and a history of at least one delivery.All women who met the inclusion criteria were
identified and invited to participate.The study design is retrospective and observational.
2. Chapter 10 Discussion: Von Willebrand diseaseSample, size, and setting34 women and 59
deliveries were included in the study. The age of the women ranged from 19 to 42 years of
age. Being that VWD is a rare disorder this sample size is considered to be relatively
large(Govorovet al., 2016).Findings and conclusionsIn thegroup with VWD incidence of PPH
was higher when compared to the general incidence in healthyindividuals. “The incidence of
primary PPH was 44%, severe primary PPH 20% and secondary PPH 12%”,(Govorovet al.,
2016). VWD typethree patientshad a higher risk of experiencing severe primary PPH
compared to other subtypes. When the diagnosis of VWD was unknown before pregnancy
researches found a higher risk of PPH as a result. Not receivinghomeostaticdrugs proved to
increase PPH ratesamong women with VWD.Low serum FVIII correlated with higher blood
loss during delivery.Implications for future researchFrom this researchfurthercan be
explored on the efficacy ofdifferent hemostatic drugtreatments in prevention PPH. Also,
clinical guidelines for women with VWD during pregnancy can be researched and studied to
help decrease the risk of PPH.Application to advanced nursing practiceIn advanced nurse
practice patients may present with different hematologic issues and advanced practice
nurses should educate themselves on those they may encounter in practice.Understanding
the issues in women with VDW face, as well as thehemostatictreatments available
tothesewomen is important in providing quality care.This study shows theimportance of
identifying women with undiagnosed VWD and getting a thorough medical history of
bleeding (personal and familial histories). The study also provides valuable information on
how different treatments can curtail the outcomes of PPH and the incidence of PPH in
different subtypes of the disease. Chapter 10 Discussion: Von Willebrand diseasePlease can
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