Anesthetic management of cesarean section in a patient with type II von Willebrand disease

von Willebrand disease is one of the inherited bleeding disorders, and caused by the deficiency or the abnormality of von Willebrand factor. A 28-year-old woman with von Willebrand disease (type II) was scheduled for cesarean section under general anesthesia. Platelet count was within normal limits. However, the prolongation of both APTT and bleeding time was confirmed. The level of von Willbrand factor was within normal ranges, but its activity was about 55%. The platelet aggregation was below 1.3%. We managed to administer factor VIII concentrate to her intravenously before and after operation. We did not perform epidural catheterization because we cannot forecast the amount of bleeding. We could successfully manage this case without any complications. Intravenous patient controlled analgesia was given for postoperative pain. The perioperative course was uneventful and the patient was discharged 7 days after the operation.