Child’s excessive bleeding from skin lesion first sign of VWD: Study
Case highlights importance of clinicians understanding indications of disorders
Excessive bleeding from a common skin abnormality was the first indication of von Willebrand disease (VWD) in a 1-year-old girl, highlighting the importance of dermatologists and other clinicians understanding signs of bleeding disorders, a case study reports.
After the child scratched a pyogenic granuloma, a benign outgrowth of small blood vessels into the skin, it bled extensively. Although pyogenic granulomas are common and can bleed easily, the degree of bleeding was higher than expected. Combined with a family history of VWD, this clinical presentation pointed to the diagnosis of VWD type 1.
“This case highlights the importance of considering an underlying bleeding disorder when faced with atypical or profuse bleeding from a commonly encountered skin lesion, such as a pyogenic granuloma,” researchers wrote.
The study, “Profuse Bleeding From a Pyogenic Granuloma As the First Clue to von Willebrand Disease in a Pediatric Patient,” was published in Cureus.
Child’s excessive bleeding ‘not typical for such a lesion’
VWD is a bleeding disorder typically caused by genetic mutations passed down through families. These mutations cause problems with the production or function of von Willebrand factor (VWF), a protein that helps blood clot, putting patients at an increased risk of bleeding.
To diagnose VWD, clinicians may rely on symptoms, family history, and several blood tests. These tests, or hematologic assessments, may be used to measure VWF levels and activity, as well as clotting speed.
There are several types of VWD that have distinct underlying causes and different levels of severity. VWD type 1 is the most common form, and typically the mildest. People with VWD type 1 have lower-than-normal levels of VWF, but the protein is still present.
In this report, the research team described the case of a 1-year-old child with a skin lesion on her lower right eyelid. After the lesion had been present for several months, the child scratched it and it bled excessively.
“While the lesion itself was consistent with a pyogenic granuloma, the magnitude of bleeding was not typical for such a lesion,” the researchers wrote.
At home, the child’s father, an emergency medicine resident, was able to control the bleeding. He put pressure on the area and injected lidocaine with epinephrine, a combination of medications that may locally reduce pain and bleeding.
The girl’s mother had a history of VWD, prompting clinicians to consider the possibility of an inherited bleeding disorder.
“Given the profuse bleeding and family history, the decision was made to pursue hematologic evaluation to rule out an inherited bleeding disorder,” the team noted.
Blood test results indicate girl had low VWF levels
Blood test results indicated the girl had low VWF levels and activity. Based on these findings, clinicians considered VWD type 1 to be a possible diagnosis. They recommended that the child undergo another round of blood tests to confirm this suspicion.
“In this case, the recommendation for follow-up testing reflects best practice per current guidelines, which emphasize the need for repeat evaluation once acute bleeding has resolved to confirm a stable diagnosis,” the team wrote.
At the time of publication, the child hadn’t yet completed these tests.
This case has since influenced internal practice guidelines in our dermatology clinic by prompting the inclusion of family bleeding history in the assessment of patients presenting with vascular lesions and atypical hemorrhage.
Clinicians also advised the family to cover the pyogenic granuloma to reduce the possibility of further injury. They also noted that surgery to remove the lesion might be an option for the girl. However, they suggested seeking guidance from a blood specialist, or hematologist, before pursuing this option.
By catching this case early, the clinical team was able to start a conversation about recognizing and caring for bleeding symptoms, according to the researchers. This highlights how non-hematologist specialists can play a role in the diagnostic process for bleeding disorders.
“This case has since influenced internal practice guidelines in our dermatology clinic by prompting the inclusion of family bleeding history in the assessment of patients presenting with vascular lesions and atypical hemorrhage,” the team wrote.
About the Author
