Perioperative management of acquired von Willebrand syndrome associated with monoclonal gammopathy of undetermined significance: A case report and review of literature

Abstract

Acquired von Willebrand syndrome (AvWS) is a bleeding disorder characterized by symptoms resulting from a decrease in the von Willebrand factor (vWF) due to an underlying disease or medication. We report our experience in managing tooth extraction in a patient with AvWS who had bleeding gums. A 90-year-old woman was admitted to a nearby hospital for gastrointestinal bleeding treatment, wherein bleeding gums were observed. Suspecting AvWS, she was referred to the hematology department for further evaluation and subsequently to our department for oral cavity treatment. Following a comprehensive evaluation by the hematology department, a diagnosis of AvWS with a background of monoclonal gammopathy was made. Upon initial presentation to our department, the residual root of the right maxillary first premolar was considered the bleeding source and thus indicated for extraction. Following Factor VIII/vWF concentrate administration during hospitalization, the tooth was extracted under local anesthesia. A local hemostatic agent was inserted into the extraction socket; a hemostatic splint was applied after suturing and closing the wound. Postoperative bleeding from the wound was absent; after Factor VIII/vWF concentrate administration, the patient was discharged the following day. However, upon sutures removal nine days after the procedure, rebleeding occurred, requiring reapplication of a hemostatic splint. Two weeks after surgery, the splint was removed and hemostasis was achieved. In such cases, collaborating with the hematology department is necessary to formulate a customized treatment plan for each case.