Anesthesia for cesarean section in patient with von Willebrand's disease and HIV infection: case report.

• Published in: Revista brasileira de anestesiologia Vol. 54; no. 6; pp. 788 - 793
• Main Authors: Balle, Vanessa Rezende, Machado, Sheila Braga, Gomes, Marcos Emanuel Wortmann, Mendes, Florentino Fernandes
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil 01-12-2004
• ISSN: 1806-907X
• DOI: 10.1590/s0034-70942004000600006

Von Willebrand's disease is the most common hereditary coagulation disorder in young women. The incidence of HIV infection among women has been progressively increasing, and vertical transmission may account for 25% of cases. This report aimed at describing the case of an HIV-positive patient with von Willebrand's disease scheduled for cesarean section.
Female HIV-positive patient, 24 years old, with microcytic anemia and von Willebrand's disease, admitted to the emergency room in early labor. She had no pre-natal care. Cesarean section was indicated to lower vertical transmission risks since HIV viral count was unknown. Patient had hematomas on both arms and legs and history of abdominal wall hematoma in previous cesarean section. Coagulation tests were mildly changed. General anesthesia was induced after factor VIII concentrate infusion. Both mother and newborn had satisfactory outcomes.
Clinical evaluation of patients with coagulopathies is critical for determining the anesthetic technique. Evaluation should be individualized, considering risks and benefits of the technique. Cesarean section for these patients should be avoided whenever possible and replaced by less invasive methods. Factor VIII concentrate therapy is the best treatment option for correcting specific deficiency and lowering viral transmission risks.