Question: Good afternoon, I'm a 31-year old male who is currently being evaluated for potential bleeding disorders, due to a 7-month history of constant petechiae. My petechiae spots are usually fairly minimal in number, and scattered throughout my body. At this point I have had several normal CBCs (platelets always within reference range, and range from 160,000-186,000), and normal comprehensive metabolic panel, INR/PT, aPTT, C-Reactive Protein, Sed rate, D-dimer, ANA, and TSH. I was referred to a hematologist for specialized bloodwork, which revealed low VWF antigen (28%), VWF RCo (27%), and low Factor VIII (33%). Other factors (I believe it was 9 and 11) were normal. The interpretive report accompanying my labs said my results were characteristic of type 1 Von Willebrand disease, due to the normal ratio of VWF antigen to RCo.

That said, is type 1 VWD sufficient to explain recurrent petechiae? It's not usually listed as a common symptom on online sources, and I get them: a) randomly, b) in response to lifting weights or working out, and c) just today I freaked out when I realized that I can even get them in some locations (inner arms, sides of abdomen) immediately following pretty minor scratching, like just normal scratching of an itch with fingernails. Can these symptoms really be attributed to minor type 1 Von Willebrand's disease or does it sound like there's something else going on here? The only other symptoms I have are having minor gum bleeding in response to brushing teeth for as long as I can remember, and a tendency to occasionally see a very minor (like a fleck) amount of blood on toilet paper, but not ever in stool.

Thank you very much for your response Dr. XXXXXXX

If I may ask one follow up question, would the fact that I've only recently begun developing petechiae suggest that I have the acquired rather than inherited form of type 1 Von Willebrand? As I mentioned before, for years I have experienced a very very minor tendency to bleed with tooth brushing, very occasional blood on toilet paper, and perhaps a tendency to bruise slightly more easily than average, but in the past I have had an impacted wisdom tooth surgically removed and I was able to heal without issue (although I think I might have bled slightly longer than average). Really the first significant bleeding concern I've ever had (petechiae) has only begun within the last 6 months and I have no known family history of Von Willebrand's, although I suppose a parent could have just been asymptomatic.

I suppose ultimately what I'm worried about is the possibility that my Von Willebrand disease could be the acquired form that is caused by a dangerous underlying condition like multiple myeloma, Waldenstrom macroglobulinemia, leukemia/lymphoma, etc and I'm trying to figure out how likely it is that my VWD is the normal hereditary kind with no known family history and only incredibly minor bleeding symptoms up until the age of 30. Any insight you could provide on the likelihood of hereditary vs acquired Von Willebrand would be greatly appreciated!!

Thank you so much for your response Doctor. One final set of questions, if you don't mind: when it comes to acquired VWD, in your experience does it tend to manifest as one particular type (i.e., a tendency to be 1,2, or 3) or have any clinical features that would distinguish it from the congenital version? I have read in 2 literature reviews on the subject that it usually manifests with the type 2 pattern of decreased RCo to Ag ratio, but then I saw another study in which the vast majority of patients with acquired VWD had lab values conforming to type 1, so I'm a bit confused.

Also, for several months I have smoked cannabis on a near-daily basis and there seems to be some medical literature indicating that cannabis inhibits platelet aggregation. Does it seem possible that I could have had nearly asymptomatic, hereditary type 1 VWD that somehow became exacerbated by frequent marijuana use? I've stopped using cannabis about a week ago but the petechiae are still developing, so I'm assuming that if nothing changes in the next few days I can pretty much rule that out as the culprit. Oh, and one thing I neglected to mention in my test results before is that my PFA-100 results were kind of unusual, in that my closure time was normal for collagen epinephrine (183 seconds, with 184 being the upper limit of normal), while the collagen ADP was actually prolonged at 127 seconds (102 is upper limit of normal). I don't know if that makes any difference in terms of what we're discussing, but I just wanted to include that in case it's of any importance. Thanks!

Thanks so very much for your assistance!

Thank you very much Dr. XXXXXXX I really appreciate the information, as well as your willingness to answer my follow up questions. Have a great day!