A 39-year-old woman with a known history of von Willebrand disease has a ventral hernia after a previous cesarean section and desires to undergo elective repair. Which of the following should be administered preoperatively?
**Core Concept**
Von Willebrand disease is a bleeding disorder caused by a deficiency or dysfunction of von Willebrand factor (VWF), a protein critical for platelet adhesion and clot formation. Patients with this condition require careful management to prevent excessive bleeding during surgical procedures.
**Why the Correct Answer is Right**
Desmopressin (DDAVP) is a synthetic analogue of vasopressin that stimulates the release of VWF from storage sites in endothelial cells. Administering desmopressin preoperatively can increase VWF levels, thereby reducing the risk of bleeding during surgery. This is particularly useful in patients with mild to moderate von Willebrand disease.
**Why Each Wrong Option is Incorrect**
**Option A:** Cryoprecipitate is a blood product rich in VWF, but it is not typically administered preoperatively due to the risk of transmission of blood-borne pathogens and the need for cross-matching.
**Option B:** Fresh frozen plasma (FFP) contains VWF, but it is not the preferred choice for patients with von Willebrand disease due to the risk of volume overload and the presence of other clotting factors that may interfere with laboratory tests.
**Option C:** Platelet transfusions are not indicated in patients with von Willebrand disease unless there is a significant platelet count abnormality or thrombocytopenia.
**Clinical Pearl / High-Yield Fact**
Desmopressin can also be used to diagnose von Willebrand disease by assessing the response of VWF levels to stimulation. A significant increase in VWF levels after desmopressin administration supports the diagnosis.
**Correct Answer:** D. Desmopressin (DDAVP)