Delayed prolonged bleeding after a minor surgery is caused by defect in
**Core Concept**
Von Willebrand factor (VWF) plays a crucial role in primary hemostasis, facilitating platelet adhesion to the site of injury. A deficiency or dysfunction of VWF can lead to impaired platelet aggregation, resulting in delayed and prolonged bleeding.
**Why the Correct Answer is Right**
Von Willebrand disease (VWD) is the most common inherited bleeding disorder, characterized by a qualitative or quantitative deficiency of VWF. The disease is caused by mutations in the VWF gene, leading to impaired platelet adhesion and aggregation. This results in delayed and prolonged bleeding, particularly after minor surgical procedures. The bleeding time is often prolonged in patients with VWD, and the condition can be exacerbated by the use of aspirin or other antiplatelet agents.
**Why Each Wrong Option is Incorrect**
**Option A:** Hemophilia A is caused by a deficiency of factor VIII, which is essential for the intrinsic coagulation pathway. While hemophilia A can cause bleeding complications, it is not typically associated with delayed prolonged bleeding after minor surgery.
**Option B:** Factor XIII deficiency is a rare bleeding disorder that affects the stabilization of blood clots. While factor XIII deficiency can cause bleeding complications, it is not typically associated with delayed prolonged bleeding after minor surgery.
**Option C:** Defects in the coagulation pathway, such as those seen in hemophilia A or B, are typically associated with acute, severe bleeding rather than delayed prolonged bleeding.
**Clinical Pearl / High-Yield Fact**
Von Willebrand disease is often underdiagnosed, particularly in females, as the symptoms can be mild and nonspecific. A high index of suspicion is required to diagnose VWD, particularly in patients with a history of delayed or prolonged bleeding after minor surgery.
**Correct Answer:** D.