Acquired vWD in ET — RACP Adult Medicine MCQ

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HardHaematologyAcquired vWD in ETRACP Adult Medicine

A 55-year-old man with ET (JAK2+, platelets 1200 × 10⁹/L) develops gum bleeding. vWF antigen and ristocetin cofactor should be checked. Why?

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Correct answer: C — Acquired von Willebrand disease from extreme thrombocytosis (adsorption of HMW vWF multimers)

Extreme thrombocytosis >1000 causes acquired vWD from adsorption/proteolysis of HMW vWF multimers. Paradoxical BLEEDING phenotype. Withhold aspirin. Cytoreduction restores vWF.

Reference: eTG – 2025 – Haematology; EHA – 2022