What are the key clinical features to consider when diagnosing Von Willebrand Disease in a primary care setting?

Key clinical features to consider when diagnosing Von Willebrand Disease (VWD) in primary care include a history of mucocutaneous bleeding such as frequent nosebleeds, easy bruising, prolonged bleeding from minor wounds, and bleeding gums. Women may present with heavy menstrual bleeding (menorrhagia), which is a common symptom prompting investigation in primary care. Other important features include prolonged bleeding after dental procedures, surgery, or childbirth, and a family history of bleeding disorders. In children, bleeding after immunisations or minor trauma may be a clue. Physical examination may reveal petechiae or ecchymoses but is often normal. Given the variability in bleeding severity, a bleeding assessment tool or bleeding score can aid in identifying patients who require further haemostatic testing. Primary care clinicians should be alert to these features especially in patients with unexplained bleeding symptoms or a family history suggestive of a bleeding disorder. NICE NG88,NICE NG121 Leonard et al. 2007