A 7-year-old with recurrent epistaxis and a mother with heavy menses; most likely diagnosis?

A 7-year-old with recurrent epistaxis and a mother with heavy menses; most likely diagnosis?

• A. Hemophilia A
• B. Platelet function defect
• C. Von Willebrand disease
• D. Iron deficiency anemia

Answer: (C)

The main idea is mucosal bleeding with a pattern that runs in families, pointing to von Willebrand disease. This condition stems from deficiency or dysfunction of von Willebrand factor, which helps platelets stick to damaged vessels and also protects factor VIII. When VWF is low or defective, mucosal sites bleed more easily—epistaxis in a child and heavy menses in the mother fit this pattern—and it’s the most common inherited bleeding disorder, often transmitted in an autosomal dominant fashion across generations. In contrast, hemophilia A is X-linked and tends to cause deep tissue bleeding (joints, muscles) rather than frequent mucosal bleeds; iron deficiency anemia explains symptoms related to anemia rather than a bleeding disorder; platelet function defects can cause mucosal bleeding too but the family history of heavy menses across generations makes von Willebrand disease the best fit.

The main idea is mucosal bleeding with a pattern that runs in families, pointing to von Willebrand disease. This condition stems from deficiency or dysfunction of von Willebrand factor, which helps platelets stick to damaged vessels and also protects factor VIII. When VWF is low or defective, mucosal sites bleed more easily—epistaxis in a child and heavy menses in the mother fit this pattern—and it’s the most common inherited bleeding disorder, often transmitted in an autosomal dominant fashion across generations.

In contrast, hemophilia A is X-linked and tends to cause deep tissue bleeding (joints, muscles) rather than frequent mucosal bleeds; iron deficiency anemia explains symptoms related to anemia rather than a bleeding disorder; platelet function defects can cause mucosal bleeding too but the family history of heavy menses across generations makes von Willebrand disease the best fit.