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Heghine Khachatryan: When Bleeding Appears Without a History — Think Acquired
Heghine Khachatryan/LinkedIn
Apr 8, 2026, 15:02

Heghine Khachatryan: When Bleeding Appears Without a History — Think Acquired

Heghine Khachatryan, Editor-in-Chief of Hemostasis Today, Head of Hemophilia and Thrombosis Center at Yeolyan Hematology and Oncology Center, shared a post on LinkedIn:

“When Bleeding Appears Without a History — Think Acquired

In hemostasis, timing is everything.

When a patient develops new-onset bleeding in adulthood, with no personal or family history — this is not a coincidence.

This is a diagnostic turning point.

Acquired von Willebrand Syndrome (AVWS)

A condition we do not look for — and therefore often miss.

The diagnostic keys

AVWS should be suspected when:

  • Bleeding begins later in life
  • No prior bleeding phenotype
  • No family history
  • Disproportionate bleeding during procedures
  • Laboratory findings mimic VWD

The absence of history is not reassurance — it is the main clue

Look beyond hemostasis

AVWS is rarely isolated.

It is often a marker of systemic disease:

  • Lymphoproliferative disorders
  • Myeloproliferative neoplasms
  • Autoimmune conditions
  • Cardiovascular pathology (e.g., shear stress states)

Sometimes, bleeding is the first sign of a hidden disease

Mechanism-oriented thinking

Do not stop at ‘low vWF’

Ask why:

  • Increased clearance?
  • Autoantibodies?
  • Shear-induced destruction?
  • Cellular adsorption?

Diagnosis is not a number — it is a pathophysiologic explanation

Clinical Shift

‘New bleeding — treat locally’

‘New bleeding — search systemically’

Acquired von Willebrand syndrome is not rare.

It is rarely recognized.

Because we forget to ask the most important question: What changed?”

Heghine Khachatryan: When Bleeding Appears Without a History — Think Acquired

Other posts featuring Heghine Khachatryan on Hemostasis Today.

Acquired von Willebrand Syndrome AVWS bleeding disorders Health Heghine Khachatryan Hematology Hemostasis Hemostasis News Hemostasis Today Medicine VWD
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