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?”
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