What is your approach to pregnant patients with type 2B von Willebrand disease, particularly when thrombocytopenia is already present?

The gist of this challenging clinical problem is that the high estrogen levels in the third trimester of pregnancy raise the VWF level normally. In type 2B VWD, this effect raises the level of the abnormal VWF, which clears more platelets from the circulation, and can lead to severe thrombocytopenia...

From an ISTH review and survey of 55 pregnancies, 26% of 55 pregnancies had a platelet count (PC <20K), though no mention of management when severely thrombocytopenic but not bleeding. Some points to consider-

• Rule out other causes of thrombocytopenia, especially if the platelet count falls <30K bef...