Immune Thrombocytopenia and Type 1 von Willebrand Disease in a Patient With a Femoral Fracture - A Case Report

Sep 28, 2026

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This article describes the case of a complex medical patient with immune thrombocytopenia (ITP) and von Willebrand disease (vWD), among other comorbidities, who underwent urgent orthopedic surgery and discusses the specificities of the perioperative anesthetic management of these bleeding disorders. Immune thrombocytopenia is an acquired autoimmune condition characterized by a diminished platelet count due to immune destruction. vWD is the most common inherited bleeding disorder, in which there is a defect of von Willebrand factor, a fundamental component of the hemostatic process. By compromising primary hemostasis, both conditions carry an important hemorrhagic risk in surgical patients, compounded by their coexistence.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Introduction

Case Presentation

Patient history and comorbidities

Admission and initial management

Review began 11/15/2025 Review ended 11/22/2025 Published 12/01/2025 © Copyright 2025 Ferreira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98215 Open Access Case Report Immune Thrombocytopenia and Type 1 von Willebrand Disease in a Patient With a Femoral Fracture: A Case Report André Ferreira 1 , André Roberto 1 1. Anesthesiology, Unidade Local de Saúde de São José -Centro Hospitalar Universitário de Lisboa Central, Lisbon, PRT Corresponding author: André Ferreira, [andremvf@hotmail.com](andremvf@hotmail.com) Abstract This article describes the case of a complex medical patient with immune thrombocytopenia (ITP) and von Willebrand disease (vWD), among other comorbidities, who underwent urgent orthopedic surgery and discusses the specificities of the perioperative anesthetic management of these bleeding disorders. Immune thrombocytopenia is an acquired autoimmune condition characterized by a diminished platelet count due to immune destruction. vWD is the most common inherited bleeding disorder, in which there is a defect of von Willebrand factor, a fundamental component ofthe hemostatic process. By compromising primary hemostasis, both conditions carry an important hemorrhagic risk in surgical patients, which is compounded by their coexistence. Categories: Hematology, Anesthesiology Keywords: case report, femoral fracture, hemorrhagic risk, thrombocytopenia, von willebrand disease Introduction We present a case that depicts the successful perioperative management of a patient with type 1 von Willebrand disease (vWD) and immune thrombocytopenia (ITP) who underwent a non-cemented right hip hemiarthroplasty for a subcapital right femur fracture. Hip surgery carries a well-established bleeding risk and an increased need for allogeneic red blood cell (RBC) transfusions in the perioperative period [1-3], which can be further exacerbated by comorbid conditions and medications. vWD is the most common inherited bleeding disorder, affecting about 1 in 100 people; nevertheless, it is asymptomatic in the majority of patients, being clinically significant in only 1 in 10,000 patients [4] . This hemostatic defect is the result of a defective von Willebrand factor (vWF), a plasmatic glycoprotein essential for normal platelet adhesion and aggregation, as well as for the maintenance of factor VIII levels. This defect can be either quantitative (low levels in type 1 and complete absence in type 3) or qualitative (impairment of action in type 2) [4-6]. As a consequence of an abnormal primary hemostasis, vWD predisposes patients to cutaneous and mucosal bleeding, easy bruising, frequent and intense epistaxis, heavy menstrual bleeding, anemia, and joint pain [5] . ITP is an acquired autoimmune type of thrombocytopenia, resulting from peripheral destruction and impaired megakaryopoiesis [7-10]. This condition configures a variable bleeding risk depending not only on the absolute platelet count but also on multiple other patient factors [7, 11, 12] . Both conditions compromise primary hemostasis, thus carrying significant hemorrhagic risk for surgery, requiring careful multidisciplinary management and optimization of the patient [7, 11, 13-15] . Case Presentation A 77-year-old woman was admitted to the hospital after being diagnosed with a non-recent subcapital right femur fracture, with the intent of performing a hemiarthroplasty of the right hip. The patient was categorized as American Society of Anesthesiologists (ASA) IV [16], had a known allergy to penicillin, and her past medical history included splenic non-Hodgkin lymphoma (currently in remission after six cycles of R-CHOP chemotherapy) ; vWD (type 1, vWF:ristocetin cofactor (RCo) of 30 . 1% at diagnosis) and ITP (baselin

FAQs

What conditions are reported in this case report?

The report describes immune thrombocytopenia (ITP) and type 1 von Willebrand disease (vWD) in a patient with a femoral fracture requiring orthopedic surgery.

Why is perioperative bleeding risk a central issue in this case?

Both ITP and vWD compromise primary hemostasis, creating an important hemorrhagic risk during surgery, especially because the two conditions coexist.

How was the patient's platelet count managed before surgery?

After admission with severe thrombocytopenia, one platelet pool was transfused and the plan was discussed with Hematology and Transfusion Medicine. Surgery was postponed until the platelet count reached a target above 50,000/μL while ITP-directed treatment was started.

Sep 28, 2026

Uploaded by Grenda