Gastro-intestinal bleeding in acquired von Willebrand's disease: efficacy of high-dose immuno-globulin where substitution treatments failed.

We report a case of acquired von Willebrand's disease with severe and persistent gastro-intestinal bleeding from multiple bleeding points. He received maximum substitution treatment including factor VIII concentrates, cryoprecipitate and platelets. He also received DDAVP. There was no change in the rate of blood loss. He was then treated with high-dose intravenous gamma-globulin and the blood loss stopped abruptly. He remained well for several months when bleeding recommenced and he again responded promptly to gamma-globulin. This is a useful maintenance treatment for patients with acquired von Willebrand's disease.