Crohn Disease in Patients with VW Disease

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29 years old male with a history of recurrent rectal bleeding, joint pain and sickle cell disease. He underwent cholecystectomy in 2005 with post operation bleeding complication stopped after blood transfusion. In March 2017 he referred with complains on abdominal pain and recurrent rectal bleeding. Colonoscopy was performed and showed mild ileitis with superficial ulcerations, compatible with crohn disease which was confirmed by pathology. The patient was put on meclizine 4 g daily, and Imuran 50 bids. Symptoms partially resolved. After one year he came for control colonoscopy, which was performed in March 2018. The patient was scoped to terminal ilium where ileitis and ulcerations persisted, biopsy was taken. At the site of biopsy started oozing, hemostasis performed with adrenaline injection which was successful. The patient was admitted to the hospital for observation, after 12 hours started to see fresh blood per rectum. Hematocrit persisted 40, PTT 42 (slightly elevated)... correction test was positive suggesting coagulation disorder. Factor VIII and VWF requested. We started treatment with plasma 2 unit’s q 4 hrs. Bleeding stopped then persisted until his hematocrit dropped to 25, we scoped again and put 3 clips at the site of biopsy but bleeding persisted. His hematocrit dropped to 22 and had blood transfusion, then after consultation with hematologist and surgeon we went for right hemi colectomy. Patient was discharged after 2 days. Till this moment we were waiting the results for the factors VIII and VW since it was not available at our hospital. After 24 hours, this patient came back to the ER with fresh blood per rectum and was admitted to start plasma again. On the second day we gat the results for the factors and we had VWF deficiency and secondary factor VIII deficiency. We started giving the factors “WY late” depending on his weight (30 units per kg q 8 hours), and exacyl PO q 8 hours.