Abstract
As in adults, desmopressin (DDAVP) can be used in children for prophylaxis of bleeding
and to stop bleeding in many hereditary and acquired bleeding disorders. DDAVP is
the treatment of choice in children with mild hemophilia and type 1 von Willebrand's
disease (vWD). It is effective in some variants of vWD and in many patients with platelet
function defects. It reduces the bleeding diathesis of children with uremia and drug-induced
bleeding complications.
In any case, a test dose of DDAVP has to be given to the patient to predict the hemostatic
effect before relying on this drug for treatment. The response can be measured by
shortening of the bleeding time (BT) and of partial thromboplastin time (PTT), indicating
a rise of Factor (F) VIII or von Willebrand factor (vWF).
Side effects such as facial flushing, transient headache, increased pulse rate, and
drop in systolic blood pressure are mild and transient. They can be minimized when
the dose is not exceeding 0.3 μg/kg body weight, and the infusion lasts at least 20
to 30 minutes. The strong antidiuretic action of DDAVP has some potential problems
that are negligible in adults and older children when water intake is restricted.
In infants and small children under the age of 18 months, however, DDAVP should be
used with caution and with close surveillance in order to prevent water intoxication
and electrolyte imbalance. The danger is increased when the patients receive parenteral
fluid substitution.
The advantages of DDAVP include the reduction in the use of plasma factor concentrates,
thereby minimizing the danger of immunological or infectious complications, as well
as the considerable reduction of costs realized by treatment with this form of medication.
Fortunately, it can be applied successfully in the most frequent hereditary bleeding
disorder, namely vWD type 1.
Keywords:
DDAVP - desmopressin - hemophilia - von Willebrand's disease - bleeding time - children
- platelet dysfunction - monitoring of desmopressin therapy
