Evidence for Stress-induced Bleeding in a Patient with von Willebrand Factor Deficiency.

Literature reveals that psychological stress is related to hemostatic mechanisms and that excess stress can lead to prothrombotic events. Patients with chronic bleeding disorders report increased levels of subjective distress. The psychobiological link between stress and bleeding tendencies is rarely investigated when compared to the wealth of the studies on stress and clotting mechanisms. We present the case of a female with recurrent depressive disorder in whom episodic stress precipitated acute bleeding spells. An extensive hematopathological investigation revealed that she had von Willebrand factor deficiency. Our report adds to the literature that, apart from inducing procoagulant states, stress can precipitate bleeding episodes in patients with certain bleeding diatheses such as von Willebrand factor deficiency. The case also highlights that adequate pharmacotherapy and psychosocial interventions can yield adequate remission of both depression and bleeding spells.