Bleeding symptoms do not correlate with laboratory assays

Increase in VWF levels with hormones or pregnancy may mask VWD diagnosis

There is no precise definition for menorrhagia, the most common symptom in VWD

Bleeding symptoms may be atypical and lack specificity for VWD

Bleeding symptoms overlap with those in healthy individuals

There is no single diagnostic test for VWD

VWD assays are difficult to perform, may vary over time, and lack reproducibility

There is no laboratory standardization for VWD testing

VWF levels do not correlate with genetic defects or bleeding symptoms

VWF levels are not specific for VWD and overlap with levels in normal individuals

Traumatic sample procurement and poor sample handling interfere with VWD assays