This week’s case highlights the importance of considering a bleeding disorder in scalp hematomas. Some scalp hematomas will develop into a worsening hemorrhage causing significant blood loss. Good return precautions and monitoring of the size of the swelling is necessary to discuss with parents.

Admitted to floor w plan for MRI/MRV/MRA in AM. MRI/MRV w slight interval expansion of scalp hematoma. Hgb dropped 3 points over the next 3 days, labs were notable for low von Willebrand antigen, which is suggestive of von Willebrand disease. Received Wilate, started on Amicar. At heme follow up 1 month after dc swelling had completely resolved. Definitive diagnostic testing for von Willebrand resulted negative after the hematology clinic follow up appointment, no need for further follow up w hematology.  

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