Is Von Willebrand's often missed by hematologists? My hematologist says I don't have VWD because my VWD test results came back normal, but I've read that anxiety and birth control pills can increase the amount of VWD factor.

It is not as difficult to diagnose type 2 VWD or type 3 VWD and severe type 1 VWD as the levels typically are less affected by "stress" on the body related to anxiety related to getting stuck for the blood draw. In the patients with low VWF (VWF levels from 30-50%) there can be significant variability. Low dose estrogen birth control pills such as Loestrin, Lo-ovral, etc typically don't elevate the VWF by much. It is recommended to check the levels when not ill and when not significantly anemic (low red blood cell count) and repeat in a few weeks to months to verify the VWF level is not truly below 50%. Rarely if there is concern one can check the VWF levels (VWF:Ag, VWF:RCo) in the first few days of the period or during the "sugar pill" time of the birth control pill pack if borderline results are noted. 

Sincerely, 

Dr. Expert