Avery, a 5-year-old male, presents to the pediatrician for his well-child visit. His parents report that he is growing and developing well, but that they are concerned about recurrent nosebleeds that are happening most nights over the past week.

He has previously had intermittent episodes of epistaxis, and they tend to occur at night resulting in “a lot” of blood all over the pillow and sheets. He tends to get the nosebleeds for several nights in a row and may also get daytime nosebleeds during these periods of bleeding. The nosebleeds can last for 20 to 30 minutes before they are stopped. The family has been pinching the nose for 5-minute intervals to stop the nosebleeds.

Avery also has a history of easy bruising. He recently started playing soccer, and they have noted bumps on his shins under the bruises.

The family has previously reported concerns about bleeding and screening studies have shown a normal CBC (platelet count 203k/mcL), normal PT (11.3s), normal PTT (29.6s) and normal vonWillebrand Factor (vWF) screening tests (vWF antigen: 98%; vwF activity: 103%; F8 activity: 115%).

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