Bleeding disorders, menorrhagia and iron deficiency: impacts on health‐related quality of life

Abstract

Summary von Willebrand disease (VWD) is a bleeding disorder that occurs in up to 1% of the general population. The great majority of females with VWD experience menorrhagia. The morbidity burden in females with VWD may relate to iron deficiency resulting from menorrhagia. To explore relationships between bleeding disorders, menorrhagia, iron deficiency and the outcomes of health-related quality of life (HRQL) and educational attainment. All subjects with VWD, and females with other bleeding disorders, in the Canadian national registry who were more than 12 years of age were eligible for survey. Survey measures included the HEALTH UTILITIES INDEX®; abridged Clinical History Assessment Tool; socio-demographic questions and serum ferritin. Statistical analyses included testing differences among groups of means using analysis of variance and of proportions using chi-squared test. Significant size differences in mean HRQL scores were detected between VWD females and both females with other bleeding disorders [diff = (−0.08); P = 0.017] and VWD males [diff = (−0.07); P = 0.039]. Mean HRQL scores differed between females with and without menorrhagia (P < 0.001). Mean HRQL scores were not significantly different between females with and without iron deficiency. Educational attainment was not associated with disease group, menorrhagia status or iron status. Females with VWD have a greater morbidity burden than females in the general population, females with other bleeding disorders and males with VWD. Menorrhagia is associated with low HRQL scores in females with bleeding disorders, including VWD. Further investigation should assess how menorrhagia impacts HRQL in females with bleeding disorders.

Heavy menstrual bleeding and health-associated quality of life in women with von Willebrand's disease

“…The incidence of HMB in the present study (50.0-53.3%) was concordant with the results of recent studies performed by Rae et al (29), Byams et al (30) and Kirtava et al (12) that reported incidence of 45.2, 51.7 and 44%, respectively. Regarding the study population, the women in the aforementioned studies were connected to hematology centers, as in the present study.…”

“…In the present study, women with HMB had a significantly lower SF-36 score in the dimension 'bodily pain'. These results were concordant with those obtained by Rae et al (29) who used the self-administered health survey, Health Utilities Index of Canada. In a group of 84 women with inherited bleeding disorders and HMB, Rae et al (29) demonstrated that the health-associated quality of life scores were lower in the dimensions 'pain' and 'cognition'.…”

“…These results were concordant with those obtained by Rae et al (29) who used the self-administered health survey, Health Utilities Index of Canada. In a group of 84 women with inherited bleeding disorders and HMB, Rae et al (29) demonstrated that the health-associated quality of life scores were lower in the dimensions 'pain' and 'cognition'. They also reported that women with VWD (n=259) experienced significantly more pain than women with other bleeding disorders (n=56) and men with VWD (n=97).…”

“…These results were concordant with those of previous studies, which demonstrated that a higher number of women with VWD compared with women in the general population perceived limitations in their overall life activities due to menstruation (12,29). Kirtava et al (12) performed a case control study on 62 women with VWD and demonstrated that 23 (32.1%) of these women perceived menstrual bleeding to limit their overall life activities and negatively affect their lives.…”

“…Among the 70 controls of the study, only 7 women (10.0%) perceived limitations (12). A study performed by Rae et al (29) concluded that among 84 women with inherited bleeding disorders and HMB, the majority (77.5%) reported that menstrual bleeding interfered with daily activities.…”