Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation

Philipp, Claire S.; Faiz, Ambarina S.; Dowling, Nicole F.; Beckman, Michele G.; Owens, Sally; Ayers, Charletta; Bachmann, Gloria

doi:10.1016/j.ajog.2007.08.070

Cited by 81 publications

(63 citation statements)

References 25 publications

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“…Philipp et al [16], also reported on the importance of flooding, not as confirmation of menorrhagia, but as a predictor of a bleeding disorder. The investigators administered a 12-page questionnaire of bleeding symptoms.…”

Section: Menorrhagia and Its Relationship To Bleeding Disordersmentioning

confidence: 99%

Women and bleeding disorders

James

2010

Haemophilia

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Summary. While women are rarely affected by haemophilia, they are equally as likely as men to have other bleeding disorders. Menorrhagia, or heavy menstrual bleeding, is the most common symptom that they experience. Not only is menorrhagia more prevalent among women with bleeding disorders, but bleeding disorders are more prevalent among women with menorrhagia. Although menorrhagia is the most common reproductive tract manifestation of a bleeding disorder, it is not the only manifestation. Women with bleeding disorders appear to be at an increased risk of developing haemorrhagic ovarian cysts and possibly endometriosis. Women suspected of having a bleeding disorder or being a carrier of haemophilia should be offered diagnostic testing before getting pregnant to allow for appropriate preconception counselling and pregnancy management. During pregnancy, women with bleeding disorders may be at an increased risk of bleeding complications. At the time of childbirth, women with bleeding disorders appear to be more likely to experience postpartum haemorrhage, particularly delayed or secondary postpartum haemorrhage. As women with bleeding disorders grow older, they may be more likely to manifest gynaecological conditions which present with bleeding. Women with bleeding disorders are more likely to undergo a hysterectomy and are more likely to have the operation at a younger age. While women with bleeding disorders are at risk for the same obstetrical and gynaecological problems that affect all women, women with bleeding disorders are disproportionately affected by conditions that manifest with bleeding. Optimal management involves the combined expertise of haemostasis experts and obstetrician-gynaecologists.

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Section: Menorrhagia and Its Relationship To Bleeding Disordersmentioning

confidence: 99%

Women and bleeding disorders

James

2010

Haemophilia

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“…8 Similar results for the screening tool were obtained whether defining menorrhagia based on a PBAC score of ≥100, as was done in this study, or basing menorrhagia on a physician diagnosis as was used in the development of the screening tool. 8 The utility of the serum ferritin level as an adjunct to screening for hemostatic abnormalities has not been demonstrated previously and may provide a similarly effective, but clinically more feasible, supplement to the screening tool than the PBAC score. Although less costefficient than a PBAC score, a serum ferritin level may offer the clinician the possibility of a more rapid evaluation and decision for hematologic referral without awaiting a menstrual cycle for a prospectively completed PBAC score.…”

Section: Author Manuscriptmentioning

confidence: 99%

“…Using data from women with menorrhagia at a single institution, a simple easy-to-administer screening tool comprised of 8 questions in 4 categories has been developed to help gynecologists assess which women with menorrhagia to refer for a comprehensive hemostatic evaluation. 8 The purpose of the current study was to test the screening tool in a prospectively recruited US multisite population of women with menorrhagia. Additionally, we examined potential modifications to the screening tool to increase the sensitivity of the identification of women with potential bleeding disorders.…”

Section: Author Manuscript Author Manuscript Author Manuscript Authormentioning

confidence: 99%

Evaluation of a screening tool for bleeding disorders in a US multisite cohort of women with menorrhagia

Philipp

Faiz

Heit

et al. 2011

American Journal of Obstetrics and Gynecology

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OBJECTIVE-The purpose of this study was to determine the usefulness of a simple screening tool for bleeding disorders in a multisite population of women with menorrhagia.STUDY DESIGN-Women with menorrhagia between the ages of 18 and 50 years from 6 geographically diverse US centers underwent hemostatic testing for bleeding disorders, complete blood cell count, and ferritin. A questionnaire that contained all elements of the 8-question screening tool was administered. Sensitivity of the screening tool, a screening tool with a pictorial blood assessment chart (PBAC) score of >185, and a screening tool with serum ferritin were calculated for hemostatic disorders.RESULTS-Two hundred and seventeen women who were identified with a PBAC score of ≥100 participated in the study. The sensitivity of screening tool was 89% for hemostatic defects, and sensitivity increased to 93% and 95% with a serum ferritin level of ≤20 ng/mL and PBAC score of >185, respectively.CONCLUSION-This study confirms the usefulness of a short screening tool for the stratification of women with menorrhagia for hemostatic evaluation. HHS Public AccessAuthor manuscript Am J Obstet Gynecol. Author manuscript; available in PMC 2015 October 08.Published in final edited form as: Am J Obstet Gynecol. 2011 March ; 204(3): 209.e1-209.e7. doi:10.1016/j.ajog.2010. Author Manuscript Author Manuscript Author Manuscript Author ManuscriptIt is estimated annually that approximately 5% of reproductive-age women seek medical attention for menorrhagia. 1,2 Underlying hemostatic abnormalities, which include decreased von Willebrand factor (VWF), platelet dysfunction, and decreased coagulation factors, are found commonly in women with menorrhagia. 1,3-5 Yet, most women with menorrhagia seek medical attention for their symptoms from gynecologists and primary care physicians, rather than from hematologists. Furthermore, few of these women are referred for hemostatic evaluation, despite the high prevalence of hemostatic abnormalities in this population 6 ; the average delay from onset of bleeding symptoms to diagnosis of a bleeding disorder has been reported to be 16 years. 7 Barriers to referral for hemostatic evaluation include difficulties gynecologists and primary care physicians have in determining whom to refer, lack of recognition by gynecologists and primary care physicians of menorrhagia as a symptom of a bleeding disorder, the size of the population with complaints of menorrhagia, and the lack of simple laboratory tests to screen for hemostatic abnormalities in this population. Given the under-recognition and delay in diagnosis of bleeding disorders and the potential for bleeding complications with surgery, childbirth or invasive procedures in women with menorrhagia, and unidentified bleeding disorders, a standardized screening tool to assist in the determination of which women to refer for hemostatic evaluation would be useful for the practicing gynecologist. Using data from women with menorrhagia at a single institution, a simple easy-to-administer sc...

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“…32 The clinician should also consider a congenital or acquired coagulopathy by reviewing the personal, medical, and family history. It is evident that a history of lifelong heavy menstrual bleeding, postpartum bleeding, excessive bleeding with surgical or dental procedures, frequent bruising, and a family history can be used as a screening tool with 8% to 90% sensitivity to detect these relatively common disorders 18,33 (Class 3). The screening by structured history is "positive," with abnormal results necessitating additional laboratory evaluation, when any of the conditions in Sidebar: Screening tool for an underlying disorder of hemostasis in the patient with excessive menstrual bleeding are met.…”

Section: History and Physical Findingsmentioning

confidence: 99%

Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

Munro

2013

TPJ

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Acute uterine bleeding unrelated to pregnancy has been defined as bleeding "sufficient in volume as to, in the opinion of the treating clinician, require urgent or emergent intervention." The Southern California Permanente Medical Group updated its guidelines for the management of this condition on the basis of the best available evidence, as identified in a systematic review of the available literature. Given the paucity of studies evaluating this condition, the guidelines, by necessity, include recommendations largely based on opinion or other sources such as case series that are, in general, categorized as low-quality evidence. Medical interventions with single or combined gonadal steroidal agents administered parenterally or orally show promise, but more high-quality studies are needed to better define the appropriate drugs, dose, and administrative scheduling. There is also some evidence that intrauterine tamponade may be useful in at least selected cases. Special attention must be paid to both diagnosing and treating inherited disorders of hemostasis, such as von Willebrand disease, that may otherwise be underdiagnosed in both adolescent and adult women.

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Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation

Cited by 81 publications

References 25 publications

Women and bleeding disorders

Women and bleeding disorders

Evaluation of a screening tool for bleeding disorders in a US multisite cohort of women with menorrhagia

Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

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