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

Abstract

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...

Third Åland islands conference on vonWillebrand disease, 26–28September 2012: meeting report

“…Screening tools have been used to identify the presence of bleeding disorders in women with menorrhagia with a PBAC score >100. The sensitivity of the screening tool has been found to be 89% for haemostatic defects, and this increased to 93% and 95% with a serum ferritin level of <20 ng mL −1 and a PBAC score of >185, respectively . A bleeding disorder was identified in 154 of 217 women in the study.…”

Quantifying the PBAC in a Pediatric and Adolescent Gynecology Population

“…In addition, a study including 217 adult women validated the sensitivity of the PBAC chart as a screening tool, verifying that the tool was 89% sensitive in confirming that a score >100 correlated with a diagnosis of any underlying hemostatic defect. When the PBAC was utilized with a cutoff value of 185 in addition to a serum ferritin <20 ng/mL, sensitivity rates increased to as high as 95% [10]. Clearly a useful screening mechanism, it is also important to recognize that even among groups with a confirmed underlying bleeding dyscrasia, not all individuals experience the same degree of heavy cycles [11].…”

Phenotyping bleeding

“…In addition to the BATs derived from the Italian group’s work, a number of other tools have been developed and published, including a comprehensive web-based system developed at Rockefeller University,(13;20**) tools designed exclusively for the assessment of menorrhagia, (29–31) and a questionnaire specific for the Quebec Platelet Disorder. (32) In order to consolidate the knowledge learned from these published studies, and to develop a consensus bleeding assessment tool, a Working Party sponsored by the VWF and Perinatal/Pediatric Hemostasis Subcommittees of the International Society on Thrombosis and Haemostasis/Scientific Standardization Committee (ISTH/SSC) was established in 2008.…”