High prevalence of reduced thrombin generation and/or decreased platelet response in women with unexplained heavy menstrual bleeding

Eising, Heleen P.; Roest, Mark; Groot, Philip G. de; Huskens, Dana; Konings, Joke; Urbanus, Rolf T.; Laat, Bas de; Remijn, Jasper A.

doi:10.1111/ijlh.12775

Cited by 3 publications

(5 citation statements)

References 28 publications

(63 reference statements)

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“…The existing literature and expert committees recommend to screen on coagulation disorders in women suffering from HMB in gynaecological practice before surgical treatment 17,28 . Our findings emphasize that gynaecologists should be aware of impaired coagulation, which might influence the outcome of endometrium ablation 29,30 …”

Section: Discussionmentioning

confidence: 72%

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The ISTH‐BAT score and outcomes after endometrial ablation in women with heavy menstrual bleeding

Eising,

Punt,

Schermer

et al. 2023

Haemophilia

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BackgroundThe International Society on Thrombosis and Haemostasis bleeding assessment tool (ISTH‐BAT), is used during the diagnostic workup of bleeding disorders. Data on ISTH‐BAT scores in women with heavy menstrual bleeding (HMB) undergoing endometrial ablation (EA) could be essential in optimizing HMB counselling.ObjectiveTo investigate the postsurgical incidence of amenorrhea, dysmenorrhea, quality of life, re‐intervention after EA, and ISTH‐BAT score.MethodsThis study included women who have undergone EA because of HMB. During a follow‐up of 2 to 5 years, ISTH‐BAT, pictorial blood assessment chart (PBAC), and Short Form‐36 survey (SF‐36) were administered. At 10 years of follow‐up surgical re‐interventions were evaluated.ResultsSeventy‐one women were included of whom 77% (n = 55) had an ISTH‐BAT score < 6, versus 23% (n = 16) ISTH‐BAT score ≥6 (mean age 46.3 versus 42.3, p = 0.004). In the ISTH‐BAT ≥6 group versus < 6 group, amenorrhea occurred in 63% (10/16) versus 82% (45/55) (p = 0.111), dysmenorrhea in 38% (6/16) versus 18% (10/55) (p = 0.111), and surgical re‐intervention in 19% (3/16) versus 25% (14/55) (p = 0.582). SF‐36 item (Bodily) pain was lower in the ISTH‐BAT ≥6 group versus < 6 (median score 58.7 vs. 80.0, p = 0.104).ConclusionsAn ISTH‐BAT score ≥6 may be related to a lower amenorrhea incidence and higher dysmenorrhea rate after EA.

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Section: Discussionmentioning

confidence: 72%

“…29,30 Doherty et al described that menorrhagia scores in BATs increase remarkably with aging in healthy women related to the procedurespecific accumulation in HMB management from medical treatment till surgical interventions. When assessed by age quartiles, the nor-…”

mentioning

confidence: 99%

The ISTH‐BAT score and outcomes after endometrial ablation in women with heavy menstrual bleeding

Eising,

Punt,

Schermer

et al. 2023

Haemophilia

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“…However, besides implementation of NGS techniques, functional haemostatic assays need to be improved. Currently, flow cytometry‐based platelet function diagnostic tests are being developed and global haemostatic assays are implemented in clinical practice …”

Section: Discussionmentioning

confidence: 99%

“…Currently, flow cytometry-based platelet function diagnostic tests are being developed and global haemostatic assays are implemented in clinical practice. [38][39][40]…”

Section: However Besides Implementation Of Ngs Techniques Functionalmentioning

confidence: 99%

Whole exome sequencing in the diagnostic workup of patients with a bleeding diathesis

et al. 2018

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Introduction Bleeding assessment tools and laboratory phenotyping often remain inconclusive in patients with a haemorrhagic diathesis. Aim To describe the phenotype and genetic profile of patients with a bleeding tendency. Methods Whole exome sequencing (WES) was incorporated in the routine diagnostic pathway of patients with thrombocytopenia (n = 17), platelet function disorders (n = 19) and an unexplained bleeding tendency (n = 51). The analysis of a panel of 126 OMIM (Online Mendelian Inheritance in Man) genes involved in thrombosis and haemostasis was conducted, and if negative, further exome‐wide analysis was performed if informed consent given. Results Eighteen variants were detected in 15 patients from a total of 87 patients (17%). Causative variants were observed in MYH9 (two cases), SLFN14, P2RY12 and GP9. In addition, one case was considered solved due to combined carriership of F7 and F13A1 variants and one with combined carriership of F2, F8 and VWF, all variants related to secondary haemostasis protein aberrations. Two variants of uncertain significance (VUS) were found in two primary haemostasis genes: GFI1B and VWF. Eight patients were carriers of autosomal recessive disorders. Exome‐wide analysis was performed in 54 cases and identified three variants in candidate genes. Conclusion Based on our findings, we conclude that performing WES at the end of the diagnostic trajectory can be of additive value to explain the complete bleeding phenotype in patients without a definite diagnosis after conventional laboratory tests. Discovery of combinations of (novel) genes that predispose to bleeding will increase the diagnostic yield in patients with an unexplained bleeding diathesis.

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“…Statistically significant difference is denoted by *** = P ≤ 0.001. more specialised laboratories. Furthermore, a recent study by Eising et al reported a high prevalence of reduced thrombin generation and/or decreased platelet response in women with unexplained heavy menstrual bleeding, implicating the need for more specialised laboratory tests [23].…”

Section: Discussionmentioning

confidence: 99%

Investigation of the contribution of an underlying platelet defect in women with unexplained heavy menstrual bleeding

et al. 2018

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Heavy menstrual bleeding (HMB) is often undiagnosed in women and can cause discomfort and distress. A haemostatic cause for excessive bleeding is often not routinely investigated and can lead to hysterectomy at an early age. A prospective cohort study was carried out to determine whether certain patients with unexplained HMB have an underlying platelet function defect (PFD). The Genotyping and Phenotyping of Platelets (GAPP) study recruited 175 women with HMB and 44 unrelated volunteers from 25 Haemophilia Centres across the UK, and a tertiary gynaecology service. Bleeding history was assessed using the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT). Platelet count, platelet size, haemoglobin and mean corpuscular volume were measured in whole blood using the Sysmex XN-1000 Haematology Analyzer. Platelet function testing using lumiaggregometry and flow cytometry was performed in patients included in this study. A PFD was identified in 47% (82/175) of patients with HMB. Cutaneous bleeding was the most frequent additional bleeding symptom (89% in PFD and 83% with no PFD). Whole blood platelet count was significantly lower ( P < 0.0001) between the PFD group and no PFD group. The prevalence of anaemia did not differ between patients and healthy volunteers. Clinical evaluation alone is insufficient to determine presence of an underlying PFD in patients with HMB. Platelet function tests may be considered and clinical guidelines may include them in their algorithms. An appropriate diagnosis and subsequent tailored management of HMB may prevent unnecessary surgery and help manage future haemostatic challenges.

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High prevalence of reduced thrombin generation and/or decreased platelet response in women with unexplained heavy menstrual bleeding

Abstract: Our approach in women with HMB using a high precision platelet function test in combination with thrombin generation showed impaired coagulation or impaired platelet function in more than 40% of the patients.

Cited by 3 publications

References 28 publications

The ISTH‐BAT score and outcomes after endometrial ablation in women with heavy menstrual bleeding

The ISTH‐BAT score and outcomes after endometrial ablation in women with heavy menstrual bleeding

Whole exome sequencing in the diagnostic workup of patients with a bleeding diathesis

Investigation of the contribution of an underlying platelet defect in women with unexplained heavy menstrual bleeding

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