von Willebrand Disease in Women: The Need for Recognition and Understanding

Dilley, Anne; Crudder, Sally O.

doi:10.1089/jwh.1.1999.8.443

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…Heavy menstrual bleeding is a common problem that is associated with considerable morbidity [1]. Recently, a survey of obstetricians‐gynaecologists in the United States found that only 6% believed that VWD and other disorders of haemostasis were a common cause of heavy menstrual bleeding [20]. In patients with an underlying bleeding disorder, morbidity includes significant decrease in the quality of life, higher incidence of school and work absenteeism and anaemia [23–27].…”

Section: Discussionmentioning

confidence: 99%

“…Most of these studies have focussed on the inpatient and emergency setting. We decided to focus on a common clinical setting presently of the Hemophilia Treatment Center (HTC)/Hematology clinic, as increased awareness of testing for VWD [20] has led to an increase in referrals to HTC [21,22] for haemostasis testing in menorrhagia patients. Our study determines by retrospective analysis the prevalence of VWD and platelet function defects (PFD) in adolescent patients referred to a HTC/Hematology clinic for menorrhagia.…”

Section: Introductionmentioning

confidence: 99%

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The prevalence of disorders of haemostasis in adolescents with menorrhagia referred to a haemophilia treatment centre

2007

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Menorrhagia at the time of menarche is relatively common and historically attributed primarily to immaturity of the pituitary-ovarian-uterine axis. Intuitively, a proportion of these patients should have an underlying disorder of haemostasis, given the 5-20% prevalence of von WillebrandÕs disease and the ‡20% prevalence of platelet dysfunction in light of recent epidemiological studies in menorrhagia, although the average age of the patients in those studies has been 35 years. However, there are a few comprehensive studies in the adolescent population determining whether widespread haemostasis evaluation should be carried out in adolescents presenting with menorrhagia. A retrospective chart review study of disorders of haemostasis was carried out in 61 consecutive adolescent patients, ages 11-19 at the time of evaluation referred to the Hemophilia Treatment Center (HTC)/Hematology unit. The mean and median ages were 15 ± 2.2 and 14 years (11, 19), respectively. Standard evaluation included complete blood count, prothrombin time, partial thromboplastin time, von Willebrand factor (VWF) levels and platelet aggregation. The proportion of patients with VWF deficiency was 22/61 (36%) [95% confidence interval (CI), 24-49%]; the proportion of patients with platelet aggregation abnormalities was 4/61 (7%) (95% CI, 2-16%). There was no difference in the frequency of additional muco-cutaneous bleeding symptoms. A relatively high proportion of adolescents are identified with an underlying disorder of haemostasis when referred to an HTC for evaluation of menorrhagia. This involves in part a selective referral bias, but underscores the role of the HTC in evaluating adolescents referred with menorrhagia for an underlying bleeding disorder, given the relatively high yield of haemostatic disorders detected in this setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The prevalence of disorders of haemostasis in adolescents with menorrhagia referred to a haemophilia treatment centre

2007

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“…Although these conditions in women used to be considered as milder forms of haemophilia, it is now understood that some of them can be severe, can have a lifelong negative impact on the health and well-being of affected individuals and may in addition impose a heavy burden on the health care system [3][4][5][6][7][9][10][11]. The impact of bleeding disorders on the health of women worldwide is considerable [2,41].…”

Section: Overview Of Haemostasis Problems In Womenmentioning

confidence: 99%

The role of haemophilia treatment centres in providing services to women with bleeding disorders

et al. 2004

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“…Widespread VWD testing in women with menorrhagia [23] has in turn raised important issues in the testing process in terms of the menstrual cycle or oral contraceptive (OC) affecting the laboratory diagnosis of VWD. The effect of the menstrual cycle or OC on the diagnosis of a platelet function disorder has not yet been comprehensively studied though it has been well established that there exists considerable variation among laboratories in trying to standardize platelet function analysis in the first place [24].…”

Section: Laboratory Aspectsmentioning

confidence: 99%

Menorrhagia associated with laboratory abnormalities of hemostasis: epidemiological, diagnostic and therapeutic aspects

Kouides

Kadir

2007

Journal of Thrombosis and Haemostasis

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Summary. Historically, the pathogenesis of menorrhagia has focused on anatomic and hormonal etiologies. However, in the past decade, numerous epidemiological studies have confirmed an association of von Willebrand factor (VWF) deficiency and menorrhagia with an incidence of VWF deficiency of 13% (95% CI, 11%, 16%). Such patients have a reduced quality of life and incur a high rate of seemingly unnecessary gynecological interventions. In addition, it appears that platelet function abnormalities are c. 3-to 4-fold more common than VWF deficiency in association with menorrhagia. The management of menorrhagia with an underlying disorder of hemostasis involves consideration of the patientÕs age, childbearing status and preference in terms of several options: hemostatic (oral tranexamic acid, intranasal desmopressin), hormonal (oral contraceptive, levonorgestrel intrauterine system) and surgical (endometrial ablation, hysterectomy). Pending ongoing comparative trials in bleeding disorder-related menorrhagia of intranasal desmopressin (DDAVP), tranexamic acid and further study of the levonorgestrel intrauterine device, specific recommendations cannot be made at present regarding whether one intervention is superior to the other. It should also be noted that the dose and schedule and combination of intranasal DDAVP and tranexamic acid have not been well established and warrant further study. It is imperative to establish algorithms of effective menorrhagia interventions in order to justify widespread hemostasis screening of the menorrhagia patient.

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von Willebrand Disease in Women: The Need for Recognition and Understanding

Cited by 9 publications

References 11 publications

The prevalence of disorders of haemostasis in adolescents with menorrhagia referred to a haemophilia treatment centre

The prevalence of disorders of haemostasis in adolescents with menorrhagia referred to a haemophilia treatment centre

The role of haemophilia treatment centres in providing services to women with bleeding disorders

Menorrhagia associated with laboratory abnormalities of hemostasis: epidemiological, diagnostic and therapeutic aspects

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