Bleeding Disorders in Women and Adolescent Girls

Fifty percent of all women during their menstruating years complain of menorrhagia. This is the population that needs to be screened for underlying bleeding disorders. Menorrhagia is defined as excessively heavy or prolonged menstrual bleeding in women. The symptoms are abnormal uterine bleeding, which may be caused by medical problems or hormonal imbalances. As many as 20% of women with heavy menstrual bleeding have von Willebrand Disease — a very common inherited bleeding disorder that profoundly affects platelet function.¹ The American College of Obstetrics and Gynecology (ACOG) recently recommends von Willebrand Disease screening for adolescents and women with heavy menstrual bleeding. At the same time, ACOG states that hysterectomies for excessive bleeding should not be performed until appropriate screening for bleeding disorders was conducted.

According to US Census, it was predicted that in 2002, there would be 143 million females in the United States. At this time, 81 million of these females were between the ages of 10 and 49 and half of these, 40.5 million, would complain of heavy menstrual bleeding at some time during their reproductive years. This figure represents the significant need for platelet function screening associated with potential cases of menorrhagia. Annually about two million females turn 10 each year, contributing to the ongoing need for first time evaluation of underlying bleeding disorders.

You may also access additional information from the National Hemophilia Foundation. The NHF has created a program called Project Red Flag; information can be accessed from their home page under 'Women with Bleeding Disorders'.

¹ American College of Obstetrics and Gynecology.

National Hemophilia Foundation
www.acog.org

Inherited Bleeding Disorders

Von Willebrand disease (vWD) is the most common hereditary bleeding disorder, affecting up to 3% of the U.S. population¹. In this disease, platelets behave abnormally because a patient's plasma lacks, or has dysfunctional, von Willebrand factor. Von Willebrand factor helps platelets adhere to damaged blood vessels to form a platelet plug, an integral aspect of hemostasis. Von Willebrand factor also serves as a carrier protein for plasma factor VIII.

vWD affects men and women in equal numbers. Because the most common symptoms of vWD in women (heavy and prolonged menstrual periods) are often misunderstood to be a gynecologic rather than a hematologic problem, the risk of misdiagnosis and undertreatment poses a greater health concern for women than it does for men. "We estimate that 10% of the hysterectomies performed in the United States are the result of underlying von Willebrand disease. A diagnosis and an appropriate follow-up would avoid many unnecessary surgeries."^2,3

¹ OBGYN.net publications. www.obgyn.net
² Triplett D.A. Coagulation and Bleeding Disorders: Review and Update. Clin Chem 46:1260-1269 (2000)
³ Kouides P.A. Females with von Willebrand Disease: 72 years as the silent majority. Hemophilia 4:665-676 (1998).

Clinical Screening

For Menorrhagia and von Willebrand Disease

While historically there may not have been accurate simple tests to assess platelet dysfunction in women, since 1997, there has been a simple and accurate, highly sensitive test to detect conditions of low levels or defective forms of von Willebrand factor (90%), as well as other causes of platelet disorders (>90%). The PFA-100® Analyzer is manufactured and marketed by Siemens Healthcare Diagnostics. The tests are performed by using a small amount of whole citrated-blood (<2mL); results are determined within 4-8 minutes.

A complete platelet function analysis can be ordered through a general practitioner, gynecologist, obstetrician, hematologist or from an emergency department physician.

For more information on using the PFA-100® Analyzer to test for underlying bleeding disorders in your institution, click on the link below.
PFA-100® System