An approach to outreach patients with von Willebrand disease in Egypt by targeting women with heavy menstrual bleeding and/or bleeding symptoms

Abstract

von Willebrand disease (VWD) is frequently ignored as a cause of menorrhagia. We investigated Egyptian women complaining of heavy menstrual bleeding (HMB) and/or other bleeding symptoms to detect potential VWD cases. Seventy-five female patients complaining of HMB and/or bleeding symptoms and 38 age-matched healthy female controls went through a family history questionnaire, a physical examination and were evaluated for bleeding score, pictorial blood assessment chart (PBAC), complete blood count, serum ferritin, blood group, prothrombin time, activated partial thromboplastin time, factor VIII (FVIII) activity, von Willebrand factor (VWF) ristocetin cofactor (RCo) activity, antigen (Ag), and RCo/Ag ratio. Sixty-eight of 75 patients presented with HMB, out of which 46 had no organic pathology and 7 presented other bleeding symptoms. Six patients were diagnosed with VWD, three with HMB, two with other bleeding symptoms and one with family history of VWD. Two related VWD patients were diagnosed in the control group. There were significant differences in bleeding and PBAC scores, ferritin level, FVIII activity, VWF:RCo and VWF:Ag between VWD patients and controls. This study indicated a high prevalence of VWD among patients with HMB without organic pathology (6.5%) and demonstrated the sensitivity of diagnostic parameters of VWD patients in an outreach campaign. The inexpensive bleeding and PBAC scoring systems are valuable to exclude cases without objective bleeding symptoms. Raising gynaecologists awareness about hereditary bleeding disorders is important to ensure a proper diagnosis and possible referral of these patients. Management of these patients with comprehensive medical care services under a multidisciplinary team would be ideal.

Coagulation hallmark indicators of menorrhagia in a comparative study between menorrhagic and healthy women attending Bungoma County Referral Hospital in Kenya

“…The present study revealed that a family history of bleeding disorders was signi cantly more common among menorrhagic women than among non-menorrhagic women; however, approximately 3-fold more menorrhagic women did not have any family history of bleeding disorders. These ndings are consistent with studies performed in Egypt (29), Sudan (25) and Sweden (30). Previous studies have shown a substantial association between idiopathic menorrhagia and a family history of heavy menstrual bleeding, suggesting that familial menorrhagia is an inherited feature (27).…”

Women and girls with heavy menstrual bleeding and inherited bleeding disorders: A call to action for the Haemophilia Treatment Centre Nurse

“…Additionally, in healthcare systems where nurses can pursue recognition as advanced practice providers (APP), there is evidence that the APP can expand outreach and services to patients with bleeding disorders 37 . One approach in Egypt demonstrated that screening with questionnaires can help identify appropriate candidates for referral to an HTC for further evaluation and laboratory testing 38 …”

Spectrum of Non-Traumatic Bleeding Complaints among women with Bleeding Disorders

“…In women with VWD, menorrhagia is the most common symptom. [7,8] It is also substantially unknown whether different bleeding symptoms may preferentially cluster together with some particular pattern within VWD patients, and whether the presence of some bleeding symptoms may actually predict occurrence of bleeding in circumstantial situations (e.g. surgery).…”