Patterns of von Willebrand Disease Screening in Girls and Adolescents With Heavy Menstrual Bleeding

Abstract

Despite recommendations by the American College of Obstetricians and Gynecologists for more than 15 years, fewer than 20% of postpubertal girls and adolescents with heavy menstrual bleeding underwent screening for von Willebrand disease in this cohort. Increased clinician awareness and adherence to recommended screening recommendations may increase diagnosis of von Willebrand disease.

Standardizing care to manage bleeding disorders in adolescents with heavy menses—A joint project from the ISTH pediatric/neonatal and women's health SSCs

“…33,34 While blood loss of >80 mL is broadly used in clinical studies and trials to define heavy menstrual bleeding, this measurement (involving extracting hemoglobin from sanitary wear) is impractical outside of research settings; therefore, a requirement to change sanitary pads or tampons more often than hourly, clots at least 1 inch in diameter, or a low ferritin level are clinical predictors of heavy periods. 8 A PBAC score > 100 has also been shown to be a sensitive and specific indicator of blood loss exceeding 80 mL per cycle. 35…”

“…5 Multidisciplinary adolescent hematology clinics have helped closed the gap between HMB onset and BD diagnosis, 6 but only 5% of women with HMB present to a hematologist 7 or get screened for common BDs. 8 At any age, a lack of patient and provider awareness causes a delay in diagnosis and bleeding complications during the reproductive lifespan of women with BD. 9 Standardization of HMB care across specialists lends the opportunity to improve diagnosis and treatment outcomes in adolescents with BD.…”

<p>Potential Undiagnosed VWD Or Other Mucocutaneous Bleeding Disorder Cases Estimated From Private Medical Insurance Claims</p>

“…17 Improvements in the recognition and diagnosis of VWD in adolescent girls are also needed. 28 Despite evidence that VWD is among the most commonly encountered bleeding disorders in adolescents with abnormal uterine bleeding 29 and that testing may be cost-effective, 30 laboratory testing is performed infrequently 31,32 and diagnosis may be delayed into adulthood. 33 In 2001, the American College of Obstetricians and Gynecologists (ACOG) indicated that routine screening for coagulation disorders in adolescents with anovulatory bleeding was warranted, and that an underlying coagulopathy such as VWD should be considered in all patients (particularly adolescents) with abnormal uterine bleeding.…”

How I approach iron deficiency with and without anemia

“…It also requires some additional considerations, most notably a detailed history of menstrual blood loss and control of acute menstrual hemorrhage, if present (Table ). Once the anemia is fully treated, it is important to consider evaluation for a bleeding disorder in patients with heavy menses prior to discharge from hematologic care . Dietary history must also be considered in adolescent females, as well as increased iron utilization or losses due to high levels of athletic activity (see “Runner's or athlete's anemia”) .…”

“…Once the anemia is fully treated, it is important to consider evaluation for a bleeding disorder in patients with heavy menses prior to discharge from hematologic care. 22,40,41 Dietary history must also be considered in adolescent females, as well as increased iron utilization or losses due to high levels of athletic activity (see "Runner's or athlete's anemia"). 42 Oral iron therapy is the typical initial therapy, although for patients experiencing substantial fatigue, headaches, and/or exercise intolerance, intravenous iron may be considered to achieve a faster response.…”