Platelet functional defects in women with unexplained menorrhagia

Abstract

Summary. Menorrhagia is a common clinical problem and is unexplained in more than 50% of women. Although studies suggest that von Willebrand's Disease (VWD) is found in a substantial number of women with unexplained menorrhagia, the prevalence of platelet defects in women with menorrhagia is unknown. To determine the prevalence of platelet and other hemostatic defects, we evaluated women ages 17-55 diagnosed with unexplained menorrhagia. Seventy-four women (52 white, 16 black, six other) were studied. Bleeding time was prolonged in 23 women (31.5%). Maximal percent platelet aggregation was decreased with one or more agonists in 35 (47.3%) women. The most commonly found platelet function defects were reduced aggregation responses to ristocetin in 22 women and to epinephrine in 16 women. Sixteen of 22 women with reduced ristocetin aggregation had von Willebrand ristocetin cofactor (VWF:RCo) and von Willebrand factor antigen (VWF:Ag) > 60%. Platelet ATP release was decreased with one or more agonists in 43 (58.1%) women. Of the black women studied, 11/ 16 (69%) had abnormal platelet aggregation studies compared with 20/52 white women (39%) (P ¼ 0.06). Black women with menorrhagia had a higher prevalence of decreased platelet aggregation in response to ristocetin and epinephrine than did white women (P ¼ 0.0075, P ¼ 0.02). Ten women (13.5%) had VWF:RCo and/or VWF:Ag < 60%. Using race and blood group specific ranges, 5 (6.8%) women had decreased VWF:RCo, VWF:Ag and/or collagen binding (VWF:CB). Mild factor XI deficiency was found in two women and one woman with mild factor V deficiency and one hemophilia A carrier were identified. We conclude that the prevalence of platelet function defects and other inherited bleeding disorders is substantial in a multiracial US population of women with unexplained menorrhagia.

von Willebrand's disease and menorrhagia: Prevalence, diagnosis, and management

“…Menorrhagia is a valuable predictor of a bleeding disorder in women. The frequency of vWD in women with menorrhagia ranges from 5% to 20% in different studies [10][11][12][13][14][15] (Table I). The different prevalences reported may reflect the different study populations (population based or referral), variable definitions of menorrhagia and vWD, timing, types of laboratory tests, and requirements for retesting.…”

“…The criteria for diagnosis and frequency and timing of testing varied among the published studies (Table I). Studies requiring testing on only one occasion may underestimate the prevalence of vWD due to the normal fluctuation in vWF levels [11,13,14]. The three studies of women with objectively confirmed menorrhagia required testing on multiple occasions [10,12,15].…”

“…Several studies of the prevalence of vWD in women with menorrhagia excluded women with pelvic pathology [11,12,15]. The prevalence of uterine abnormalities in women with vWD and menorrhagia is unknown.…”

Thrombin generation in different cohorts: Evaluation of the haemostatic potential

“…Platelet dysfunction has been reported as the most prevalent bleeding disorder among women with menorrhagia, with von Willebrand disease being the second most prevalent (13%) [103,104].…”

Gynaecological problems and choices for contraception in women with inherited bleeding disorders

“…27 Platelet disorders and factor deficiencies are less common but have also been identified in women with menorrhagia. 26,28,29 Therefore IBDs should be borne in mind when investigating women with menorrhagia.…”