Screening hemostatic defects in Saudi University students with unexplained menorrhagia: a diagnosis, which could be missed

Abstract

Bleeding disorders are a common cause of unexplained menorrhagia in adolescents. However, there is lack of information provided on Arab girls. To estimate the prevalence of coagulation factor deficiencies and platelet dysfunction among Saudi university students with unexplained menorrhagia. In this cross sectional study, 463 adolescent girls surveyed for having heavy menses for further evaluation of underlying bleeding tendencies using screening standardized questionnaire. Only 109 girls out of the total 463 girls reported menorrhagia and were included in the evaluation. All girls with menorrhagia were evaluated by Pictorial blood assessment chart (PBAC) for precise evaluation of menstrual blood loss (PBAC score >100), had underwent pelvic ultrasonography and screening of hemostatic abnormalities (complete blood count, PFA-100, PT, aPTT, vWF:RCo, vWF:Ag, coagulation factors assay). On the basis of the score of PBAC more than 100, 25.6% (28/109) of adolescent women (age ranged: 17–25 years old) had confirmed menorrhagia. In 30.8% of them, an ultimate diagnosis of bleeding tendency or hemostatic abnormality was detected [five cases of probable von Willebrand disease (vWD) or low level of vWF:Ag and/or vWF:RCo, two cases of probable platelet dysfunction, and one case of factorV (FV) deficiency]. Anemia was found in 39.28% (11/28) of them; however, only 4 (36%) had received iron supplements. Our study demonstrated that hemostatic defects are not uncommon in Saudi adolescent women presenting with menorrhagia but mostly unrecognized and untreated. It is probably advisable to screen women with menorrhagia for these defects.

prevalence and risk factors of microcytic hypochromic anaemia among students in the Kingdom of Saudi Arabia. A mini-review study

“…Haemostatic defects and menorrhagia are reported as factors in developing anaemia as well according to Bakr, et al 2021 [24]. Similarly, the study of Friberg, 2006 [38] reported that heavy menstrual bleeding is frequently reported in 37% of school students.…”

“…After searching and conducting a critical appraisal of the articles, 14 studies were selected for the systematic review [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. A summary of these studies is presented in Table 1.…”

Point-of-Care Testing in Patients with Hereditary Disorders of Primary Hemostasis: A Narrative Review

“…PFA-100 is extensively studied in patients with (suspected) VWD. 17 18 19 21 22 23 24 26 27 28 29 30 31 32 33 34 35 36 37 43 51 52 53 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 Favaloro et al reported an overall sensitivity of 83.2% and 91.5% of the ADP and EPI cartridge respectively in a review in 2008. 79 A current analysis including all articles published before and after 2008 yielded similar test performance outcomes, as shown in Fig.…”

Bleeding disorders in Saudi Arabia, causes and prevalence: a review

“…30.8% of this group were diagnosed with a hemostatic abnormality or bleeding tendency, including one case of factor V (FV) deficiency, two cases of probable platelet dysfunction, and five cases of probable vWD based on the low levels of vWF:Ag and/or vWF:RCo. 39.28% of those cases were anemic; however, only 36% [ 4 ] of them received iron supplementation [ 11 ].…”