The condensed MCMDM-1 VWD bleeding questionnaire as a predictor of bleeding disorders in women with unexplained menorrhagia

Azzam, Hanan; Goneim, Hayam R.; El-Saddik, Amr Mohamed; Azmy, Emad; Hassan, Mohammed H.; El-Sharawy, Solafa

doi:10.1097/mbc.0b013e32835274d9

Cited by 35 publications

(29 citation statements)

References 17 publications

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“…A condensed MCMDM-1VWD bleeding score > 3 can suggest a bleeding disorder (eg coagulation factor deficiency and platelet function disorders) and an elevated score can distinguish women with and without a bleeding disorder when investigated for unexplained menorrhagia. 9,14,[18][19][20] The value of the bleeding score in UBD is uncertain; there are no diagnostic reference criteria for UBD, which has an indistinguishable bleeding pattern compared to patients with established mild bleeding disorders and diagnosis is at clinician's discretion. 3,10 The predominant bleeding pattern is mucocutaneous ( Figure 1), which can suggest a platelet function disorder or mild Reference range not quotes due to changes throughout the study.…”

Section: Discussionmentioning

confidence: 99%

Characterization of a large cohort of patients with unclassified bleeding disorder; clinical features, management of haemostatic challenges and use of global haemostatic assessment with proposed recommendations for diagnosis and treatment

MacDonald

Wright

Beuche

et al. 2019

Int J Lab Hematology

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Introduction There is an unmet need to characterize the diagnosis and management of patients with an unclassified bleeding disorder (UBD). Methods Retrospective review of registered patients with UBD at our centre. Assessment including rotational thromboelastometry (ROTEM) and thrombin generation (TG) were used. Results A total of 124 patients were identified; 91% female. Mean age of presentation was 38.3 years. Mean bleeding score was 8.8 (standard deviation [SD] 3.8); 6.6 in men (SD 1.4) and 9.7 in women (SD 3.3), which was significantly different (P < .05). In women, after deduction of scores for menorrhagia and postpartum haemorrhage, the mean score was 6.4 which was not significantly different to the male score (P = .11). Twenty‐three percent of patients have been transfused, 61% women had treatment for menorrhagia and 17% for epistaxis. TxA and desmopressin were effective at preventing bleeding in 69 procedures and 13 deliveries. TG revealed 26% patients with a long lag time and 19% with a decreased endogenous thrombin potential but no diagnostic pattern was seen. ROTEM (NATEM) was unable to characterize patients; 9% had a prolonged clot time or maximum lysis. ThromboGenomics was normal in 45 tested patients. Conclusions We provide data which shows the bleeding score is biased towards gynaecological bleeding but which remains elevated even when the bleeding score is deducted. Tranexamic acid and desmopressin are effective as haemostatic prophylaxis but there is an urgent need for clinical trials. In conclusion, we describe the use of the bleeding score in these patients and phenotype, diagnosis (including ThromboGenomic testing) and management with practice recommendations.

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Section: Discussionmentioning

confidence: 99%

Characterization of a large cohort of patients with unclassified bleeding disorder; clinical features, management of haemostatic challenges and use of global haemostatic assessment with proposed recommendations for diagnosis and treatment

MacDonald

Wright

Beuche

et al. 2019

Int J Lab Hematology

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“…The NPV was again shown to be high (0.82-0.99), meaning that a negative or normal bleeding score can help to exclude a clinically significant inherited bleeding disorder [8]. The Condensed MCMDM-1 VWD Bleeding Questionnaire was also studied in a group of 30 women presenting with menorrhagia, and was able to distinguish those with a bleeding disorder from those without a bleeding disorder (sensitivity 85%, specificity 90%, PPV 0.89, NPV 0.86), and was also able to distinguish disease severity; women with type 3 VWD had the highest bleeding scores [9].…”

Section: Batsmentioning

confidence: 99%

The evolution and value of bleeding assessment tools

Rydz

James

2012

Journal of Thrombosis and Haemostasis

129

127

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Summary. A personal history of excessive mucocutaneous bleeding is a key component in the diagnosis of a number of mild bleeding disorders, including von Willebrand disease (VWD), platelet function disorders (PFD), and coagulation factor deficiencies. However, the evaluation of hemorrhagic symptoms is a well‐recognized challenge for both patients and physicians, because the reporting and interpretation of bleeding symptoms is subjective. As a result, bleeding assessment tools (BATs) have been developed and studied in a variety of clinical settings. This work has been pioneered by a group of Italian researchers, and the resultant ‘Vicenza Bleeding Questionnaire’ stands as the original BAT. In this review, we will discuss the modifications of the Vicenza Bleeding Questionnaire that have taken place over the years, as well as the validation studies that have been published. Other BATs that have been developed and published will be reviewed, as will the special situations of assessing pediatric bleeding as well as menorrhagia. Lastly, the clinical utility of BATs will be discussed including remaining challenges and future directions for the field.

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“…Assessment of the severity of bleeding symptom is challenging because of the difficulties in reporting subjective bleeding symptoms in a consistent way. This has led to the evolution of bleeding assessment tools and in 2008, the condensed form of the European Molecular, and Clinical Markers for the Diagnosis and Management of type 1 von Willebrand disease (MCMDM‐1vWD) questionnaire was established and independently validated . Further, in 2010, the International Society on Thrombosis and Hemostasis – Bleeding Assessment Tool (ISTH‐BAT) was developed and validated …”

Section: Introductionmentioning

confidence: 99%

Bleeding score in type 1 von Willebrand disease patients using the condensed MCMDM‐1 vWD validated questionnaire

Pathare

Hajri

Omrani

et al. 2018

Int J Lab Hematology

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The condensed MCMDM-1 VWD bleeding questionnaire as a predictor of bleeding disorders in women with unexplained menorrhagia

Cited by 35 publications

References 17 publications

Characterization of a large cohort of patients with unclassified bleeding disorder; clinical features, management of haemostatic challenges and use of global haemostatic assessment with proposed recommendations for diagnosis and treatment

Characterization of a large cohort of patients with unclassified bleeding disorder; clinical features, management of haemostatic challenges and use of global haemostatic assessment with proposed recommendations for diagnosis and treatment

The evolution and value of bleeding assessment tools

Bleeding score in type 1 von Willebrand disease patients using the condensed MCMDM‐1 vWD validated questionnaire

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