Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand disease
Abstract Background Heavy menstrual bleeding (HMB) is often the first bleeding symptom for female individuals with inherited bleeding disorders. Guidelines recommend performing the hemostatic evaluation at HMB presentation. Von Willebrand factor (VWF) levels increase with stress, making it unclear i...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-05-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/rth2.12513 |
| _version_ | 1797725314978152448 |
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| author | Megan C. Brown Michael H. White Rachel Friedberg Kalinda Woods Krista Childress Mona Kulkarni Robert F. Sidonio Jr |
| author_facet | Megan C. Brown Michael H. White Rachel Friedberg Kalinda Woods Krista Childress Mona Kulkarni Robert F. Sidonio Jr |
| author_sort | Megan C. Brown |
| collection | DOAJ |
| description | Abstract Background Heavy menstrual bleeding (HMB) is often the first bleeding symptom for female individuals with inherited bleeding disorders. Guidelines recommend performing the hemostatic evaluation at HMB presentation. Von Willebrand factor (VWF) levels increase with stress, making it unclear if VWF studies during acute bleeding are beneficial in diagnosing von Willebrand disease (VWD). Objectives To determine the utility of testing for VWD during acute HMB. Patients/Methods This retrospective cohort study evaluated VWF levels of individuals presenting to the emergency department (ED) with HMB from January 1, 2017, to December 31, 2018, after prospective implementation of a clinical practice guideline recommending hemostatic evaluation in the ED. We compared VWF and factor VIII (FVIII) levels between acute presentation and follow‐up visit after bleeding resolution. We compared the diagnostic accuracy of initial and follow‐up labs. Results During the study period, 221 individuals were seen in the ED for acute HMB, and 39 had VWD testing at both time points. Median FVIII and VWF levels were higher during acute bleeding than at follow‐up. The difference in VWF levels between visits was negligible when initial FVIII value was normal. Overall incidence of VWD was 7.5%; 69% of those with VWD had low VWF levels during acute HMB. Conclusion VWD testing during acute HMB detects the majority of individuals with VWD but also leads to elevated levels of VWF, potentially limiting at the accuracy of diagnostic labs during acute bleeding episodes. Delayed testing until resolution of anemia and active bleeding may provide more accurate diagnostic evaluation for VWD. |
| first_indexed | 2024-03-12T10:29:24Z |
| format | Article |
| id | doaj.art-0f02716468af4d9c98086b003c655bf8 |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T10:29:24Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-0f02716468af4d9c98086b003c655bf82023-09-02T09:20:13ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792021-05-0154n/an/a10.1002/rth2.12513Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand diseaseMegan C. Brown0Michael H. White1Rachel Friedberg2Kalinda Woods3Krista Childress4Mona Kulkarni5Robert F. Sidonio Jr6Aflac Cancer and Blood Disorders Center Children's Healthcare of AtlantaEmory University Atlanta GA USAAflac Cancer and Blood Disorders Center Children's Healthcare of AtlantaEmory University Atlanta GA USAChildren’s Healthcare of Atlanta Atlanta GA USADepartment of Gynecology and Obstetrics Emory University Atlanta GA USADivision of Pediatric Surgery Children's Healthcare of Atlanta Atlanta GA USAChildren’s Healthcare of Atlanta Atlanta GA USAAflac Cancer and Blood Disorders Center Children's Healthcare of AtlantaEmory University Atlanta GA USAAbstract Background Heavy menstrual bleeding (HMB) is often the first bleeding symptom for female individuals with inherited bleeding disorders. Guidelines recommend performing the hemostatic evaluation at HMB presentation. Von Willebrand factor (VWF) levels increase with stress, making it unclear if VWF studies during acute bleeding are beneficial in diagnosing von Willebrand disease (VWD). Objectives To determine the utility of testing for VWD during acute HMB. Patients/Methods This retrospective cohort study evaluated VWF levels of individuals presenting to the emergency department (ED) with HMB from January 1, 2017, to December 31, 2018, after prospective implementation of a clinical practice guideline recommending hemostatic evaluation in the ED. We compared VWF and factor VIII (FVIII) levels between acute presentation and follow‐up visit after bleeding resolution. We compared the diagnostic accuracy of initial and follow‐up labs. Results During the study period, 221 individuals were seen in the ED for acute HMB, and 39 had VWD testing at both time points. Median FVIII and VWF levels were higher during acute bleeding than at follow‐up. The difference in VWF levels between visits was negligible when initial FVIII value was normal. Overall incidence of VWD was 7.5%; 69% of those with VWD had low VWF levels during acute HMB. Conclusion VWD testing during acute HMB detects the majority of individuals with VWD but also leads to elevated levels of VWF, potentially limiting at the accuracy of diagnostic labs during acute bleeding episodes. Delayed testing until resolution of anemia and active bleeding may provide more accurate diagnostic evaluation for VWD.https://doi.org/10.1002/rth2.12513adolescentblood coagulation testsfemalehemostaticsmenorrhagiaVon Willebrand disease |
| spellingShingle | Megan C. Brown Michael H. White Rachel Friedberg Kalinda Woods Krista Childress Mona Kulkarni Robert F. Sidonio Jr Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand disease Research and Practice in Thrombosis and Haemostasis adolescent blood coagulation tests female hemostatics menorrhagia Von Willebrand disease |
| title | Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand disease |
| title_full | Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand disease |
| title_fullStr | Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand disease |
| title_full_unstemmed | Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand disease |
| title_short | Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand disease |
| title_sort | elevated von willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von willebrand disease |
| topic | adolescent blood coagulation tests female hemostatics menorrhagia Von Willebrand disease |
| url | https://doi.org/10.1002/rth2.12513 |
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