Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand disease
| Autor: | Kalinda Woods, Michael H. White, Robert F. Sidonio, Rachel Friedberg, Megan C. Brown, Mona Kulkarni, Krista J. Childress |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
congenital hereditary and neonatal diseases and abnormalities Anemia von Willebrand factor Von Willebrand factor menorrhagia Internal medicine hemic and lymphatic diseases Von Willebrand disease hemostatics Medicine Diseases of the blood and blood-forming organs Blood coagulation test biology business.industry Incidence (epidemiology) Brief Report blood coagulation tests Retrospective cohort study Hematology Guideline Emergency department medicine.disease female adolescent biology.protein Brief Reports RC633-647.5 business |
| Zdroj: | Research and Practice in Thrombosis and Haemostasis Research and Practice in Thrombosis and Haemostasis, Vol 5, Iss 4, Pp n/a-n/a (2021) |
| ISSN: | 2475-0379 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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