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Gynecological bleeding in women with congenital bleeding disorders: A comprehensive cohort from Iran
Alireza Zafarani1, Elnaz Ghodratnia2, Mohammad Reza Amirzargar2
1Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran; Department of Hematology and Blood Banking, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran.
Insights
Menorrhagia is a significant issue for women with inherited bleeding disorders, particularly von Willebrand disease (VWD). Early diagnosis and awareness among specialists are crucial for effective management of gynecological bleeding.
Area of Science:
- Gynecology
- Hematology
- Medical Diagnostics
Background:
- Gynecological bleeding, including menorrhagia and postpartum hemorrhage (PPH), significantly impacts women's quality of life, especially those with inherited bleeding disorders.
- The Iranian Comprehensive Hemophilia Care Center (ICHCC) is a key facility for managing such cases in Iran.
Purpose of the Study:
- To evaluate gynecological bleeding, with a focus on menorrhagia, in Iranian female patients diagnosed with inherited bleeding disorders.
- To assess the prevalence and characteristics of menorrhagia and PPH in this patient cohort.
Main Methods:
- A study involving 156 female patients aged 12 and above with diagnosed inherited bleeding disorders at ICHCC.
- Utilized demographic data, laboratory results, and validated bleeding assessment tools: ISTH-BAT, MCMDM-1, and PBAC.
- Employed Mann-Whitney and Spearman's rho tests for statistical analysis of metric and categorical data.
Main Results:
- Von Willebrand disease (VWD), Factor VII deficiency, and combined factor deficiency were the most prevalent disorders.
- Menorrhagia was the most frequent diagnosis, with high scores recorded on bleeding assessment tools (ISTH-BAT, MCMDM-1, PBAC).
- Significant positive correlations were found between overall bleeding scores and menorrhagia/PPH, and between VWF:Ag/VWF:RCo and bleeding assessment questionnaires.
Conclusions:
- Menorrhagia is the predominant gynecological issue in females with inherited bleeding disorders, especially VWD.
- Enhanced awareness among gynecologists and hematologists regarding bleeding disorders is vital for managing unexplained menorrhagia.
- Optimal patient management necessitates a collaborative approach between specialists to address these complex bleeding conditions.
Background:
Gynecological bleeding including menorrhagia and postpartum hemorrhage (PPH) face women's quality of life constantly with difficulties, especially those suffering from inherited bleeding disorders. In this study, we aim to evaluate gynecological bleeding particularly menorrhagia among Iranian women patients with inherited bleeding disorders admitted to the Iranian Comprehensive Hemophilia Care Center (ICHCC).
Methods:
This study was conducted on 156 females aged ≥ 12 diagnosed with an inherited bleeding disorder in ICHCC. Demographic and laboratory data were documented for all patients. Bleeding questionnaires (the International Society on Thrombosis and Hemostasis bleeding assessment tool (ISTH-BAT), Molecular and Clinical Markers for the Diagnosis and Management of Type 1 von Willebrand disease (MCMDM-1), and Pictorial blood loss assessment chart (PBAC)) were filled out for all patients. For comparing metric and categorical parameters, Mann-Whitney was performed. Spearman's rho test was used for analyzing correlation.
Results:
The mean age of patients was 33. Von Willebrand disease (VWD), Factor (F) VII deficiency and combined factor deficiency were the most diagnosed disorders. The median of ISTH-BAT, MCMDM-1, and PBAC was 7,7, and 517, respectively. Menorrhagia was the most common reason for diagnosis. Menorrhagia and PPH domain scores ≥ 2 were recorded in 82 and 34 patients, respectively, and PBAC scores > 100 were seen in 118 patients. Significant positive correlations were observed between bleeding scores and menorrhagia and PPH scores. No significant correlations were recorded for VWF: Ag and VWF: RCo with menorrhagia and PPH scores; however, significant correlations were seen for VWF: Ag and VWF: RCo with bleeding score questionnaires.
Conclusion:
Menorrhagia is the most common problem in females affected by different types of inherited bleeding disorders, particularly VWD. Increased awareness among gynecologists and hematologists about bleeding disorders in cases with unexplained menorrhagia is an essential step for optimal management.
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