Von Willebrand disease among Egyptian women suffering from menorrhagia

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Abstract

Aim of the work

The aim of the present study was to estimate the prevalence of von Willebrand disease (vWD) among Egyptian women suffering from menorrhagia and without pelvic pathology.

Patients and methods

This multicenter, prospective cohort study involved 1476 women who complained of menorrhagia at the outpatient clinics of five medical centers in Egypt. Only 359 were diagnosed with dysfunctional uterine bleeding without screening for bleeding disorders, which is not a routine work up among most gynecologists. Those women were tested for von Willebrand factor antigen (vWF Ag), von Willebrand factor activity (vWF Ac), complete blood count, prothrombin time, and international normalized ratio.

Results

Among the screened women, 17.8% (64/359) had been diagnosed with vWD. The vast majority (81%) had deficient vWF Ag (52/64), whereas only 19% (12/64) were suffering from defective function of the factor. None of our women had type III vWD. There was a significant positive correlation between vWF Ag or vWF Ac and the hemoglobin level (r=0.231 and 0.174, respectively), whereas the correlation showed a significant negative pattern between vWF Ag and international normalized ratio (r=−0.230, P<0.001). Furthermore, the less activity of the factor the more the menorrhagia days among women recruited (r=−0.422, P<0.001).

Conclusion

Inherited bleeding disorders are not an uncommon cause of menorrhagia; therefore, it is recommended to test for those disorders especially in the absence of pelvic pathology or with additional bleeding symptoms. We endorse testing for vWD factor and activity among Egyptian women with dysfunctional uterine bleeding and absent pelvic pathology or unresponsive to traditional treatment.

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