LOW VON WILLEBRAND FACTOR (VWF) LEVEL IS THE MORE FREQUENT FINDING IN A PROSPECTIVE COHORT OF CHILDBEARING WOMEN WITH BLEEDING HISTORY

SÁNCHEZ LUCEROS A; WOODS AI; MESCHENGIESER SS; GROSSO SH; BLANCO AN; ALBERTO MF; BERMEJO EI; LAZZARI MA

KYOTO

Congreso; XXIII CONGRESS IF THE INTERNATIONAL SOCIETY ON THROMBOSIS AND HAEMOSTASIS; 2011

INTERNATIONAL SOCIETY ON THROMBOSIS AND HAEMOSTASIS

Introduction and Objective: Menstruation and childbirth affect excessively women with bleeding disorders. To investigate the prevalence of hemostatic and platelet functional disorders we studied a prospective cohort of childbearing women with bleeding complaints. Patients and Methods: One hundred and thirty-eight women (mean age 30 years, range 12–49) were included. Gynecological and obstetric history (menorrhage defined by PBAC), as well as other bleeding symptoms were registered. Bleeding was defined as major if it was associated with either a decrease in the hemoglobin level of at least 2 g/dL or the need for transfusion of two or more units of red cells or hospitalization or surgical procedure. Laboratory parameters: platelet count, bleeding time, PT, aPTT, fibrinogen euglobulin lysis time, FVIII:C, VWF:Ag, VWF:RCo. Platelet aggregation and ATP release were done as platelet functional studies. Patients and Methods: One hundred and thirty-eight women (mean age 30 years, range 12–49) were included. Gynecological and obstetric history (menorrhage defined by PBAC), as well as other bleeding symptoms were registered. Bleeding was defined as major if it was associated with either a decrease in the hemoglobin level of at least 2 g/dL or the need for transfusion of two or more units of red cells or hospitalization or surgical procedure. Laboratory parameters: platelet count, bleeding time, PT, aPTT, fibrinogen euglobulin lysis time, FVIII:C, VWF:Ag, VWF:RCo. Platelet aggregation and ATP release were done as platelet functional studies. Results: 65.2% of women had moderate bleeding that required medical intervention, and 30 patients (21.7%) had a major bleeding. The frequency of symptoms was: 85.5% muco-cutaneous; 79.7% menorrhage; 18.8% had post-surgical bleeding; 6.5% hemorrhagic ovarian follicle; 25/67 bleeding after delivery; and 7/11 women had bleeding after miscarriage. The diagnosis were: eight mild thrombocytopenia; possible VWD type 1: 17 (two associated to storage pool disease-SPD); VWD type 1: 2; VWD type 2: 2; VWD type 2M: 1; Normandy phenotype: 5; SPD: 1; Immune Thrombocytopenia: 1. Major bleeding was more frequent in patients older than 26 years old (N = 85) vs. younger (N = 53) (27% vs. 13.2%, P = 0.04, OR 1.33, CI 1.03–1.72). There was a tendency for higher risk of major bleeding in patients with an hemostatic/platelet defect (OR 1.99; CI 0.8–4.9, P = 0.09). Discussion: In 138 consecutive women at childbearing age with bleeding symptoms, 26.8% had an hemostatic and/or platelet disorder. VWD (72.9%) was the most frequent one, although platelet function should be studied as well in every patient. DEVELOPING WORLD SCIENTISTS AWARD