Update on laboratory findings in a prospective cohort of chilbearing women with bleeding history

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

Amsterdam

Congreso; XXIV Congress of the ISTH; 2013

International Society on Thrombosis and Haemostasis

Background: Menstruation and childbirth affect excessively women with bleeding disorders. Previously (ISTH Congress 2011), we described that the most frequent disorder in women with bleeding complaints was low von Willebrand factor level. Aims: To investigate the prevalence of hemostatic and platelet functional disorders we studied a prospective cohort of childbearing women with bleeding complaints. Patients and Methods: Three-hundred women (mean age 30 years, range 10?50, 54% blood group O) 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 2 or more units of red cells or hospitalization or surgical procedure. Laboratory parameters: platelet count, bleeding time (BT), PT, aPTT, fibrinogen, factor XIII, euglobulin lysis time, FVIII:C, VWF:Ag, VWF:RCo. Platelet aggregation and ATP release were done as platelet functional studies. Results: Sixty-nine percent of women had moderate bleeding that required medical intervention, and 61 patients (20.3%) had a major bleeding. The frequency of symptoms was: 87% muco-cutaneous; 68% menorrhage; 5% hemorrhagic ovarian follicle; 51/118 bleeding after delivery. The diagnosis were: 16 mild thrombocytopenia; possible VWD type 1: 37 (2 associated to storage pool disease-SPD); VWD type 1: 26; VWD type 2: 9; Normandy phenotype: 8; Abnormal platelet function: 15; Immune Thrombocytopenia: 2; abnormal ELT: 7; Factor deficiencies: 7. Discussion: In 300 consecutive women at childbearing age with bleeding symptoms, 41.7% had an hemostatic and/or platelet disorder. VWF abnormalities (62.9%) were the most frequent findings. Platelet function, factor levels and ELT should be studied as well in every patient.