scholarly journals Do We Need To Evaluate Patients With Spontaneous Subconjunctival Hemorrhage For Bleeding Disorders?

2021 ◽  
Author(s):  
Selim Sayın ◽  
Arif Ülkü Yener
Keyword(s):  
Fibrinogen Level ◽  
Normal Population ◽  
Young Patients ◽  
The Elderly ◽  
Bleeding Disorder ◽  
Von Willebrand Disease ◽  
Etiologic Factor ◽  
Type I ◽  
Bleeding Disorders ◽  
Need To Evaluate

Aim of the study: Subconjunctival hemorrage (SCH) is a frequent bleeding manifestation and a common cause of visits to the primary care. Trauma in young patients and vascular damage such as hypertension in the elderly are the most common causes of SCH and the prevalence of hematological diseases is less than 1%. We aimed to evaluate the prevalence of congenital or acquired bleeding disorders in patients with once or recurrent SCH. Methods used to conduct the study: It is a retrospective study and included fifty-two patients with SCH whose etiologic factor was not detected. Hemostatic tests were studied in 52 patients (25 male and 27 females). All patients included were evaluated for congenital or acquired bleeding disorder and SCH with once and those with 2 or more were compared for the laboratory results. Results of the study: Type I von Willebrand disease (vWD) was diagnosed in one patient with recurrent SCH and one patient with single SCH (3.8%). The prevalence of patients with type 1 vWD in the study was not statistically significant when compared with the frequency of vWD in the normal population. Fibrinogen level was found to be statistically higher in patients who had SCH once than those who had recurrent SCH. But fibrinogen level was in normal range in all patients. Conclusions drawn from the study and clinical implications: There was no increase in the incidence of congenital or acquired bleeding disorder in SCH compared to normal population. For this reason it was thought that there was no need for evaluation for bleeding disorders in spontaneous SCH.

scholarly journals Do We Need To Evaluate Patients With Spontaneous Subconjunctival Hemorrhage For Bleeding Disorders?

2021 ◽  
Author(s):  
Selim Sayın ◽  
Arif Yener
Keyword(s):  
Fibrinogen Level ◽  
Normal Population ◽  
Young Patients ◽  
The Elderly ◽  
Bleeding Disorder ◽  
Von Willebrand Disease ◽  
Etiologic Factor ◽  
Type I ◽  
Bleeding Disorders ◽  
Von Willebrand

Aim of the study: Subconjunctival hemorrage (SCH) is a frequent bleeding manifestation and a common cause of visits to the primary care. Trauma in young patients and vascular damage such as hypertension in the elderly are the most common causes of SCH and the prevalence of hematological diseases is less than 1%. We aimed to evaluate the prevalence of congenital or acquired bleeding disorders in patients with once or recurrent SCH. Methods used to conduct the study: It is a retrospective study and included fifty-two patients with SCH whose etiologic factor was not detected. Hemostatic tests were studied in 52 patients (25 male and 27 females) with. All patients included were evaluated for congenital or acquired bleeding disorder and SCH with once and those with 2 or more were compared for the laboratory results. Results of the study: One patient with once and one patient with recurrent SCH (3.8%) were diagnosed a type I von Willebrand disease (vWD). The prevalence of patients with type 1 vWD in the study was not statistically significant when compared with the frequency of von Willebrand favctor (vWF) deficiency in the normal population. Fibrinogen level was found to be statistically higher in patients who had SCH once than those who had recurrent SCH. But fibrinogen level was in normal range in all patients. Conclusions drawn from the study and clinical implications: There was no increase in the incidence of congenital or acquired bleeding disorder in SCH patients compared to normal population. Therefore, it was considered that spontaneous SCH patients do not need to be evaluated for bleeding disorder.

Coagulopathies

2020 ◽  
Author(s):  
Michael Levine
Keyword(s):  
Key Words ◽  
Bleeding Disorder ◽  
Von Willebrand Disease ◽  
Coagulation Cascade ◽  
Bleeding Disorders ◽  
Platelet Disorders ◽  
Von Willebrand

Coagulopathy can be caused by numerous hereditary or acquired etiologies. Although some of these conditions are known and the patient is aware of the bleeding disorder, other bleeding disorders are diagnosed only after the onset of excessive hemorrhage. This review discusses both hereditary and acquired disorders of coagulopathy. Platelet disorders are discussed elsewhere. This review contains 2 figures, 7 tables, and 72 references. Key words: Coagulopathies; Coagulopathy; Bleeding disorder; Hereditary bleeding disorder; Acquired bleeding disorder; von Willebrand disease; Hemophilia; Coagulation cascade; Hemorrhage; Anticoagulant-associated hemorrhage

scholarly journals The effect of ABO blood group on the diagnosis of von Willebrand disease

Blood ◽  
1987 ◽  
Vol 69 (6) ◽  
pp. 1691-1695 ◽  
Author(s):  
JC Gill ◽  
J Endres-Brooks ◽  
PJ Bauer ◽  
WJ Jr Marks ◽  
RR Montgomery
Keyword(s):  
Blood Group ◽  
Normal Population ◽  
Genetic Defect ◽  
Von Willebrand Disease ◽  
Blood Type ◽  
Abo Blood Group ◽  
Type I ◽  
Group A ◽  
Group B ◽  
Von Willebrand

Abstract In order to firmly establish a normal range for von Willebrand factor antigen (vWF:Ag), we determined plasma vWF:Ag concentrations in 1,117 volunteer blood donors by quantitative immunoelectrophoresis. The presence of the ABO blood group has a significant influence on vWF:Ag values; individuals with blood group O had the lowest mean vWF:Ag level (74.8 U/dL), followed by group A (105.9 U/dL), then group B (116.9 U/dL), and finally group AB (123.3 U/dL). Multiple regression analysis revealed that age significantly correlated with vWF:Ag levels in each blood group. We then performed reverse ABO typing on stored plasma from 142 patients with the diagnosis of von Willebrand disease (vWd). Of 114 patients with type I vWd, blood group O was found in 88 (77%), group A in 21 (18%), group B in 5 (4%), and group AB in none (0%), whereas the frequency of these blood groups in the normal population is significantly different (45%, 45%, 7% and 3%, respectively) (P less than .001). Patients with type II or III vWd had ABO blood group frequencies that were not different from the expected distribution. There may be a subset of symptomatic vWd patients with decreased concentrations of structurally normal vWf (vWd, type I) on the basis of blood group O. Some individuals of blood group AB with a genetic defect of vWF may have the diagnosis overlooked because vWF levels are elevated due to blood type.

scholarly journals Von Willebrand Disease Screening in Women Undergoing Hysterectomy for Heavy Menstrual Bleeding

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 674-674
Author(s):  
Amanda E. Jacobson ◽  
Sara K. Vesely ◽  
Terah Koch ◽  
Janis Campbell ◽  
Sarah H. O'Brien
Keyword(s):  
Surrogate Marker ◽  
Bleeding Disorder ◽  
Von Willebrand Disease ◽  
Heavy Menstrual Bleeding ◽  
Menstrual Bleeding ◽  
Common Symptom ◽  
Metropolitan Statistical Area ◽  
Bleeding Disorders ◽  
Nationally Representative ◽  
Von Willebrand

Abstract Background Bleeding disorders in women are under-recognized and under-treated. Women are equally as likely as men to have bleeding disorders other than hemophilia and are disproportionately affected by these diseases due to the bleeding challenges of menstruation and childbirth. The most common bleeding disorder identified in women is von Willebrand disease (VWD). Heavy menstrual bleeding (HMB) is the most common symptom in women with VWD, occurring in up to 93% of patients. Among women with HMB, the reported prevalence of VWD ranges from 5─20%. Women with VWD are also more likely to be diagnosed with hemorrhagic ovarian cysts due to ovulation-associated bleeding and endometriosis due to increased retrograde menstruation. As a result, women with bleeding disorders are more likely to undergo hysterectomy and also undergo hysterectomy at an earlier age than women without bleeding disorders. In 2001, the American College of Obstetrics and Gynecology (ACOG) recommended VWD screening prior to hysterectomy in women with HMB. The actual frequency of VWD screening in clinical practice is unknown. Objectives In this study, we assess patterns of VWD screening in a nationally representative sample of women undergoing hysterectomies for HMB. Methods We used the Truven Health MarketScan® Research Databases which include the medical prescription claims of over 109 million covered lives as well as Medicaid data on 8.6 million patients from 14 states. The MarketScan Databases contain patient demographics, physician and facility claims and pharmacy claims. Procedure codes were used to identify women ages 10-44 years undergoing hysterectomy or hysterectomy alternative (HA) from 2011-2013. Subjects were required to have 12 months of continuous enrollment prior to surgery date. We utilized ICD-9 codes to categorize hysterectomy indications and only included women with a diagnosis of excessive bleeding as the indication for surgery. Women with fibroids, genital tract malignancy, and previously diagnosed bleeding disorders were excluded. We defined VWD screening as a laboratory claim for either VWF:Antigen and/or VWF:Activity within the 12 months preceding hysterectomy. To determine if patient and facility level characteristics impacted access to specialty hematology care and/or screening for VWD, we collected the following information: 1) known bleeding disorder diagnosis and/or endometriosis prior to surgery; 2) age; 3) whether patient was living in metropolitan statistical area (MSA; used as a surrogate marker for urban vs rural inhabitance); 4) number of miles and approximate travel time to nearest Hemophilia Treatment Center (HTC). We used ArcMAP® software to calculate distance between the MSA and nearest HTC. MSA data was only available for commercially-insured patients. (Figure 1) Logistic regression was used to assess factors related to the occurrence of VWD screening. Results We identified 13,790 women who underwent hysterectomy/HA for HMB. We excluded 138 with known bleeding disorders leaving 13,652 women in our final analysis (Table 1). Of these, 74 (0.5%) were screened for VWD within 12 months preceding surgery. There were 2,000 women (15%) who underwent other coagulation tests, most commonly prothrombin time and partial thromboplastin time. We had MSA data on 11,557 commercially-insured women, of whom 72.4% lived within a MSA. Women living in a MSA were screened more often than those outside of a MSA (p=0.013). For those living within a MSA, the odds of being screened for VWD was lower in women with endometriosis (OR=0.54, 95% CI 0.31, 0.97; p=0.038) and women living >100 miles from the nearest HTC (OR=0.29, 95% CI 0.11, 0.81; p=0.017). Discussion This study demonstrated that despite ACOG expert recommendations, the frequency of VWD screening in a nationally-representative population of publically and commercially-insured women undergoing hysterectomy for HMB was very low. Greater distance from a HTC or a prior diagnosis of endometriosis further reduced the likelihood of VWD screening. It is important to increase awareness that a diagnosis of endometriosis does not rule out the presence of a bleeding disorder. This study brings to light the need for the hematology community to improve education and awareness among women's health providers in order to identify women with bleeding disorders and allow for optimal medical management of HMB prior to surgical consideration. Disclosures No relevant conflicts of interest to declare.

scholarly journals Puberty menorrhagia Requiring Inpatient Admission

2010 ◽  
Vol 49 (178) ◽  
Author(s):  
AH Khosla ◽  
L Devi ◽  
P Goel ◽  
PK Saha
Keyword(s):  
Blood Transfusion ◽  
Medical Condition ◽  
Severe Anaemia ◽  
Bleeding Disorder ◽  
Von Willebrand Disease ◽  
Bleeding Disorders ◽  
Age Group ◽  
Idiopathic Thrombocytopenia Purpura ◽  
Von Willebrand ◽  
Significant Health

INTRODUCTION: Puberty menorrhagia is a significant health problem in adolescent age group and severe cases may require admission and blood transfusion. Aim of this study was to evaluate the causes, associated complications and management of puberty menorrhagia. METHODS: Hospital records of all patients of puberty menorrhagia requiring admission were analyzed for etiology, duration since menarche, duration of bleeding, investigation profile and management. RESULTS: There were 18 patients of puberty menorrhagia requiring hospital admission. Etiology was anovulatory bleeding in 11 patients, bleeding disorders in five which included idiopathic thrombocytopenia purpura in three and one each with Von-Willebrand disease and leukemia. Two patients had hypothyroidism as the cause. Fourteen patients presented with severe anaemia and required blood transfusion. All except one responded to oral hormonal therapy. CONCLUSIONS: Puberty menorrhagia can be associated with severe complications and requiring blood transfusion. Although most common cause is anovulation but bleeding disorder, other medical condition and other organic causes must be ruled out in any patient of Puberty menorrhagia.KEYWORDS: anovulation, bleeding disorder, puberty, menorrhagia, anaemia.

Is a Pbac-Score a Good Tool to Quantify Menorrhagia in Women with Von Willebrand Disease and Rare Bleeding Disorders?

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1133-1133
Author(s):  
Susan Halimeh ◽  
Hannelore Rott ◽  
Manuela Siebert ◽  
Guenther Kappert
Keyword(s):  
Blood Loss ◽  
Bleeding Disorder ◽  
Von Willebrand Disease ◽  
Factor Vii ◽  
Menstrual Blood ◽  
Cycle Period ◽  
Coagulation Disorder ◽  
Bleeding Disorders ◽  
Menstrual Blood Loss ◽  
Von Willebrand

Abstract Abstract 1133 Introduction: Von Willebrand disease (VWD) is the most common inherited bleeding disorder. VWD and other autosomal inherited bleeding disorders equally affect women and men. Menorrhagia or severe menstrual bleeding (HMB) is the most common symptom of women with bleeding disorders. HMB is defined as bleeding that lasts for more than seven days or as the loss of more than 80 mL of blood per menstrual cycle. The menstrual blood loss can be quantified by the use of a pictorial bleeding assessement chart (PBAC). Samples and methods: In 195 women with menorrhagia and in 45 controls menstrual blood loss was quantified using pictorial blood assesment charts (PBAC) and results were compared. Results: In 169 of 195 women (86%) a bleeding disorder could be detected. In those with a bleeding disorder, the distribution was as followed: 62% had a von Willebrand disease, 14,4% had a factor-VII-deficiency (F7D), 5% had a factor-XIII-deficiency (F13D) and the remaining 18,6% had other beedling disorders (e. g. hypofibrinogenaemia and other mild factor deficiencies). The median PBAC-Score of all patients was 268 (range: 10–4212). In our controi group of 45 women the median PBAC-Score was 46,5 (3- 137).ROC-Analysation shows that the PBAC (AUC=0.977) is much more useful than the number of bleeding days (AUC=0.855) in order to distingish controls from patients suffering from menorrhagia due to a coagulation disorder. We found that the best cutoff for the PBAC is 100 with an sensitifity of 88% and a specifity of 97%. Discussion: Attempts to measure the quantity of menstrual blood loss can be useful in clinic practice. One study found that variables predicting a blood loss higher than 80ml per menses were clots greater than one inch, low ferritin levels, or changing a pad or tampon more than hourly (flooding). A prospective method of quantifying menstrual blood loss includes the use of a pictorial bleeding assessement calendar (PBAC). We are of the opinion, that we would have detected more bleeding disorder also in the patients, where we did not find any diagnosis until now, if we would have controlled them more than one time during the cycle period. Conclusions: Women with hyermenorrhagia frequently suffer from a bleeding disorder, in 86% of our patients an abnormal coagulation was found. The PBAC-Score is an easy tool to quantify menstrual blood loss in women. In our study a PBAC-Score above 100 was suspicious of having a bleeding disorder. Disclosures: No relevant conflicts of interest to declare.

The Prevalence of von Willebrand Disease in the Primary Care Setting.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1780-1780 ◽  
Author(s):  
Mackenzie Bowman ◽  
Paula James ◽  
Marshall Godwin ◽  
Dilys Rapson ◽  
David Lillicrap
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Normal Population ◽  
Post Partum ◽  
Oral Anticoagulant Therapy ◽  
Von Willebrand Disease ◽  
Type I ◽  
Von Willebrand

Abstract Von Willebrand Disease (VWD), the most common inherited bleeding disorder in humans, results from a deficiency or abnormal functioning of von Willebrand factor (VWF). The most widely accepted estimate of VWD prevalence in the literature is 1%, which is derived from epidemiological studies performed in the USA and Italy. However, both of these studies were based on investigations of healthy, school aged children without overt bleeding symptoms. In contrast, the prevalence of symptomatic VWD has been estimated to be approximately 1 in 10,000 based on patients referred to specialized bleeding clinics. The discrepancy between these prevalence figures has not been explained and requires further investigation. This uncertainty is further complicated by a lack of consensus concerning the frequency of bleeding symptoms in the normal population. VWD can cause a range of symptoms from mild bruising to significant mucocutaneous bleeding. Such symptoms are often presented to primary care physicians by their patients but are not always significant enough to prompt a referral to a specialist. Thus, the primary care setting provides a unique context for assessing the prevalence of symptomatic VWD. The objective of the present study is to perform a prospective assessment of the prevalence of symptomatic VWD in the primary care setting. The on-going study has been carried out since September 2004 in four primary care clinics in the Kingston, Ontario area. Patients of all ages were approached in the waiting rooms of the clinics and asked if they had ever experienced problems with bleeding or bruising. Those that were significantly concerned by their symptoms and not aware of the cause of their bruising or bleeding (e.g. oral anticoagulant therapy) were then eligible to complete a detailed standardized bleeding questionnaire adapted from that used in the recent European multicenter type 1 VWD study (MCMDM-1VWD). The questionnaires were scored in terms of the severity and frequency of the following symptoms: epistaxis, bruising, oral cavity bleeding, post-dental extraction bleeding, gastrointestinal bleeding, post-operative bleeding, menorrhagia, post-partum hemorrhaging, hemarthrosis and central nervous system bleeding. Subjects with a positive score of five or greater on the questionnaire were then sent for VWD laboratory studies on two separate occasions, at least 4–6 weeks apart. To date, 5,000 patients have been approached and asked if they have ever experienced problems with bruising or bleeding. Of those, approximately 11% reported problems with bruising or bleeding, a number significantly lower than the 25% reported in the literature. Only 104 patients reported significant symptoms and 45 people went on to complete the bleeding questionnaire. Approximately 53% of the subjects had a positive bleeding score leading to laboratory investigations for VWD. Of the subjects that have had blood work performed, we have made a new diagnosis of type I VWD in one individual. As well, three patients approached at the clinics had been previously diagnosed with VWD. Therefore, the prevalence of symptomatic VWD in the primary care setting evaluated thus far in this study is 0.08%.

Bleeding Disorders in Premenopausal Women: (Another) Public Health Crisis for Hematology?

Hematology ◽  
2006 ◽  
Vol 2006 (1) ◽  
pp. 474-485 ◽  
Author(s):  
Andra H. James ◽  
Margaret V. Ragni ◽  
Vincent J. Picozzi
Keyword(s):  
Public Health ◽  
Public Health Problem ◽  
Premenopausal Women ◽  
Bleeding Disorder ◽  
Von Willebrand Disease ◽  
Deficiency Anemia ◽  
Public Health Approach ◽  
Major Public Health Problem ◽  
Bleeding Disorders ◽  
Health Crisis

Abstract Premenopausal women with bleeding disorders represent a major public health problem. Estimates suggest up to 20% of women with menorrhagia have an underlying bleeding disorder (corresponding to a prevalence of 1.5–4 million American women). Von Willebrand disease (VWD) is the most common bleeding disorder among women with menorrhagia, affecting up to 20% of such patients. Besides menorrhagia, important consequences of bleeding disorders in premenopausal women include iron deficiency anemia, miscarriage, postpartum bleeding, uterine bleeding and hysterectomy. These patients face many obstacles in achieving optimum care. Recognition is difficult as women may consider their symptoms “normal” and come to attention only after serious bleeding events. Symptoms of VWD may also overlap with benign conditions, primary providers may not suspect the diagnosis, and convenient hematologic input may be unavailable. Diagnosis is difficult as there is no single definitive test for VWD, and test results are variable, often being affected by extragenic factors, including stress, contraceptives, hormones, and pregnancy. Hemostatic treatment is limited by DDAVP tachyphylaxis, the lack of recombinant VWD concentrates, and the ineffectiveness of hormonal therapy, leading to unnecessary procedures and early hysterectomy. Finally, significant controversy exists regarding classification of type 1 VWD as a disease: given the overlap in symptoms and laboratory assays within the normal population, evaluation for those with VWD might be seen as identification of potential bleeding risk rather than detection of a disease. This symposium seeks to explore these issues in greater detail from the combined perspectives of the obstetrician-gynecologist and the hematologist to promote a better public health approach to this problem.

Menorrhagia and bleeding disorders in adolescent females

2012 ◽  
Vol 32 (01) ◽  
pp. 45-50 ◽  
Author(s):  
S. Halimeh
Keyword(s):  
Screening Tool ◽  
Treatment Options ◽  
Adolescent Females ◽  
Bleeding Disorder ◽  
Von Willebrand Disease ◽  
Menstrual Bleeding ◽  
Common Symptom ◽  
Bleeding Disorders ◽  
Factor Deficiency ◽  
Von Willebrand

SummaryIn women, von Willebrand disease (VWD) is the most common inherited bleeding disorder. Since VWD and other inherited bleeding disorders are autosomal disorders, they affect women and men. Menorrhagia, or heavy menstrual bleeding (HMB), is the most common symptom of women with bleeding disorder experience. Objectively, it is defined as bleeding that lasts for more than seven days or results in the loss of more than 80 ml of blood per menstrual cycle. The prevalence of menorrhagia in a woman with a bleeding disorder ranges from 32 to 100% in patients with VWD, from 5 to 98% in patients with a platelet dysfunction and from 35 to 70% in women with a rare factor deficiency. A detailed history and a careful physical exam are the first steps towards a diagnosis in adolescents, adding a PBAC > 100 increased the sensitivity of the screening tool further to 95%. Laboratory testing should be made at the time of menstrual bleeding in an effort to capture the lowest level of VWF : Ag and FVIII : C. Treatment options for menorrhagia in VWD: antifibrinolytic therapy with tranexamic acid, (2) the non-transfusional agent desmopressin (DDAVP), (3) purified blood products that contain factor VIII and VWF concentrated from plasma and (4) hormonal preparations.

scholarly journals The effect of ABO blood group on the diagnosis of von Willebrand disease

Blood ◽  
1987 ◽  
Vol 69 (6) ◽  
pp. 1691-1695 ◽  
Author(s):  
JC Gill ◽  
J Endres-Brooks ◽  
PJ Bauer ◽  
WJ Jr Marks ◽  
RR Montgomery
Keyword(s):  
Blood Group ◽  
Normal Population ◽  
Genetic Defect ◽  
Von Willebrand Disease ◽  
Blood Type ◽  
Abo Blood Group ◽  
Type I ◽  
Group A ◽  
Group B ◽  
Von Willebrand

In order to firmly establish a normal range for von Willebrand factor antigen (vWF:Ag), we determined plasma vWF:Ag concentrations in 1,117 volunteer blood donors by quantitative immunoelectrophoresis. The presence of the ABO blood group has a significant influence on vWF:Ag values; individuals with blood group O had the lowest mean vWF:Ag level (74.8 U/dL), followed by group A (105.9 U/dL), then group B (116.9 U/dL), and finally group AB (123.3 U/dL). Multiple regression analysis revealed that age significantly correlated with vWF:Ag levels in each blood group. We then performed reverse ABO typing on stored plasma from 142 patients with the diagnosis of von Willebrand disease (vWd). Of 114 patients with type I vWd, blood group O was found in 88 (77%), group A in 21 (18%), group B in 5 (4%), and group AB in none (0%), whereas the frequency of these blood groups in the normal population is significantly different (45%, 45%, 7% and 3%, respectively) (P less than .001). Patients with type II or III vWd had ABO blood group frequencies that were not different from the expected distribution. There may be a subset of symptomatic vWd patients with decreased concentrations of structurally normal vWf (vWd, type I) on the basis of blood group O. Some individuals of blood group AB with a genetic defect of vWF may have the diagnosis overlooked because vWF levels are elevated due to blood type.

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