An adolescent who is being evaluated for acute heavy menstrual bleeding and has von Willebrand factor (VWF) antigen levels of 80% or lower on initial presentation should have the test repeated at a later timepoint when she is back to her normal state of health, according to an analysis presented at the 64th ASH Annual Meeting and Exposition.
“Diagnosing a young woman with VWD [von Willebrand disease] can be challenging, as these patients often present in the setting of physiologic stress, acute bleeding, anemia, and iron deficiency,” said presenter Clay T. Cohen, MD, of Baylor College of Medicine in Houston. “These factors can cause von Willebrand laboratory levels to be elevated and not represent the individual’s true antigen baseline.”
VWD is the most common bleeding disorder, with an estimated prevalence between 0.1% and 1% of the population, and is the most common bleeding disorder among adolescent girls with heavy menstrual bleeding. Adolescent girls who present with complications of heavy menstrual bleeding should undergo VWF testing, according to Dr. Cohen. However, guidance on whether to repeat VWF testing is lacking.
Dr. Cohen and colleagues analyzed VWD testing patterns among 6,125 adolescent girls between the ages of 9 and 21 who underwent VWF testing through the Texas Children’s Hospital network during a five-year period. To develop a prediction model that could guide repeat testing decisions, the researchers collected patient demographics, VWF testing results, and other hematologic factor test results, including serum ferritin and hemoglobin.
Based on the resulting prediction model, there was a greater than 97% probability of having normal repeat VWF values in adolescents with initial VWF antigen values greater than 80%. There was no association between age and VWF antigen level. Those young women assessed through outpatient adolescent medicine or gynecology clinics were more likely to have low VWF values, while young women with normal values were more frequently assessed in the acute care setting (p<0.001).
Median serum ferritin and hemoglobin values were 13 ng/mL and 12.8 g/dL, respectively, with no significant difference between those with normal versus low VWF antigen values.
“Based on our results, all adolescent girls evaluated for heavy menstrual bleeding are at a high risk of iron deficiency and should be treated, whether they have VWD or not,” Dr. Cohen added.
The researchers also concluded that iron deficiency screening should be considered for all adolescents with heavy menstrual bleeding, not just those with a confirmed bleeding disorder.
Any conflicts of interest declared by the authors can be found in the original abstract.
Reference
Cohen CT, Zobeck, M, and Powers JM. To repeat or not repeat, that is the question: von Willebrand testing in adolescent girls with heavy menstrual bleeding. Abstract #589. Presented at the 2022 American Society of Hematology Annual Meeting and Exposition; December 11, 2022; New Orleans, Louisiana.
