Assessment of Menorrhagia in Females Followed for Bleeding Disorders at the Hemophilia Center of Western New York-Correlation between Clinical Presentation and Laboratory Parameters.

Menorrhagia is a common problem among women. The cause of which, in some individuals, has been attributed to von Willebrand’s disease. The assessment of this condition has been hampered by the lack of easily available and consistent laboratory assessment of levels of this factor that correlate with the patient’s clinical presentation. Therefore we initiated a study to correlate the patient’s self assessment of their menorrhagia with their levels of von Willebrand’s factor (VWF) and platelet function. A peripheral blood assessment chart (PBAC) was utilized for patient self-assessment of blood loss during their menstrual cycle. The PBAC is a validated, well-established method which utilized a point system that quantifies the number and extent of soiling of tampons and pads used during a patient’s menstrual cycle. The PFA-100 has been used as an adjunct for lab assessment of platelet function. This is a high shear-inducing device which simulates primary hemostasis after injury to small vessel. This apparatus consists of a reservoir for whole blood and a small capillary surmounted by a collagen-coated membrane with a central aperture. Platelet agonist which is either epinephrine or ADP is present on the membrane. Closure time is reported as a variable which inversely corresponds with von Willebrand factor levels (or platelet function). Clinical correlation with its results are needed. In addition, blood samples were analyzed for Von Willebrand’s factor antigen (VWFA) and Ristocetin co-factor activity (RCOA) using a CLIA approved laboratory. We explored the relationship between PBAC, PFA-100 and VWFA and RCOA levels. Twenty-six patients were enrolled after obtaining an institutional board approved informed consent. Pearson association estimates and P values to assess the association between one month PBAC scores and PFA-100 showed 0.463 (with a p-value of 0.017). A similar analysis between one month PBAC scores and VWFA and RCOA showed 0.099 (p=0.632) and the association between PFA-100 and VWFA and RCOA showed an inverse relationship of −0.481 (p=0.013). These results confirm a correlation between VWFA and RCOA and assessment of platelet function utilizing a PFA-100. Furthermore, there was a correlation between PBAC scores and the results of the PFA-100. The association between PBAC scores and VWAF screening levels did not show significance. These results suggest further data are necessary to understand the relationship between these variables and further suggests that the PFA-100 may offer a more sensitive assessment of platelet function that correlates with clinical presentation than levels of VWFA or RCOA.