Significance of Evaluation for von Willebrand Disease in Premenopausal Women with Iron Deficiency Anemia and Menorrhagia

• Main Authors: Ji Hyun Kim, Ji Yeon Lee, Bo Lyun Lee, Kwang Hoon Kim, Jeong Eun Lee, Ji Kyoung Park
• Format: Article
• Language: English
• Published: The Korean Society of Pediatric Hematology-Oncology 2021-04-01
• Series: Clinical Pediatric Hematology-Oncology
• Subjects: von willebrand disease; anemia; iron deficiency; menorrhagia
• Online Access: https://doi.org/10.15264/cpho.2021.28.1.39

Background : : In Korea, in the case of patients with significant bleeding symptoms due to unknown causes, there are very few studies that evaluate bleeding disorders, including von Willebrand disease (VWD). VWD should be considered as an important causative factor in patients with iron deficiency anemia (IDA) and unexplained menorrhagia. This study aimed to understand the clinical characteristics of VWD and the significance of evaluation for VWD in premenopausal women in Korea with menorrhagia and IDA.Methods : : Premenopausal women who were diagnosed with IDA and menorrhagia from January 2009 to March 2020 were included. IDA was diagnosed by either low ferritin or transferrin saturation with microcytic anemia. Menorrhagia was evaluated based on the medical records obtained from a gynecologist. VWD diagnosis was defined as von Willebrand factor antigen <50% and von Willebrand factor ristocetin cofactor activity <50%, which were low according to the Hospital for Sick Children criteria.Results : : Out of a total of 120 patients, only 12 were tested for VWD, all of whom were pediatric patients. Four of the 12 pediatric patients tested were diagnosed with VWD and 4 of the 120 (3.3%) patients with IDA and menorrhagia were diagnosed with VWD. Three out of the 4 patients was diagnosed with VWD by repeat screening test. Although all parameters are not statistically significant, VWD patients tended to have IDA at a younger age (13.25 vs. 15.00 years) and were more likely to have recurrent IDA than patients without VWD.Conclusion : : Clinical doctors should consider VWD if patients have menorrhagia with IDA. If VWD is suspected, repeated VWD screening tests are necessary to increase the diagnosis rate. Accurate diagnosis of VWD in patients with significant bleeding may facilitate decisions for appropriate treatment.