Evaluation of coagulation disorders and iron deficiency in women with heavy menstrual bleeding

Abstract

Objective: To explore the incidence of congenital bleeding disorders (CBD), which may result in anemia, in a large cohort of women referred for heavy menstrual bleeding (HMB) in a specialized gynecologic unit.

Methods: Between January 2022 and January 2024, all women referred for HMB were screened. All benefited from Higham and ISTH-BAT scoring to assess the importance of blood loss. Gynecologic ultrasound was performed and antecedents were recorded. Standard coagulation tests, complete blood count, hemoglobin, ferritin, and C-reactive protein assays were performed.

Results: Among 454 women, medical history disclosed eight cases of CBD (six von Willebrand diseases, one case of FVII deficiency and a CBD carrier). In the 446 others, coagulation tests identified 41 (9.2%) with von Willebrand Factor deficiency (VWF:GPAbR ≤ 50 IU/dL), very severe in three cases (0.7%). Overt anemia (hemoglobin ≤120 g/L) was found in 155 (34.7%) women, and low ferritin (<15 μg/L) in 191 (42.8%), with less than 30 μg/L for 324 patients (72.5%). Although the incidence of transfusions was limited, 341 (75.1%) of these women had received oral iron supplementation.

Conclusion: Laboratory screening in a large series of women with HMB disclosed potential CBD in almost 10% of them and overt or rampant anemia in at least 40%. These observations support the need to reinforce the detection and management of HMB.

Keywords: anemia; congenital blood disorder; heavy menstrual bleeding.