International Panel of Experts Reaches Consensus on Diagnosis and Treatment of Bleeding Disorders in Women

New York, 2 June 2009 – Because bleeding from the reproductive tract is a naturally occurring event during menstruation and childbirth, women who exhibit menorrhagia, or excessive bleeding after their menstrual cycle, may have underlying diseases that are underdiagnosed. In order to address important issues related to the diagnosis and management of reproductive tract bleeding in women with bleeding disorders, a consensus conference was convened. Results are published in the July 2009 issue of the American Journal of Obstetrics & Gynecology.

The goals of the consensus conference were to highlight the problems these women experience and to provide clinical information and recommend strategies to guide practicing obstetricians and gynecologists. Where the international panel of experts in obstetrics, gynecology and hematology reached consensus, recommendations were made.

Von Willebrand Disease (VWD) is the most common inherited bleeding disorder. VWD results from a deficiency in, or a dysfunction of, von Willebrand factor (VWF), a protein necessary for normal platelet adhesion and protection of factor VIII (FVIII) from proteolysis in the circulation. The prevalence of menorrhagia in women with VWD is 74–92%.

Although the majority of women who present with menorrhagia do not have a bleeding disorder, the conference participants identified more than a dozen symptoms that suggest further evaluation, including menorrhagia since puberty, a family history of a bleeding disorder, and personal history of one, but usually several, of the following symptoms: nosebleeds (generally bilateral for more than 10 minutes), more than once in the past year; notable bruising without injury (and with bruises >2 cm in diameter); minor wound bleeding from trivial cuts lasting for more than 5 minutes; or prolonged or excessive bleeding following dental extraction.

A hematologic evaluation of the patient’s platelet number and function and her coagulation factor profile should be assessed in collaboration with a hematologist. Meeting participants also agreed that hematologic evaluations should be repeated to confirm the diagnosis of a bleeding disorder.

Writing in the article with her co-authors, Andra H. James, MD, Women’s Hemostasis and Thrombosis Clinic, Duke University Medical Center, Durham, NC, states, “Obstetricians and gynecologists should be aware of bleeding disorders such as VWD, rare bleeding disorders and platelet disorders, which remain underdiagnosed in women with menorrhagia and potentially in other cases of abnormal bleeding such as postpartum hemorrhage. Clues, including a family or personal history of bleeding events, should provoke suspicion of an underlying bleeding disorder. Responding to these clues facilitates collaboration among obstetrician–gynecologists and hematologists that could lead to a decrease in the diagnosis of “idiopathic” menorrhagia and allow more effective management of bleeding events.”

The article is “Von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international expert panel” by Andra H. James, MD; Peter A. Kouides, MD; Rezan Abdul-Kadir, MD; Mans Edlund, MD, PhD; Augusto B. Federici, MD; Susan Halimeh, MD; Pieter W. Kamphuisen, MD; Barbara A. Konkle, MD; Oscar Martínez-Perez, MD, PhD; Claire McLintock, MD; Flora Peyvandi, MD, PhD; and Rochelle Winikoff, MD. It appears in the American Journal of Obstetrics & Gynecology, Volume 201, Issue 1 (July 2009) published by Elsevier.

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Full text of the article is available upon request. Contact Pamela Poppalardo at 212-633-3944 or ajogmedia@elsevier.com to obtain a copy. To schedule an interview with Dr. Andra H. James, please contact Debbe Geiger, Senior Media Relations Strategist, Duke Medicine News and Communications, at 919-660-9461 or Debbe.Geiger@duke.edu.

About the American Journal of Obstetrics & Gynecology
The American Journal of Obstetrics & Gynecology, known as “The Gray Journal,” presents coverage of the entire spectrum of the field, from the newest diagnostic procedures to leading-edge research. The Journal provides comprehensive coverage of the specialty, including maternal-fetal medicine, reproductive endocrinology/infertility, and gynecologic oncology. It also publishes the annual meeting papers of several of its 7 sponsoring societies, including the Society for Maternal-Fetal Medicine and the Society of Gynecologic Surgeons.

The American Journal of Obstetrics & Gynecology's 2007 Impact Factor is 2.917 (previously 2.805) and it continues to be ranked #1 in citations in the Obstetrics & Gynecology category, according to the latest Journal Citation Reports® 2008, published by Thomson Reuters. Having moved up to the #7 position, the Journal’s standard of excellence and continued success can be attributed to the strong leadership of the Editors-in-Chief, Thomas J. Garite, MD, and Moon H. Kim, MD, and their outstanding nationally and internationally recognized editorial board and reviewers. The journal has also been recognized as one of the 100 most influential journals in Biology & Medicine over the last 100 years, as determined by the BioMedical & Life Sciences Division of the Special Libraries Association (2009).

About Elsevier
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey— and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries. www.elsevier.com

Media Contact:
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