Von Willebrand factor activity and activated partial thromboplastin time in women with menorrhagia at the gynaecology clinic of the University Teaching Hospital,Lusaka,Zambia

Abstract

von Willebrand Disease (vWD) is the most common or prevalent inherited bleeding disorder. It is caused by a deficiency or dysfunction of von Willebrand Factor, which is a glycoprotein that carries Factor VIII (Anti haemophilic factor) and an adhesive protein in platelet-vessel wall interactions. Most women with Von Willebrand disease present with menorrhagia (74 to 92%) and this can sometimes be the only symptom. Other symptoms may include easy bruising, epistaxis, prolonged bleeding on wounds, post-partum haemorrhage to mention a few. This study aimed at determining von Willebrand Factor activity (vWF activity) and activated Partial Thromboplastin Time (aPTT) in women with menorrhagia at the University Teaching Hospital and the relationship between menorrhagia and other bleeding tendencies or the coagulation test scores (aPTT and vWF activity). This was a case-control study undertaken at the Gynaecology clinic of the University Teaching Hospital. It included 56 cases and 112 controls of age range 18 to 45 years, (mean age of 30 +/- 7.4). The cases were women with menorrhagia and the controls women with gynaecology problems other than menorrhagia. Blood grouping, Activated Partial Thromboplastin Time and von Willebrand Factor Activity test were performed on both study groups. A questionnaire was also used to obtain demographic information from both groups. The study findings were the following, von Willebrand Factor Activity levels were higher in individuals without menorrhagia (97.8 ± 53.1) than women with menorrhagia (66.6 ± 31.5) p < 0.001. Further, aPPT levels in women without menorrhagia were 30.395 ± 7.733) and 31.092 ± 8.259 in women with menorrhagia, with a non-statistically significant difference of p = 0.5924. Based on pathological scores in both VWF activity and a PTT, vWD was diagnosed in 1.8 percent of controls and 10.7 percent of cases. Other significant findings were in Epistaxis and menorrhagia association (p <0.001), Menorrhagia and family history of menorrhagia (p=0.003). There were no significant findings between Blood groups and VWF activity. v Our study showed that vWF activity levels were associated with menorrhagia while aPTT was not associated with menorrhagia. Further, vWF activity levels did not depend on the presence of a specific Blood Group. Our study also showed that the prevalence of vWD was significantly higher in participants with menorrhagia. Further that repeated epistaxis and a positive family history of menorrhagia pointed to a higher risk of menorrhagia. These results highlight the need for haemostatic evaluation in women with excessive menstrual bleeding. This could help in better management of these patients and avoid complications during and after child-birth and surgery.