Special contributionIntroduction: abnormal uterine bleedingHemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding
Section snippets
Primary evaluation for an underlying disorder of hemostasis in women with EMB
Laboratory investigation for an underlying disorder of hemostasis in a woman with EMB cannot be carried out by the practitioner who is oblivious to the clinical history. Consequently, the first step is not venipuncture but a focused history for a family history of bleeding and a personal history of bleeding symptoms (Table 2). These symptoms for all women include easy bruising of >5 cm 1–2 times/month, frequent gum bleeding when flossing or brushing teeth, and epistaxis 1–2 times per month. In
Secondary evaluation for an underlying disorder of hemostasis in women with EMB
Those women with a “positive” screen and normal platelet count should then undergo a logical, stepwise sequence of testing for various disorders of hemostasis. Accurate hemostasis testing is crucial because the specificity of bleeding symptoms is poor and many “normal” patients without an identifiable disorder of hemostasis will report bleeding symptoms (1). Hemostasis testing ideally should be done on site with immediate on-site processing, given the frequent misdiagnosis of von Willebrand
Future research in the investigation of underlying disorders in women with EMB
Finally, future clinical trials of hemostasis testing in the women with excessive menstrual bleeding should include the following:
- 1
In the light of the preliminary data cited above showing a relatively high prevalence of platelet function abnormalities in menorrhagia, further study of the potential role of subtle platelet aggregation and release abnormalities with concurrent study of platelet aggregation and release in normally menstruating women in determining if these abnormalities are a cause
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