The prevalence of Von Willebrand disease among women with Menorrhagia of African descent

Abstract

Background: Von Willebrand Disease (VWD) is the most common heritable bleeding disorder and women affected present with  menorrhagia and post-partum hemorrhage. Studies particularly on Caucasians have found that 5-24% of women presenting with  menorrhagia have VWD.

Objectives: The aim of this study was to determine the prevalence of VWD and Low von Willebrand factor (VWF)  among African women with menorrhagia.

Methodology: The study was designed as an unmatched case control study with a final 1:2  ratio. The participants filled out pictorial bleeding assessment charts and MCMDM-1- VWD bleeding questionnaire and subsequently  underwent laboratory testing.

Results: The study recruited 19 cases and 49 controls. The prevalence of VWD was 0% among cases and  4.1% among controls with an overall prevalence of 2.9%. Low VWF had a prevalence of 5.3% among women seen with menorrhagia and  10.2% among controls with an over-all prevalence of 8.8%. There was no association between bleeding score and VW Ristocetin co-factor  activity. Bleeding scores were higher among cases than controls and cases had a higher likelihood of having features of Iron deficiency  anemia.

Conclusion: The lower prevalence of VWD among cases despite a higher bleeding score indicates the need to investigate for  other bleeding disorders in this population. It was postulated that the higher prevalence of Low VWF among controls may be in keeping  with the British Committee of Standards in Hematology finding that these individuals are less likely to bleed. Studies with higher numbers  are recommended to conclusively establish the significance of VWD in this population.