Von Willebrand Factor Levels and Activity in Women With Menorrhagia in Kenyatta National Hospital

Abstract

Levels and activity of Von Willebrand Factor in Women with Menorrhagia Study Background Von Willebrand disease (VWD) is the most prevalent inherited bleeding disorder. It is a qualitative or quantitative defect in von Willebrand factor that leads to prolonged and excessive bleeding. The global prevalence is estimated to be 1-3 %. The most common presentation of VWD in women is menorrhagia, however mild the disease is. This reduces the quality of life of these patients. The role of haemostasis is important in management of obstetrics and gynaecological conditions. Mild forms of the disease often go undetected and eventually cause clinical complications. Women with VWD have low quality of life. Prolonged and excessive bleeding among patients with VWD is often documented after surgical procedures. Few studies have been done on women with VWD in Africa, including Kenya. Testing for levels and activity of Von Willebrand Factor in women with menorrhagia in Kenyatta National Hospital will be a basis for specific testing for the disease. The findings of this study were meant to prompt reviews on how patients with chronic gynaecological bleeds are evaluated. Obstetrician/gynaecologists and haematologists will set up new practices when managing these patients. Broad Objective To determine antigen levels and activity of Von Willebrand Factor among women with menorrhagia in KNH between January 2021 and August 2021 Study design and Site This was a descriptive cross-sectional study which took place in Kenyatta National Hospital gynaecology clinics and acute gynaecology ward (1D). Participants and Methods The study population was women of reproductive age (15-45 years, WHO) on management for heavy menstrual bleeding in KNH between January 2021 and August 2021. Consecutive sampling technique was applied and 50 participants were recruited for the study after signing consent and/or assent. Patients‟ information was collected using questionnaires. In the questionnaire, the severity of menorrhagia was assessed using the ISTH/SSC bleeding assessment tool focusing on menorrhagia. Venous blood samples were collected. Processing took place at the KNH haematology laboratory. The tests included; Haemoglobin levels, platelet count, ABO blood group, PT, APTT, Von Willebrand antigen, activity and factor VIII levels. Data Management Data analysis was done using MS Excel and SPSS version 21. Frequency distribution and percentage was used in univariate analysis for categorical analysis. Chi square t-test was used to compare VWF levels antigen and activity between patients with blood group O and non-O groups. Tables and graphs were used to present data. Results were disseminated to UON Pathology department and KNH Obstetrics and Gynaecology department, where they were placed in the patients‟ files. Outcomes Out of 50 women with HMB, age ranges 17 to 49 years, 29 (58%) were over 35 years. 21 (42%) of the participants had a nonspecific clinical diagnosis of abnormal uterine bleeding (AUB) while the most common specific diagnosis was uterine fibroids that affected 19 (38%) patients. 48 had normal platelet count, one had mild thrombocytopenia and one had thrombocytosis. 4% of the patients had prolonged PT and 10% had prolonged APTT. 1 out of 50 patients had low levels and activity of VWF. The levels of VWF were significantly higher in non-O blood groups individuals than those of blood group O (P = 0.035) while antibody levels in O and non-O groups had no significant difference (P = 0.255). Most of the patients had menorrhagia score of 1 (32%) and 2 (32%). 10 (20%) of the patients had a score of 4 and 8 (16%) had a score of 8. Conclusion In this study, 2% of patients had low levels of VWF antigen and activity Patients of blood group O had significantly lower VWF: Ag levels than those with non-O blood. Majority of the patients had low menorrhagia scores of 1 and 2 (on the ISTH tool) (32%) for each score. Recommendations Low VWF antigen and/or antibody levels and VWD being hereditary disorders, multicenter/ethnic studies should be done to include all age groups to determine the true prevalence of the disease in our population as this study population in KNH was mainly from Nairobi and environs.