Screening for von Willebrand disease in pregnant women with self-reported bleeding histories in Southeast Nigeria

Abstract

Background: Menorrhagia affects 18 million women globally aged 30–55 years and poses a significant health concern. This study assessed the coagulation profile of pregnant women with bleeding problems who were screened for von Willebrand Disease (VWD). Methods: This cross-sectional study included 150 pregnant women from the Odumegwu Ojukwu University and Enugu State University Teaching Hospitals. Forty-five age-matched nonpregnant women served as controls. Blood samples were collected for coagulation studies, complete blood counts, and measurement of von Willebrand factor parameters. Data were collected from January 2021 to August 2022, and bleeding severity was assessed using the International Society for Thrombosis and Haemostasis-Bleeding Assessment Tool. Categorical variables are represented as frequencies and percentages. The Kruskal–Wallis test and descriptive statistics were performed for continuous variables. Dunn’s multiple comparison test was performed for the groups, whereas the Mann–Whitney U test was used for the two groups. Statistical significance was set at P < 0.05. Results: Postpartum hemorrhage (38%) was the most prevalent symptom. Levels of VWF: Ag, FVIII, and VWF:CB increased as pregnancy progressed but were significantly lower in pregnant women with a history of bleeding. A low FVIII:C/VWF:Ag ratio (<0.7) suggested hemophilia A or 2NVWD, with further differentiation possible through assays or genetic analyses of the F8 and VWF genes. A low discordance (<0.7) VWF:CB/Ag ratio may indicate VWD types 2A, 2B, 2M, or PT. Conclusion: Thus, additional evaluations using assays such as ristocetin-induced platelet aggregation, multimer analysis, and genetic testing are needed, although these may be unavailable in resource-limited settings.

Keywords

• bleeding disorders
• coagulation profile
• pregnant women
• von willebrand collagen binding
• von willebrand disease