What is the best next step to evaluate a 20-year-old woman's bleeding disorder, given her history of postpartum bleeding, heavy menstrual cycles, and family history of bleeding disorder?

From the Guidelines

The best next step to evaluate this 20-year-old woman's bleeding disorder is to use a standardized bleeding assessment tool to further evaluate her bleeding history. Given her history of postpartum bleeding, heavy menstrual cycles, and family history of bleeding disorder, von Willebrand disease is a strong possibility and should be specifically investigated 1. The use of a standardized bleeding assessment tool is recommended as the initial step in evaluating bleeding disorders, as it can help to identify patients who are at risk of having a bleeding disorder and guide further testing and management 1.

Key Considerations

• The patient's history of postpartum bleeding, heavy menstrual cycles, and family history of bleeding disorder suggests a possible inherited bleeding disorder, such as von Willebrand disease 1.
• The use of a standardized bleeding assessment tool can help to evaluate the patient's bleeding history and guide further testing and management 1.
• Further testing, such as von Willebrand factor antigen and activity levels, factor VIII levels, and platelet function studies, may be necessary to confirm the diagnosis and guide management 1.

Recommendations

• Use a standardized bleeding assessment tool to evaluate the patient's bleeding history 1.
• Consider further testing, such as von Willebrand factor antigen and activity levels, factor VIII levels, and platelet function studies, to confirm the diagnosis and guide management 1.
• Refer the patient to a hematologist for confirmation and management if initial testing suggests von Willebrand disease or another specific factor deficiency 1.

From the Research

Evaluation of Bleeding Disorder

To determine the best next step in evaluating the 20-year-old woman's bleeding disorder, given her history of postpartum bleeding, heavy menstrual cycles, and family history of bleeding disorder, the following points should be considered:

• The patient's symptoms, including postpartum bleeding and heavy menstrual cycles, suggest a possible underlying bleeding disorder, such as von Willebrand disease (VWD) 2.
• A thorough bleeding, medical, and family history is essential in determining the nature and severity of bleeding symptoms 3.
• The use of a standardized bleeding assessment tool (BAT) can help evaluate the patient's bleeding history and determine the severity of bleeding symptoms 3, 4.
• BATs have been developed and validated to assess bleeding symptoms in various clinical settings, including the diagnosis of VWD and other bleeding disorders 4.

Recommended Next Step

Based on the available evidence, the best next step would be to:

• Use a standardized bleeding assessment tool to further evaluate the patient's bleeding history, as recommended by 3 and 4. This approach will allow for a comprehensive evaluation of the patient's bleeding symptoms and help determine the severity of the bleeding disorder.

Laboratory Testing

While laboratory testing, such as measuring von Willebrand factor (VWF) antigen, platelet-dependent VWF activity, and factor VIII activity, may be necessary in the diagnosis of VWD, it is not the best next step in this case 5, 2. The use of a BAT will help determine the need for further laboratory testing and guide the diagnostic process.

Other Options

Other options, such as ordering mixing studies or performing a bleeding time test, are not the best next step in this case, as they may not provide sufficient information to evaluate the patient's bleeding disorder 3, 6.