Complications of hysterectomy in women with von Willebrand disease.
Authors: James AH, Myers ER, Cook C, Pietrobon R.
Journal: Haemophilia. 2009 Apr 6. [Epub ahead of print]
Study performed at: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
Problem: Some women having bleeding complications from surgery that can require blood transfusions or, rarely, even cause serious complications or death. An inherited condition, named von Willebrand disease (VWD) after the man who discovered it, can cause both the heavy bleeding that can lead to having a hysterectomy, and cause sometimes dangerous bleeding during surgery.
Study: The authors wanted to estimate how often women with VWD who had a hysterectomy had serious bleeding or other complications. The United States Nationwide Inpatient Sample (NIS) for the years 1988-2004 was examined for all hysterectomies for non-malignant conditions. The differences between women with and without VWD were analyzed.
Results: 545 women with VWD had a hysterectomy. Women with VWD were more likely to experience bleeding during and after surgery (2.75% vs. 0.89%) and require transfusion (7.34% vs. 2.13%) than women without VWD. One woman with VWD died.
Conclusions: Women with VWD did experience significantly more bleeding complications than women without VWD.
Dr. Parker’s Comments: Because I see a lot of women with fibroids, I also see a lot of women with a history of very heavy menstrual periods. Most often, this is due to fibroids (usually the submucous type). Every once in a while, a woman also has a history of heavy menstrual bleeding since adolescence, heavy bleeding during childbirth or during a previous surgery, or she tells me that her mother or sister hemorrhaged after childbirth or surgery. This is the Red Flag that gets me to send them to a hematologist for evaluation for von Willebrand disease (VWD).
As a result, our consultant hematologist, using simply blood tests, has made the diagnosis of VWD many times. This is good news for the patient. First, VWD does not usually cause serious bleeding unless a woman is having surgery or childbirth, so it is not a frightening diagnosis. Second, there is a medication that can be given in the IV just before surgery or childbirth that prevents serious bleeding and, therefore, avoids the complications described in this study. Third, VWD disease makes it less likely that the fibroids are responsible for the heavy periods and often this changes the treatment options.
So, if you have a history of very heavy periods since adolescence, or you have had heavy bleeding during surgery or after childbirth, or you have a family history of heavy bleeding, then you should ask your doctor about being tested for VWD.
