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Gynaecological issues in women with bleeding disorders: CSL Behring Symposium

Angelika Batorova

Angelika Batorova

Director of the National Haemophilia Centre, University Hospital BratislavaBratislava, Slovakia
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Batorova, Angelika
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Karin van Galen

Karin van Galen

Utrecht University Medical CentreUtrecht, The Netherlands
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Galen, Karin van
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Sylvia von Mackensen

Sylvia von Mackensen

Department of Psychology, University Medical CentreHamburg, Germany
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Mackensen, Sylvia von
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Ioannis Tsimpanakos

Ioannis Tsimpanakos

Consultant in Obstetrics and Gynaecology, Royal Free HospitalLondon, UK
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Tsimpanakos, Ioannis
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Evelyn Grimberg

Evelyn Grimberg

Women and Bleeding Disorders Committee, European Haemophilia ConsortiumUtrecht, The Netherlands
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Grimberg, Evelyn
  
21 oct 2019
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Categoría del artículo: Women With Bleeding Disorders
Publicado en línea: 21 oct 2019
Páginas: 28 - 38
DOI: https://doi.org/10.17225/jhp00142
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© 2019 Angelika Batorova, Karin van Galen, Sylvia von Mackensen, Ioannis Tsimpanakos, Evelyn Grimberg, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1A

Obstetric and gynaecological-related surgeries in women with VWD in Slovakia, 1998–2018
Obstetric and gynaecological-related surgeries in women with VWD in Slovakia, 1998–2018

Figure 1B

Obstetric and gynaecological-related surgeries in women with FVII deficiency in Slovakia 1998–2019
Obstetric and gynaecological-related surgeries in women with FVII deficiency in Slovakia 1998–2019

Figure 2

Impact of heavy menstrual bleeding on overall life activities in women with von Willebrand disease (% affected, n=22) [23]
Impact of heavy menstrual bleeding on overall life activities in women with von Willebrand disease (% affected, n=22) [23]
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Ovulation bleeding occurs in up to 30% of women, but women with bleeding disorders are at risk from excessive bleeding. In a normal menstrual cycle, ovulation occurs during the second week, coinciding with a trough in the cyclic variation of von Willebrand factor.© Shutterstock
Ovulation bleeding occurs in up to 30% of women, but women with bleeding disorders are at risk from excessive bleeding. In a normal menstrual cycle, ovulation occurs during the second week, coinciding with a trough in the cyclic variation of von Willebrand factor.© Shutterstock
Evelyn Grimberg, who has Glanzmann’s thrombasthenia, advocates a team approach to preparing for surgery for women with bleeding disorders. The woman herself should be involved, alongside the surgeon, anaesthetist, haematologist and her treatment centre.
Evelyn Grimberg, who has Glanzmann’s thrombasthenia, advocates a team approach to preparing for surgery for women with bleeding disorders. The woman herself should be involved, alongside the surgeon, anaesthetist, haematologist and her treatment centre.

Women’s personal experiences of surgery

“I need surgery and got my treatment plan. This one is different from the last one. I’m worried if everything will go well”“Surgery went well, but I had a bleed afterwards when I was back home. I got hospitalised again”“My physician was too scared of bleeds during surgery, so he decided not to perform surgery”“I had surgery but they didn’t consult my haematologist”“They almost gave me painkillers with blood thinners”

Dosage and monitoring recommendations for patients with VWD undergoing surgery [4,6,7]

MAJOR SURGERYMINOR SURGERY
Loading dose VWF:RCo40–60 IU/kg30–60 IU/kg
Target level for surgeryVWF: RCo and FVIII 100 IU/dLVWF: RCo and FVIII ≥80 IU/dL
Maintenance dose VWF:RCo20–40 IU/kg every 8–24 hours20–40 IU/kg every 12–24 hours
Sustained post-OP troughs of VWF:RCo and FVIII>50 IU/dL for 7–14 days>50 IU/dL for 3–5 days
Monitoring FVIII and VWF:RCotroughs and peaks dailytrough and peak at least once
Safety parameterVWF:RCo <200 and FVIII<200-300 IU/dL
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Temas de la revista:
Medicina, Ciencias médicas básicas, Ciencias médicas básicas, otros, Medicina Clínica, Medicina Clínica, otros, Farmacia, Farmacología
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