Tool effectively screens women with menorrhagia for bleeding disorders

A short questionnaire used in combination with a test for serum ferritin levels or the pictorial blood assessment chart (PBAC) can help determine which women with menorrhagia should be evaluated for a possible bleeding disorder, according to a new study.

The easy-to-administer, 8-question screening tool developed by hematologists at the UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, performed well in an initial test on 146 women with unexplained menorrhagia and a subsequent multicenter prospective study of 217 women 18 to 50 years of age.

The 8 questions on the screening tool cover severity of menorrhagia (ie, menses lasting 7 days or longer and flooding or bleeding through a tampon or napkin in 2 hours or less); family history of diagnosed bleeding disorder; personal history of excessive bleeding after specific events such as delivery, miscarriage, surgery, or tooth extraction; and history of treatment for anemia.

The questionnaire had a sensitivity of 89% and a positive predictive value of 72% for hemostatic abnormalities. Sensitivity rose to 95% when the questionnaire was coupled with a PBAC score higher than 185 and 93% when it was combined with a serum ferritin level of
20 ng/mL or lower. The positive predictive value remained the same in both cases.

“The utility of the serum ferritin level as an adjunct to screening for hemostatis abnormalities has not been demonstrated previously and may provide a similarly effective, but clinically more feasible supplement to the screening tool than the PBAC score,” the researchers write. They add that although serum ferritin may be less cost effective than the PBAC, it may enable quicker decision making because it eliminates the need to wait for a menstrual cycle or a prospectively completed PBAC score.

This study was published online January 19 in the American Journal of Obstetrics and Gynecology.