High Prevalence of Platelet Function Disorders in Women Referred for Surgical Management of Refractory Heavy Menstrual Bleeding

Introduction: Heavy menstrual bleeding (HMB) is a common presenting symptom in women with bleeding disorders, yet haemostatic testing is sometimes overlooked, even when refractory HMB requires surgical intervention. Aim: To determine the prevalence of bleeding disorders in women referred for surgical management of HMB and investigate screening approaches for bleeding disorders in this population. Methods: Women with refractory HMB referred for surgical management were enrolled prospectively and underwent a detailed haemostatic investigation. The International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT) and PFA-100 assay were interrogated as screening tools for bleeding disorders. Multiplate whole blood impedance aggregometry (WBIA) was compared to the current gold-standard lumiaggregometry testing for platelet dysfunction. Results: Fifty women underwent laboratory testing. Sixteen percent (95% confidence interval [CI] 7.2%-29.1%) were diagnosed with platelet function defects based on persistently abnormal lumiaggregometry results. No other clinically significant abnormalities were diagnosed. Women were more likely to be diagnosed with platelet dysfunction if they had failed a greater number of prior therapies, particularly prior endometrial ablation. The ISTH-BAT lacked diagnostic accuracy, even at the calculated optimal cutoff value, and PFA-100 assay lacked sensitivity. Multiplate WBIA was inferior to lumiaggregometry for the detection of platelet function disorders, with sensitivity of 62.5% (95% CI 24.5%-91.5%) and specificity of 87.5% (95% CI 73.2%-95.8%). Conclusion: Study findings support platelet function analysis by lumiaggregometry in women with refractory HMB requiring surgery. Accurate diagnosis would allow targeted haemostatic therapy and implementation of additional perioperative safety measures if surgery is still required.