Should we perform diagnostic workup of bleeding disorders in a patient with heavy menstrual bleeding causing anemia?
Alfonso Iorio, MD, PhD: It is a borderline situation. In absence of other bleeding symptoms, so no bruising, no perisurgical bleeding, no family history, very likely it is not warranted to go on with diagnostic workup for bleeding disorders. Von Willebrand cases are usually familial. Factor XIII deficiency does not usually show up as heavy menstrual bleeding.
So I would suggest to supplement with iron. See if normal iron supplementation is enough to keep a decent balance. You can treat the patient with tranexamic acid to reduce the heavy menses. Even if you were diagnosing mild von Willebrand disease, you would still treat the patient with tranexamic acid.
The tricky situation is when patients like these will go on asking you to be screened before surgery. If there is a surgical indication, then it might become worth testing for von Willebrand disease. But it is not worth testing just because of anemia without history of other symptoms.