Three adolescents with low von Willebrand factor identified during evaluation for menorrhagia: a case series

Abstract

Low von Willebrand factor (VWF) was diagnosed in three adolescent females who underwent evaluation for menorrhagia. All patients were blood type O, and their Pictorial Blood loss Assessment Chart (PBAC) scores substantially exceeded the proposed cutoff of 171 points for Japanese females. PBAC provides a rapid and objective assessment of menstrual blood loss. After exclusion of structural abnormalities by imaging, repeated measurements of VWF levels served as an appropriate screening approach in adolescents with menorrhagia. Tranexamic acid or desmopressin was selected according to the clinical context, resulting in improvement of menstrual bleeding. These findings suggest that the combined use of PBAC and VWF measurements may facilitate the early diagnosis of low VWF in adolescents with menorrhagia and support appropriate therapeutic decision-making.