Assessment of menstrual blood loss using a pictorial chart

von Willebrand disease (VWD) is a commonly encountered inherited bleeding disorder affecting both males and females, causing mucous membrane and skin bleeding symptoms, and bleeding with surgical or other haemostatic challenges. VWD may be disproportionately symptomatic in women of child-bearing age. It may also occur less frequently as an acquired disorder (acquired von Willebrand syndrome). VWD is caused by deficiency or dysfunction of von Willebrand factor (VWF), a plasma protein that mediates platelet haemostatic function and stabilizes blood coagulation factor VIII. The pathophysiology, classification, diagnosis and management of VWD are relatively complex, but understanding them is important for proper diagnosis and management of patients with VWD. These evidence-based guidelines for diagnosis and management of VWD from the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel (USA) review relevant publications, summarize current understanding of VWD pathophysiology and classification, and present consensus diagnostic and management recommendations based on analysis of the literature and expert opinion. They also suggest an approach for clinical and laboratory evaluation of individuals with bleeding symptoms, history of bleeding or conditions associated with increased bleeding risk. This document summarizes needs for further research in VWF, VWD and bleeding disorders, including clinical research to obtain more objective information about bleeding symptoms, advancements in diagnostic and therapeutic tools, and enhancement in the education and training of clinicians and scientists in bleeding and thrombotic disorders. The NHLBI Web site (http://www.nhlbi.nih.gov/guidelines/vwd) has a more detailed document, a synopsis of these recommendations, and patient education information.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2516.2007.01643.x

von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA).

Iron Deficiency in Infancy and Childhood

INTRODUCTION 123 MEASUREMENTS OF DIETARY BIOAVAILABILITY OF IRON 124 Earlier Methods 124 Extrinsic Tag Method 125 BIOAVAILABILITY OF NON-HEME IRON 126 Individual Factors Influencing Bioavailability 126 Iron status 126 Pregnancy 127 Disease states 128 Dietary Factors Influencing lron Bioavailability 128 Bioavailability of iron in single foods 128 Pool concept and concept of bioavailability 129 Diet factors that particularly influence bioavailability of non-heine iron 130 Bioavailabilio~ of iron in meals from different countries 132 Bioavailability of fortification iron 133 BIOAVAILABILITY OF HEME IRON 140 Individual Factors 140 Dietary Factors 141 ASSESSMENT OF BIOAVAILABILITY OF IRON IN THE WHOLE DIET ...... 141 Earlier Studies 141 Implications of the Pool Concept 142 Estimations Based on Bioavailable Nutrient Density 143 CONCLUSIONS 144

/pdf/bioavailability-of-dietary-iron-in-man-51kzd1zdsb.pdf

Bioavailability of dietary iron in man.

In women, endometrial morphology and function undergo characteristic changes every menstrual cycle. These changes are crucial for perpetuation of the species and are orchestrated to prepare the endometrium for implantation of a conceptus. In the absence of pregnancy, the human endometrium is sloughed off at menstruation over a period of a few days. Tissue repair, growth, angiogenesis, differentiation, and receptivity ensue to prepare the endometrium for implantation in the next cycle. Ovarian sex steroids through interaction with different cognate nuclear receptors regulate the expression of a cascade of local factors within the endometrium that act in an autocrine/paracrine and even intracrine manner. Such interactions initiate complex events within the endometrium that are crucial for implantation and, in the absence thereof, normal menstruation. A clearer understanding of regulation of normal endometrial function will provide an insight into causes of menstrual dysfunction such as menorrhagia (heavy menstrual bleeding) and dysmenorrhea (painful periods). The molecular pathways that precipitate these pathologies remain largely undefined. Future research efforts to provide greater insight into these pathways will lead to the development of novel drugs that would target identified aberrations in expression and/or of local uterine factors that are crucial for normal endometrial function.

/pdf/endocrine-regulation-of-menstruation-2jsj6iqvat.pdf

Endocrine regulation of menstruation.

The previous literature on menstrual blood loss studies was reviewed. A new study was conducted to ascertain the variation of menstrual blood loss at various ages and to establish the upper normal limit of menstrual blood loss. The study involved 476 women of all ages in Goteborg Sweden. Amenorrheic women were excluded from the study. Measurement of hemoglobin concentration plasma iron concentration and hematocrit levels indicated wide variation among women. No statistically significant differences in menstrual blood loss were observed among age groups except that women 50 and older had the highest and women 15 and under the lowest mean loss levels. It was concluded that a loss of 60-80 ml is normal; losses above 80 ml should be considered pathological.

Ann‐Marie Högdahl

Papers

Menstrual blood loss--a population study. Variation at different ages and attempts to define normality.

Menstrual blood loss and iron deficiency.

The effect of some ovulation inhibitors on the lipid metabolism. Preliminary report.

Plasma lipids in women. Variation in cholesterol, phospholipids and triglycerides at different ages in a random population sample.

Individual Plasma Phospholipids in Healthy Young Women