47 Reduced thrombin generation and/or decreased platelet response in women with HMB was one patient with HMB, who had a severely reduced Peak and ETP, indicating a severe deficiency to form thrombin. Furthermore, there were three patients with a reduced Peak and one with a reduced ETP. Figure 4: Thrombin generation was measured upon stimulation with 1 pmol/L tissue factor (X-axis) and 5 pmol/L tissue factor (Y-axis). At both conditions, we calculated the lag time (A), the time to peak (B), the peak thrombin concentration (C) and (D) the endogenous thrombin potential (ETP). The reference ranges of TG parameters of healthy volunteers in and around the Maastricht UMC were plotted. If patients fall in the white area, which represents hypocoagulable state, they were classified with a coagulation defect. A total of 17 patients of the 58 (29%) were defined with a platelet function defect in our study. The cumulative outcomes of the combined haemostasis tests are summarized in Figure 5. Our data indicate that reduced VWF levels and impaired function, impaired platelet function and impaired coagulation response may play a role in HMB complaints. In our patientgroup, impaired platelet function was measured in 14 (24%) women” “and a similar number of women had impaired coagulation response (n = 17; 29%). Within both groups, five women (8.6%) had combined impaired platelet function and impaired coagulation. Only 2 (3.4%) women had a reduced VWF response to ristocetin, indicating a VWF function defect or a low VWF level, one of them in combination with impaired coagulation. 3
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