A 16-year-old girl presents with heavy menstrual bleeding since menarche 14 months ago. Cycles are irregular (21-45 days), lasting 8-12 days with clots. She is pale, heart rate 102/min, blood pressure 100/65 mmHg. Hemoglobin is 7.2 g/dL, platelet count 210,000/microL, and coagulation screen is normal. Which investigation is most important to perform next?

• A Thyroid function tests
• B Serum prolactin level
• C Pelvic MRI
• D Von Willebrand factor antigen and activity (ristocetin cofactor assay) ✓

Explanation

Von Willebrand disease is the most common inherited bleeding disorder in adolescents with heavy menstrual bleeding, affecting up to 10-20% of this population. Normal platelet count and coagulation screen (PT/aPTT) do not exclude VWD. Thyroid testing is relevant but less immediately important than ruling out a bleeding diathesis in a severely anemic adolescent. MRI and prolactin are not first-line in this setting.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.