27yr old referred to me for menorrhagia from Gyn after FVIII activity came back at 39%. VWF panel normal. Bleeding score 1. I'm having trouble getting Hemophilia genetic testing done. She would also like to know for future conception purposes. In the interim would you recommend tranexamic acid for her?
If she is not already on an estrogen containing OCP then that would be a good place to start as estrogen will increase factor VIII activity. Tranexamic acid is also useful, I usually does this 1.5g three times daily while menstruating. When working up Hemophilia carrier status be sure to include genetic testing for Type 2N von Willebrand disease as this can present with normal vWF studies and low factor VIII. so it can be difficult to distinguish from Hemophilia A, though this patient's bleeding appears to be milder than I would expect with 2N vWD.
