A 28-year-old woman presents with heavy menstrual bleeding and a family history of prolonged bleeding. What is the most likely cause of her bleeding disorder?

• A. Decreased platelet glycoprotein IIb/IIIa
• B. Increased antiplatelet antibodies
• C. Decreased platelet adhesion
• D. Increased platelet sequestration in the spleen

Answer: (C)

The presentation of heavy menstrual bleeding and a family history of prolonged bleeding suggests an underlying bleeding disorder, particularly one that affects platelet function or levels. In this context, decreased platelet adhesion is a significant factor.

Decreased platelet adhesion often points to a condition like von Willebrand's disease, which is characterized by a deficiency or dysfunction of von Willebrand factor (vWF). This factor is crucial for normal platelet function, particularly in the adhesion process where platelets must stick to the damaged vascular endothelium to form a clot. If there is inadequate adhesion, bleeding can occur, notably in situations like heavy menstrual periods.

This understanding aligns with the woman's symptoms and family history; since bleeding disorders can often be hereditary, familial conditions like von Willebrand's disease could explain her bleeding tendency. Recognizing that decreased platelet adhesion is a central mechanism in several bleeding disorders provides clarity on why this is the most likely cause of her symptoms.