Screening Bleeding Disorders in Adolescents and Young Women with Menorrhagia

Abstract

Abstract:Objective: Chronic menorrhagia causes anemia and impairment of life quality. In this study the aim was the screening of bleeding disorders in adolescents and young women with menorrhagia. Materials and Methods:The study was performed prospectively by pediatric hematologists. A form including demographic characteristics of the patients, bleedings other than menorrhagia, familial bleeding history, characteristics of the menorrhagia, and impairment of life quality due to menorrhagia was filled out by the researcher during a face-to-face interview with the patient. A pictorial blood assessment chart was also used for evaluation of blood loss. All patients underwent pelvic ultrasound sonography testing and women also received pelvic examination by gynecologists. Whole blood count, peripheral blood smear, blood group, serum transaminases, urea, creatinine, ferritin, PFA-100, PT, aPTT, INR, TT, fibrinogen, VWF:Ag, VWF:RCo, FVIII, and platelet aggregation assays were performed. Platelet aggregations were studied by lumiaggregometer. Results:Out of 75 patients enrolled, 60 patients completed the study. The mean age was 20.68±10.34 (range: 10-48) years and 65% (n=39) of the patients were younger than 18 years. In 18 (46%) of the adolescents, menorrhagia subsided spontaneously. In 20% (n=12) of the patients, a bleeding disorder was detected (1 case of type 3 von Willebrand disease, 2 patients with low VWF:Ag, 1 case of probable von Willebrand disease, 3 cases of Bernard-Soulier syndrome, 2 cases of Glanzmann thrombasthenia, 2 cases of immune thrombocytopenic purpura, 1 case of congenital factor VII deficiency). Conclusion:In patients with menorrhagia, at least complete blood count, peripheral smear, aPTT, PT, VWF:Ag, VWF:RCo, FVIII, and fibrinogen assays must be performed. When there is history of nose and gum bleeding, platelet function assay by lumiaggregometer must also be performed. In nearly 50% of adolescents, menorrhagia is dysfunctional and transient. Detailed coagulation assays can be postponed in adolescents if bleeding history other than menorrhagia and/or family history of bleeding and/or parental consanguinity is absent. All subjects with menorrhagia must consult with gynecologists and hematologists.

Reproductive health and hemostatic issues in women and girls with congenital factor VII deficiency: A systematic review

“…Bleeding symptoms reported in women with FVII deficiency are shown in Figure 1 . HMB was reported in 94 women (82%); 10 , 11 , 13 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 of these women, 37 had severe FVII deficiency, 7 , 10 , 11 , 16 , 18 , 25 , 26 , 28 , 30 , 34 , 35 , 36 , 41 , 42 , 44 19 had non‐severe deficiency, 7 , 13 , 15 ,…”

“… 19 , 20 , 21 , 22 , 23 , 31 , 33 , 37 , 38 , 39 , 40 , 43 , 45 HMB was confirmed by pictorial blood assessment chart (PBAC; score >100) in 11 cases. 24 , 29 , 31 , 33 Acute episodes in which HMB was a presenting symptom that required hospitalization were reported in 16 (14%) women, detailed in Table 2 . 10 , 15 , 20 , 22 , 23 , 25 , 26 , 30 , 33 , 35 , 36 , 44 …”

“…*Of 11 women assessed by PBAC, all 11 were confirmed as having HMB (score >100). 24 , 29 , 31 , 33 **Includes ovarian hemorrhage, peritoneal bleeding/hemorrhage, ovulation bleeding, hemorrhagic ovarian cyst, intraperitoneal bleeding/hemorrhage/hematoma, corpus luteum cyst/bleeding. † Includes melena and hematemesis.…”

“…HMB treatments were described for 41 women, 10 , 11 , 13 , 15 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 30 , 33 , 34 , 35 , 36 , 41 , 44 21 of whom were severely FVII deficient. 10 , 11 , 16 , 25 , 26 , 30 , 34 , 35 , 36 , 41 All 16 patients with acute HMB (i.e., requiring hospitalization, surgery, or blood transfusion) are included in Table 2 ; this describes all treatments used to manage each patient as the case studies did not necessarily order the treatments chronologically.…”

“… 23 , 25 , 34 , 36 , 44 Intravenous plasma‐derived FVII concentrate was used in four cases 10 , 11 , 13 , 34 and fresh frozen plasma (FFP) in two cases. 20 , 25 Other hemostatic treatments included antifibrinolytics such as oral tranexamic acid (TXA; five cases, 12%) 20 , 24 , 25 , 26 , 27 and intravenous prothrombin complex concentrate (one case, 2%). 36 …”