The prevalence of disorders of haemostasis in adolescents with menorrhagia referred to a haemophilia treatment centre

Abstract

Menorrhagia at the time of menarche is relatively common and historically attributed primarily to immaturity of the pituitary-ovarian-uterine axis. Intuitively, a proportion of these patients should have an underlying disorder of haemostasis, given the 5-20% prevalence of von WillebrandÕs disease and the ‡20% prevalence of platelet dysfunction in light of recent epidemiological studies in menorrhagia, although the average age of the patients in those studies has been 35 years. However, there are a few comprehensive studies in the adolescent population determining whether widespread haemostasis evaluation should be carried out in adolescents presenting with menorrhagia. A retrospective chart review study of disorders of haemostasis was carried out in 61 consecutive adolescent patients, ages 11-19 at the time of evaluation referred to the Hemophilia Treatment Center (HTC)/Hematology unit. The mean and median ages were 15 ± 2.2 and 14 years (11, 19), respectively. Standard evaluation included complete blood count, prothrombin time, partial thromboplastin time, von Willebrand factor (VWF) levels and platelet aggregation. The proportion of patients with VWF deficiency was 22/61 (36%) [95% confidence interval (CI), 24-49%]; the proportion of patients with platelet aggregation abnormalities was 4/61 (7%) (95% CI, 2-16%). There was no difference in the frequency of additional muco-cutaneous bleeding symptoms. A relatively high proportion of adolescents are identified with an underlying disorder of haemostasis when referred to an HTC for evaluation of menorrhagia. This involves in part a selective referral bias, but underscores the role of the HTC in evaluating adolescents referred with menorrhagia for an underlying bleeding disorder, given the relatively high yield of haemostatic disorders detected in this setting.

Platelet Disorders in Adolescents

“…9 Even in studies where platelet aggregation testing was performed in only a small proportion of patients, platelet dysfunction was found in a substantial portion of adolescents with menorrhagia (Table 1). 1,4,10 In patients with mucocutaneous bleeding symptoms, platelet function defects were also found to be the most common hemostatic abnormality. 11 Inherited platelet function disorders can be characterized on the basis of structure and function ( Table 2).…”

“…1e3 In adolescent females, platelet disorders may present with heavy menstrual bleeding which may be difficult to distinguish from excessive menstrual blood loss due to immaturity of the hypothalamic-pituitaryovarian axis. 4 In females with known platelet disorders, menorrhagia is the most common bleeding symptom. 5,6 Disorders of Platelet Number…”

The Frequency of Menorrhagia and Bleeding Disorders in University Students

“…Bleeding disorders are the second most  T. Gursel et al common cause of menorrhagia in this age group [13][14][15][16][17][18][19]. In a recent systematic review of eight published studies by Ahuja et al, the prevalence of VWD, PFD, and clotting factor deficiencies in adolescents girls with menorrhagia range between 5%-36%, 2%-44%, and 8%-9%, respectively [20].…”

von Willebrand Disease in the Pediatric and Adolescent Population

“…13 Studies evaluating the prevalence of VWD in adolescents with menorrhagia have included over 500 patients (Table 1) with a prevalence range from 3% to 36%, depending on the clinical setting studied. 14e22 The highest prevalence is seen in adolescents referred to an outpatient Hemophilia Center, 19 while the lowest prevalence is seen in the acute hospital setting. 14 …”