Screening Bleeding Disorders in Adolescents and Young Women with Menorrhagia

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.Conflict of interest:None declared.

The Frequency of Menorrhagia and Bleeding Disorders in University Students

“…These studies mostly involve retrospective chart reviews of inpatients with acute menorrhagia or referrals to hemophilia treatment centers. Data on the frequency and etiology of menorrhagia in university students are scarce, despite gynecological complaints are common in this age group [21][22][23]. The pictorial blood-loss assessment chart (PBAC) is a practical and objective method that has a high sensitivity and specificity when >100 score is accepted to define menorrhagia [24,25].…”

Severe anemia from heavy menstrual bleeding requires heightened attention

“…There is now a better understanding of its pathophysiology. [1][2][3][4] There is more precise terminology 5 and an improved classification system. 6,7 New, effective medical therapies [8][9][10][11] and less invasive surgical treatment options have also become available.…”

Menometroraji ile Başvuran Ergen Kızlarda Hemostaz Parametrelerinin Değerlendirilmesi ve Sağlıklı Ergenler ile Karşılaştırılması

“…Studies have reported that the frequency of coagulation disorders in adolescent and adult women with increased and irregular menstrual bleeding is between 17% and 50%, and von Willebrand disease is the most common among these disorders. [14][15][16] The relationship between increased menstrual bleeding and von Willebrand has been well known for a long time. However, it may be overlooked when the patient does not give a good history.…”