Treatment of menorrhagia due to aplastic anemia by hysteroscopic resection of endometrial functional layer and levonorgestrel-releasing intra-uterine system

Abstract

RationaleIn women, menorrhagia associated with aplastic anemia (AA) is secondary to thrombocytopenia and can be acute and severe. Endometrial ablation or hysterectomy has been reported to achieve beneficial results. However, serious limitations and long-term complications exist. We report this clinical case series with the aim of sharing our experiences and exploring a safe and effective way to treat abnormal uterine bleeding (AUB) AA women with future fertility desire.Patient concernsThe 3 young patients aged 25 to 29 years old suffered from AUB secondary to AA.DiagnosisThey were diagnosed with AA by bone marrow biopsy and presented with symptoms and signs of AUB without other identified causations.InterventionsWhen the platelet count was between 30∗109 /L∼50∗109 /L after a blood transfusion, each patient received a hysteroscopic resection of endometrial functional layer and was fitted a levonorgestrel-releasing intra-uterine system (LNG-IUS) in uterine cavity following the surgery.OutcomesAll the patients recovered without incident and were discharged in clinically stable conditions.LessonsIn conclusion, AUB secondary to AA can be acute and severe. Hemostasis is more difficult due to progressive pancytopenia. For young women with future fertility desire, LNG-IUS following hysteroscopic resection of endometrial functional layer is a safe and effective way against endometrial ablation or hysterectomy.

Effect of ginsenoside Rg1 on hematopoietic stem cells in treating aplastic anemia in mice via MAPK pathway

“…In Chinese traditional medicine, AA is considered to be attributed to “acute consumptive disease” and “bone marrow deficiency”[ 29 ]. Increasingly, studies have revealed the effectiveness of traditional Chinese herbal medicine in treating AA[ 30 - 32 ].…”

Systematic review, meta-analysis and statistical analysis of laparoscopic supracervical hysterectomy vs. endometrial ablation

“…EA is an effective and minimally invasive surgical technique that has been developed to remove the entire thickness of the endometrium while sparing the uterine body ( 17 , 18 ). After EA, any residual endometrium is theoretically beneath the created scar, and as a result this prevents further bleeding.…”