Hemostatic defects in Thai adolescents with menorrhagia

Twenty-eight adolescents with menorrhagia by pictorial blood loss assessment chart (PBAC) criteria were investigated for underlying hemostatic defect. CBC, ABO blood group, bleeding time, APTT, PT, TT FVIII:C, VWF:Ag, RiCoF and platelet aggregation study were evaluated. Six patients (21.4%) were addressed with underlying hemostatic defect. Of these, severe aplastic anemia (n=1) and thrombotic thrombocytopenicpurpura (n=1) were identified in 2 patients with low platelets after an initial CBC. Four patients with prolonged bleeding time demonstrated inherited hemostatic defect: von Willebranddisease (VWD) type 3 (n=1), Glanzmann thrombasthenia (n=1) and Bernard-Soulier syndrome (n=2). Median PBAC score of patients with hemostatic defect was significantly higher than that of patients with unknown cause of menorrhagia (436.5 vs. 251.3, p = 0.01). After the exclusion of six patients with well-identified bleeding risks, isolated abnormal platelet aggregation response to adrenaline was detected in 11 (50%) adolescents using platelet aggregation study. No significant difference of median PBAC score was noted among patients with and without evidence of this impaired responsiveness to adrenaline. In addition, the authors also found an abnormal platelet aggregation with adrenaline stimulant in 15 (75%) among 20 healthy female controls who had no history of bleeding diathesis. No significant difference infrequency of abnormal platelet aggregation to adrenaline was observed between affected cases and controls. In summary, an impaired responsiveness of platelets to adrenaline in the present study is insufficient to support its risk of bleeding. On the contrary, the simple test such as CBC and bleeding time revealed a worthy contribution to investigate coexisting coagulopathy in adolescents with menorrhagia.