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Screening bleeding disorders in adolescents and young women with menorrhagia
Suar Cakı Kılıç1, Nazan Sarper1, Emine Zengin1
1Kocaeli University Medical Faculty, Department of Pediatric Hematology, Kocaeli, Turkey.
Insights
Screening for bleeding disorders in adolescents and young women with menorrhagia is crucial. A significant percentage of patients, particularly adolescents, were found to have underlying bleeding conditions requiring prompt diagnosis and management.
Area of Science:
- Hematology
- Gynecology
- Pediatrics
Background:
- Chronic menorrhagia significantly impacts quality of life and can lead to anemia.
- Early identification of bleeding disorders in young women is essential for effective management.
Purpose of the Study:
- To screen for bleeding disorders in adolescents and young women experiencing menorrhagia.
- To evaluate the prevalence of various bleeding disorders in this patient cohort.
Main Methods:
- Prospective study involving pediatric hematologists and gynecologists.
- Comprehensive data collection including patient history, bleeding assessment charts, pelvic examinations, and extensive laboratory assays (e.g., complete blood count, coagulation studies, von Willebrand factor assays, platelet function tests).
Main Results:
- Out of 60 patients who completed the study, 20% (n=12) were diagnosed with a bleeding disorder, including von Willebrand disease, Bernard-Soulier syndrome, Glanzmann thrombasthenia, immune thrombocytopenic purpura, and factor VII deficiency.
- Approximately 46% of adolescent patients experienced spontaneous resolution of menorrhagia, suggesting a dysfunctional and transient nature in nearly 50% of cases.
- Specific laboratory tests like complete blood count, peripheral smear, PT, aPTT, VWF:Ag, VWF:RCo, FVIII, and fibrinogen assays are recommended for initial screening.
Conclusions:
- A thorough hematological and gynecological evaluation is vital for all patients with menorrhagia.
- Detailed coagulation assays can be deferred in adolescents lacking specific risk factors (e.g., family history of bleeding).
- Platelet function assays are recommended when there is a history of bleeding from the nose and gums.
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.
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