Abstract
Study Objective
On this study we sought to determine the relationship of bleeding disorders to iron
deficiency anemia. Additionally, this study was undertaken to examine all current
treatment modalities used in a menorrhagia clinic with respect to heavy menstrual
bleeding management to identify the most effective options for menstrual management
in the setting of an underlying bleeding disorder.
Design, Setting, Participants, Interventions, and Main Outcome Measures
We performed a retrospective chart review of adolescents younger than 21 years with
heavy menstrual bleeding attending a multidisciplinary hematology-adolescent gynecology
clinic. Information including demographic characteristics, bleeding diathesis, hematologic
parameters, treatment, and the diagnosis was extracted from each chart. Subjects were
grouped into 2 categories on the basis of the diagnosis of a bleeding disorder. Hemoglobin
level, iron deficiency anemia, and need for transfusion were compared between a bleeding
disorder and no bleeding disorder group. Subjects were grouped into categories depending
on hormonal modality and treatment success of the groups were compared.
Results
Seventy-three subjects were tested for a bleeding disorder. Of the subjects who completed
testing, 34 (46%) were diagnosed with a bleeding disorder. Thirty-nine subjects (54%)
had heavy menstrual bleeding because of other causes. There was no significant difference
in hemoglobin between those with and without a bleeding disorder. Iron deficiency
anemia was significantly higher in subjects without a bleeding disorder. In a comparison
of hormone therapy success, the levonorgestrel intrauterine device (89%, 8 out of
9 subjects) had the highest rate of menstrual suppression followed by norethindrone
acetate 5-10 mg/d (83%, 5 out of 6 subjects), and the transdermal patch (80%, 4 out
of 5 subjects). All subjects using tranexamic acid as well as hormonal therapy had
100% achievement of menstrual suppression.
Conclusion
A high frequency of bleeding disorders was found in those tested. Subjects with a
bleeding disorder were less likely to present with severe anemia requiring blood transfusion
and less likely to have iron deficiency anemia. Although combined oral contraceptives
were commonly used clinically for menstrual suppression, they were not found to be
the most effective option.
Key Words
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Article info
Publication history
Published online: March 07, 2018
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2018 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
