Abstract
Study Objective
To assess the frequency, severity, and inpatient management of girls admitted with
heavy menstrual bleeding and iron deficiency anemia at US children's hospitals, with
a focus on hematologic considerations.
Design
Retrospective multicenter cohort study from October 2012 through September 2015.
Setting
Children's hospitals submitting data to the Pediatric Health Information System.
Participants
Female patients, age 8-18 years, admitted with heavy menstrual bleeding and anemia
as either a primary or secondary diagnosis. Patients with cancer, immune thrombocytopenic
purpura, aplastic anemia, and pregnancy were excluded.
Interventions and Main Outcome Measures
Hemostatic evaluation; provision of iron therapy.
Results
We identified 1183 admissions (1134 unique patients). Patients’ median (interquartile
range) age was 14 (11-17) years. Forty-one percent were Caucasian (n = 480), 31% African
American (n = 371), and 26% Hispanic ethnicity (n = 310). Intensive care use occurred
in 5% of admissions (n = 56). Hemostatic assessment was inconsistent; 15% (n = 182)
had no such evaluation. Two-thirds (n = 797; 67%) involved transfusions, 37% (n = 433)
received no inpatient iron therapy, and 17% (n = 197) received no hormonal or antifibrinolytic
therapy. Hemostatic evaluation was associated with intensive care use: odds ratio
(OR), 4.80 (95% confidence interval [CI], 1.16-19.86; P = .03); emergency department visit: OR, 2.60 (95% CI, 1.86-3.65; P < .01); private insurance: OR, 1.62 (95% CI, 1.12-2.35; P = .01); and younger age: OR, 0.84 (95% CI, 0.77-0.92; P < .01).
Conclusion
Hundreds of girls with heavy menstrual bleeding and anemia are hospitalized at US
children's hospitals each year with variable inpatient hematologic evaluation and
management. Future guidelines should emphasize early identification of at-risk patients
and promote effective implementation strategies to reduce the burden of this preventable
complication.
Key Words
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Article info
Publication history
Published online: June 22, 2018
Footnotes
The authors indicate no conflicts of interest.
This work was presented, in part, as a poster at the American Society of Pediatric Hematology/Oncology 30th Annual Meeting in Montreal, Canada in April 2017.
Identification
Copyright
© 2018 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
