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CC BY 4.0 · TH Open 2022; 06(03): e291-e298
DOI: 10.1055/a-1892-1987
Original Article

Diagnosis of Bleeding Disorders in Adolescents Hospitalized for Heavy Menstrual Bleeding

Lauren E. Amos 
1   Division of Hematology/Oncology/Bone Marrow Transplant, Children's Mercy Hospital, Kansas City, Missouri, United States
2   Department of Pediatrics, The University of Missouri-Kansas City, Kansas City, Missouri, United States
,
Ashley K. Sherman
3   Department of Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Shannon L. Carpenter
1   Division of Hematology/Oncology/Bone Marrow Transplant, Children's Mercy Hospital, Kansas City, Missouri, United States
2   Department of Pediatrics, The University of Missouri-Kansas City, Kansas City, Missouri, United States
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Abstract

Hundreds of adolescents are hospitalized in the United States yearly with anemia due to heavy menstrual bleeding (HMB). Limited data exist regarding how these patients are evaluated and how many are diagnosed with a bleeding disorder. The aim of this study was to determine the prevalence of bleeding disorders in adolescents hospitalized for HMB. Secondary aims included identification of risk factors for severe anemia leading to hospitalization and the hematology assessment. This was a retrospective cohort study of patients aged 9 to 21 years hospitalized for HMB and anemia at a tertiary care children's hospital from January 1, 2000, to December 31, 2017. A total of 118 girls hospitalized for HMB and anemia were included. Almost 30% of patients were African American. Hematology involvement did not occur in 42% of patients. Sixty patients completed bleeding disorder testing and 57% (34/60) were diagnosed with a bleeding disorder. Most patients diagnosed with von Willebrand disease (VWD) tested while hospitalized and anemic had VW levels <100%A but 9/25 (36%) girls not evaluated by Hematology also had VW levels <100%. Despite an established Inpatient Coagulation Consult service, many adolescents hospitalized with HMB did not receive an appropriate evaluation for bleeding disorders. African Americans were disproportionately hospitalized for HMB. VW levels are elevated with HMB and severe anemia, but levels <100 seem to be predictive of VWD in this setting. Further research is needed to determine optimal timing of bleeding disorder evaluation, but many adolescents hospitalized for HMB may have an underlying bleeding disorder.

Keywords

pediatric hemostasis - von Willebrand disease - menorrhagia - hemophilia

Author contributions

L. E. A. designed and performed the research and wrote the manuscript. A. K. S. analyzed the data, contributed to the manuscript, and reviewed the manuscript. S. L. C. contributed to study design and reviewed the manuscript.




Publication History

Received: 02 February 2022

Accepted: 17 May 2022

Accepted Manuscript online:
05 July 2022

Article published online:
26 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Haamid F, Sass AE, Dietrich JE. Heavy Menstrual Bleeding in Adolescents. J Pediatr Adolesc Gynecol 2017; 30 (03) 335-340
    CrossrefPubMedGoogle Scholar
  • 2 Powers JM, Stanek JR, Srivaths L, Haamid FW, O'Brien SH. Hematologic Considerations and Management of Adolescent Girls with Heavy Menstrual Bleeding and Anemia in US Children's Hospitals. J Pediatr Adolesc Gynecol 2018; 31 (05) 446-450
    CrossrefPubMedGoogle Scholar
  • 3 Oral E, Cağdaş A, Gezer A, Kaleli S, Aydin Y, Oçer F. Hematological abnormalities in adolescent menorrhagia. Arch Gynecol Obstet 2002; 266 (02) 72-74
    CrossrefPubMedGoogle Scholar
  • 4 Mikhail S, Varadarajan R, Kouides P. The prevalence of disorders of haemostasis in adolescents with menorrhagia referred to a haemophilia treatment centre. Haemophilia 2007; 13 (05) 627-632
    CrossrefPubMedGoogle Scholar
  • 5 Zia A, Jain S, Kouides P. et al. Bleeding disorders in adolescents with heavy menstrual bleeding in a multicenter prospective US cohort. Haematologica 2020; 105 (07) 1969-1976
    CrossrefPubMedGoogle Scholar
  • 6 Jacobson AE, Vesely SK, Koch T, Campbell J, O'Brien SH. Patterns of von Willebrand Disease Screening in Girls and Adolescents With Heavy Menstrual Bleeding. Obstet Gynecol 2018; 131 (06) 1121-1129
    CrossrefPubMedGoogle Scholar
  • 7 O'Brien B, Mason J, Kimble R. Bleeding Disorders in Adolescents with Heavy Menstrual Bleeding: The Queensland Statewide Paediatric and Adolescent Gynaecology Service. J Pediatr Adolesc Gynecol 2019; 32 (02) 122-127
    CrossrefPubMedGoogle Scholar
  • 8 Vo KT, Grooms L, Klima J, Holland-Hall C, O'Brien SH. Menstrual bleeding patterns and prevalence of bleeding disorders in a multidisciplinary adolescent haematology clinic. Haemophilia 2013; 19 (01) 71-75
    CrossrefPubMedGoogle Scholar
  • 9 Nichols WL, Hultin MB, James AH. et al. von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA). Haemophilia 2008; 14 (02) 171-232
    CrossrefPubMedGoogle Scholar
  • 10 Adeyemi-Fowode O, Simms-Cendan J. Screening and Management of Bleeding Disorders in Adolescents with Heavy Menstrual Bleeding: ACOG Committee Opinion. Obstet Gynecol 2019; 134: 71-83
    CrossrefPubMedGoogle Scholar
  • 11 Rosen MW, Weyand AC, Pennesi CM. et al. Adolescents Presenting to the Emergency Department with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol 2020; 33 (02) 139-143
    CrossrefPubMedGoogle Scholar
  • 12 Weyand AC, Kouides P, Malvar J, Jaffray J. Is ≥ 100% the magic number to rule out the laboratory diagnosis of von Willebrand disease based on initial testing?. Am J Hematol 2021; 96 (11) E439-E441
    CrossrefPubMedGoogle Scholar
  • 13 Baronciani L, Peyvandi F. How we make an accurate diagnosis of von Willebrand disease. Thromb Res 2020; 196: 579-589
    CrossrefPubMedGoogle Scholar
  • 14 Doshi BS, Rogers RS, Whitworth HB. et al. Utility of repeat testing in the evaluation for von Willebrand disease in pediatric patients. J Thromb Haemost 2019; 17 (11) 1838-1847
    CrossrefPubMedGoogle Scholar
  • 15 Harrison P. The role of PFA-100 testing in the investigation and management of haemostatic defects in children and adults. Br J Haematol 2005; 130 (01) 3-10
    CrossrefPubMedGoogle Scholar
  • 16 Sanchez J, Andrabi S, Bercaw JL, Dietrich JE. Quantifying the PBAC in a pediatric and adolescent gynecology population. Pediatr Hematol Oncol 2012; 29 (05) 479-484
    CrossrefPubMedGoogle Scholar
  • 17 United States Census Bureau [homepage on the Internet]. Updated 2018 Apr 5. Cited 2021 Apr 7. Available from: https://www.census.gov/econ/geo-zip.html
    Google Scholar
  • 18 Philipp CS, Dilley A, Miller CH. et al. Platelet functional defects in women with unexplained menorrhagia. J Thromb Haemost 2003; 1 (03) 477-484
    CrossrefPubMedGoogle Scholar
  • 19 Díaz R, Dietrich JE, Mahoney Jr D, Yee DL, Srivaths LV. Hemostatic abnormalities in young females with heavy menstrual bleeding. J Pediatr Adolesc Gynecol 2014; 27 (06) 324-329
    CrossrefPubMedGoogle Scholar
  • 20 Marsh EE, Brocks ME, Ghant MS, Recht HS, Simon M. Prevalence and knowledge of heavy menstrual bleeding among African American women. Int J Gynaecol Obstet 2014; 125 (01) 56-59
    CrossrefPubMedGoogle Scholar
  • 21 Naar S, Ellis D, Cunningham P. et al. Comprehensive Community-Based Intervention and Asthma Outcomes in African American Adolescents. Pediatrics 2018; 142 (04) e20173737
    CrossrefPubMedGoogle Scholar
  • 22 Dickerson KE, Menon NM, Zia A. Abnormal Uterine Bleeding in Young Women with Blood Disorders. Pediatr Clin North Am 2018; 65 (03) 543-560
    CrossrefPubMedGoogle Scholar
  • 23 Moyer G, Huguelet P. Iron Deficient Anemia May Obscure a Diagnosis of Low VWF, VWD, or Mild Hemophilia a in Biological Females with Heavy Menstrual Bleeding. Blood 2020; 136 (Suppl. 01) 32-33
    CrossrefPubMedGoogle Scholar
  • 24 Brown MC, White MH, Friedberg R. et al. Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand disease. Res Pract Thromb Haemost 2021; 5 (04) e12513
    CrossrefPubMedGoogle Scholar
  • 25 Cooke AG, McCavit TL, Buchanan GR, Powers JM. Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol 2017; 30 (02) 247-250
    CrossrefPubMedGoogle Scholar
  • 26 Lysteda (tranexamic acid) tablets. Package insert. Ferring Pharmaceuticals, Inc; 2013
    Google Scholar
  • 27 Zia A, Stanek J, Christian-Rancy M, Ahuja SP, Savelli S, O'Brien SH. Utility of a screening tool for haemostatic defects in a multicentre cohort of adolescents with heavy menstrual bleeding. Haemophilia 2018; 24 (06) 957-963
    CrossrefPubMedGoogle Scholar
  • 28 Alaqzam TS, Stanley AC, Simpson PM, Flood VH, Menon S. Treatment Modalities in Adolescents Who Present with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol 2018; 31 (05) 451-458
    CrossrefPubMedGoogle Scholar
  • 29 Seravalli V, Linari S, Peruzzi E, Dei M, Paladino E, Bruni V. Prevalence of hemostatic disorders in adolescents with abnormal uterine bleeding. J Pediatr Adolesc Gynecol 2013; 26 (05) 285-289
    CrossrefPubMedGoogle Scholar
  • 30 Bevan JA, Maloney KW, Hillery CA, Gill JC, Montgomery RR, Scott JP. Bleeding disorders: A common cause of menorrhagia in adolescents. J Pediatr 2001; 138 (06) 856-861
    CrossrefPubMedGoogle Scholar
  • 31 Kanbur NO, Derman O, Kutluk T, Gürgey A. Coagulation disorders as the cause of menorrhagia in adolescents. Int J Adolesc Med Health 2004; 16 (02) 183-185
    CrossrefPubMedGoogle Scholar
  • 32 Smith YR, Quint EH, Hertzberg RB. Menorrhagia in adolescents requiring hospitalization. J Pediatr Adolesc Gynecol 1998; 11 (01) 13-15
    CrossrefPubMedGoogle Scholar
  • 33 Claessens EA, Cowell CA. Acute adolescent menorrhagia. Am J Obstet Gynecol 1981; 139 (03) 277-280
    CrossrefPubMedGoogle Scholar