Rosa Díaz1, Jennifer E Dietrich2, Donald Mahoney3, Donald L Yee3, Lakshmi V Srivaths3. 1. Texas Children's Hospital, Houston, TX. Electronic address: rxdiaz@txch.org. 2. Texas Children's Hospital, Houston, TX; Baylor College of Medicine, Houston, TX. 3. Texas Children's Hospital, Houston, TX.
Abstract
OBJECTIVE: To study the prevalence of hemostatic abnormalities, including bleeding disorders and risk factors, in young females referred to a multidisciplinary clinic for evaluation of heavy menstrual bleeding (HMB). METHODS: Retrospective chart review was undertaken for 131 post-menarchal girls with HMB, 7 to 17 years of age, enrolled in the institutional 'Menorrhagia Data Registry' protocol. The diagnostic approach included: (1) complete blood count, prothrombin time, partial thromboplastin time, fibrinogen, von Willebrand panel (2) platelet aggregometry, specific clotting factor assay, fibrinolytic pathway analysis, and factor XIII level as needed. The prevalence of hemostatic abnormalities and the prognostic significance of clinical variables associated with hemostatic abnormalities in young girls with HMB were evaluated. RESULTS: A hemostatic abnormality was identified in 69 (53%) young girls with HMB. Of these, 27 (21%) had an underlying bleeding disorder and 42 (32%) had a risk factor for bleeding, namely low von Willebrand factor activity. A larger number of girls with underlying bleeding disorder had personal history of other bleeding symptoms (48% vs 31%) and bleeding after surgical or dental procedure (25% vs 8%) when compared to females without hemostatic abnormality. Furthermore, girls with risk factor for bleeding (low vWF activity) were more likely to have bleeding after surgical or dental procedure (15% vs 8%) and family history of bleeding (79% vs 60%) than patients without hemostatic abnormality. CONCLUSIONS: There is high prevalence of hemostatic abnormalities, including bleeding disorders and risk factors, in young girls with HMB. These findings support comprehensive and systematic hemostatic evaluation in this group of patients.
OBJECTIVE: To study the prevalence of hemostatic abnormalities, including bleeding disorders and risk factors, in young females referred to a multidisciplinary clinic for evaluation of heavy menstrual bleeding (HMB). METHODS: Retrospective chart review was undertaken for 131 post-menarchal girls with HMB, 7 to 17 years of age, enrolled in the institutional 'Menorrhagia Data Registry' protocol. The diagnostic approach included: (1) complete blood count, prothrombin time, partial thromboplastin time, fibrinogen, von Willebrand panel (2) platelet aggregometry, specific clotting factor assay, fibrinolytic pathway analysis, and factor XIII level as needed. The prevalence of hemostatic abnormalities and the prognostic significance of clinical variables associated with hemostatic abnormalities in young girls with HMB were evaluated. RESULTS: A hemostatic abnormality was identified in 69 (53%) young girls with HMB. Of these, 27 (21%) had an underlying bleeding disorder and 42 (32%) had a risk factor for bleeding, namely low von Willebrand factor activity. A larger number of girls with underlying bleeding disorder had personal history of other bleeding symptoms (48% vs 31%) and bleeding after surgical or dental procedure (25% vs 8%) when compared to females without hemostatic abnormality. Furthermore, girls with risk factor for bleeding (low vWF activity) were more likely to have bleeding after surgical or dental procedure (15% vs 8%) and family history of bleeding (79% vs 60%) than patients without hemostatic abnormality. CONCLUSIONS: There is high prevalence of hemostatic abnormalities, including bleeding disorders and risk factors, in young girls with HMB. These findings support comprehensive and systematic hemostatic evaluation in this group of patients.
Authors: Lakshmi Srivaths; Charles G Minard; Sarah H O'Brien; Allison P Wheeler; Eric Mullins; Mukta Sharma; Robert Sidonio; Shilpa Jain; Ayesha Zia; Margaret V Ragni; Roshni Kulkarni; Jennifer E Dietrich; Peter A Kouides Journal: Blood Adv Date: 2020-07-14
Authors: Anne D Rocheleau; Ayesha Khader; Anh T P Ngo; Colin Boehnlein; Cara McDavitt; Susan Lattimore; Michael Recht; Owen J T McCarty; Kristina M Haley Journal: Pediatr Res Date: 2018-01-03 Impact factor: 3.756
Authors: F Atiq; J L Saes; M C Punt; K P M van Galen; R E G Schutgens; K Meijer; M H Cnossen; B A P Laros-Van Gorkom; M Peters; L Nieuwenhuizen; M J H A Kruip; J de Meris; J G van der Bom; F J M van der Meer; K Fijnvandraat; I C Kruis; W L van Heerde; H C J Eikenboom; Frank W G Leebeek; S E M Schols Journal: EClinicalMedicine Date: 2021-01-29