1
|
Batorova A, Galen KV, Mackensen SV, Tsimpanakos I, Grimberg E. Gynaecological issues in women with bleeding disorders: CSL Behring Symposium. ACTA ACUST UNITED AC 2019. [DOI: 10.17225/jhp00142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
The symposium focused on issues around surgery, ovulation bleeding, health-related quality of life (HRQoL) and pelvic pain in women with bleeding disorders.
Surgery
Young women with congenital bleeding disorders, especially those with severe forms, are more likely to experience gynaecological and obstetric disorders than unaffected women. Surgery may be required to manage heavy menstrual bleeding (HMB), ovulatory bleeding, endometriosis and delivery. Major surgery should be undertaken only in hospitals with a haemophilia centre and 24-hour laboratory capability. Correction of haemostasis, either by desmopressin, coagulation factor or platelet transfusion, is essential for a successful outcome of surgery. Management of pregnancy requires a multidisciplinary approach; the mode of delivery is based on the consensus of gynaecologist and haematologist, and with respect to the patient’s diagnosis.
Ovulation bleeding
Women with bleeding disorders are at risk for excessive gynaecological bleeding associated with menstruation, ovulation, pregnancy and delivery. Ovulation bleeding is associated with the rupture of ovarian cysts and causes abdominal pain; complications include haemoperitoneum, fertility problems and ovarian torsion. Management includes hormonal and haemostatic therapies, in combination if necessary, and surgery as a last resort. Current management is based on experience in a relatively small number of cases and more clinical data are needed.
Health-related quality of life
In addition to experiencing joint and tissue bleeds, women experience psychosocial and medical issues associated with menstruation, pregnancy, labour and delivery. HMB has the greatest impact, and is associated with impaired HRQoL in almost all and dissatisfaction with the burden of treatment. There is a need for focused psychosocial support and a specific tool for the assessment of HRQoL in women with bleeding disorders.
Pelvic pain
Gynaecological causes of pelvic pain in women with bleeding disorders include dysmenorrhoea, mid-cycle pain, bleeding into the corpus luteum and endometriosis. There is no correlation between bleeding tendency and endometriosis severity; however, screening for a bleeding disorder should be considered. Pharmacological management may be hormonal or non-hormonal. Gonadotrophin-releasing hormone agonists offer an alternative to surgery for women with severe bleeding disorders who have endometriosis. Paracetamol is the preferred early analgesic option. Endometrial ablation controls heavy bleeding and pelvic pain but is not recommended for women with large fibroids or a large endometrial cavity. Hysterectomy is an option of last resort. Education for health professionals should include raising awareness about the management of pain in women with bleeding disorders.
Collapse
Affiliation(s)
- Angelika Batorova
- Director of the National Haemophilia Centre, University Hospital Bratislava , Bratislava Slovakia
| | - Karin van Galen
- Utrecht University Medical Centre , Utrecht , The Netherlands
| | - Sylvia von Mackensen
- Department of Psychology , University Medical Centre , Hamburg -Eppendorf, Germany
| | | | - Evelyn Grimberg
- Women and Bleeding Disorders Committee, European Haemophilia Consortium Utrecht , The Netherlands
| |
Collapse
|
2
|
Denny N, Scott M, Hay C, Thachil J. Expecting the unexpected: Acquired haemophilia A in a patient with homozygous factor V deficiency. Haemophilia 2019; 25:e101-e103. [PMID: 30690823 DOI: 10.1111/hae.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/14/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Nicholas Denny
- Department of Haematology, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Martin Scott
- Department of Haematology, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Charles Hay
- Department of Haematology, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| |
Collapse
|
3
|
Kesireddy S. Recurrent Ruptured Hemorrhagic Corpus Luteal Cyst in a Known Case of Combined Deficiency of Factor V and VIII. J Obstet Gynaecol India 2018; 68:229-231. [DOI: 10.1007/s13224-017-1028-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/12/2017] [Indexed: 11/27/2022] Open
|
4
|
An opinion on the benefits of concomitant oral contraceptive therapy in premenopausal women treated with oral anticoagulants. Thromb Res 2018; 165:14-17. [DOI: 10.1016/j.thromres.2018.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 12/11/2022]
|
5
|
Recurrent hemoperitoneum secondary to haemorrhage from the corpus luteum unmasks factor V deficiency. Blood Coagul Fibrinolysis 2015; 26:703-6. [DOI: 10.1097/mbc.0000000000000303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Stalnaker M, Esquivel P. Managing menorrhagia in a familial case of factor V deficiency. J Pediatr Adolesc Gynecol 2015; 28:e9-e12. [PMID: 25256869 DOI: 10.1016/j.jpag.2014.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/20/2014] [Accepted: 03/21/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Factor V deficiency is a rare coagulation disorder. Excessive uterine bleeding is common in affected women. We describe a case of 2 siblings with Factor V deficiency and menorrhagia who achieved control of bleeding with differing treatments. CASES Patient 1 is a 16-year-old female with Factor V deficiency and menorrhagia which was previously controlled with oral contraceptives (OC). She developed heavy bleeding treated with fresh frozen plasma, anti-inhibitor coagulant complex (AICC), and OC taper. A levonorgestrel IUD was placed with good control of her menorrhagia. Patient 2 is the 12-year-old sister of Patient 1. She was treated with AICC, aminocaproic acid, and her menorrhagia was ultimately controlled with continuous OCs. SUMMARY AND CONCLUSION Factor V deficiency is a rare cause of menorrhagia. Various treatment modalities are available. In these adolescent sisters desiring future fertility, menorrhagia was managed with OCs and an IUD.
Collapse
Affiliation(s)
- M Stalnaker
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
| | - P Esquivel
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| |
Collapse
|
7
|
Spontaneous massive hemoperitoneum from hemorrhagic corpus luteum cyst as initial presentation of aplastic anemia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
8
|
Millet I, Bouic-Pages E, Alili C, Curros-Doyon F, Ruyer A, Taourel P. Hémopéritoine, comment gérer ? IMAGERIE DE LA FEMME 2014. [DOI: 10.1016/j.femme.2014.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
9
|
Sun WC, Li W, Chen QH, Tong JY. Corpus luteum hemorrhage in a patient with aplastic anemia. J Obstet Gynaecol Res 2012; 39:399-401. [PMID: 22640265 DOI: 10.1111/j.1447-0756.2012.01895.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Corpus luteum hemorrhage may lead to a life-threatening intraperitoneal hemorrhage in women with bleeding disorders. A 17-year-old girl with aplastic anemia presented to the emergency ward with complaints of severe abdominal pain for the last 24h. On examination, she was noted to be pale with circulatory compromise. Transabdominal pelvic ultrasonography revealed a left complex adnexal mass, 6.9×5.1×5.1cm(3) in size, with a large anechoic area of fluid in the abdomen. On laparoscopic exploration, there was a massive hemoperitoneum (2.6L) with a ruptured corpus luteum on the surface of the left ovary. Hemostatic electric coagulation was successfully applied to the bleeding surface. The patient recovered without incident and was transferred to a special hospital for blood disease treatment one week after surgery. We concluded that corpus luteum hemorrhage in women with aplastic anemia can cause therapeutic difficulties. Laparoscopy is feasible for the management of a massive intraperitoneal hemorrhage secondary to a ruptured corpus luteum in such patients.
Collapse
Affiliation(s)
- Wen-Chao Sun
- Department of Obstetrics and Gynecology, First People's Hospital of Hangzhou, Hangzhou, Zhejiang Province, China
| | | | | | | |
Collapse
|
10
|
Girolami A, Vettore S, Ruzzon E, Marinis GBD, Fabris F. Rare and Unusual Bleeding Manifestations in Congenital Bleeding Disorders. Clin Appl Thromb Hemost 2011; 18:121-7. [DOI: 10.1177/1076029611416638] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Epistaxis, superficial and deep hematomas, hemarthrosis, gastrointestinal bleeding, hematuria represent the most frequent hemorrhagic events in congenital coagulation disorders. Occasionally, bleeding manifestations occur in unusual sites or are peculiar. A clotting defect may alter the clinical aspect of skin conditions or infections (hemorrhagic scabies or varicella). Hemobilia may occur as a complication of transjugular liver biopsy in hemophilia or Bernard-Soulier syndrome. Hemarthrosis of small joints of feet and hands occur in patients with hemophilia treated with protease inhibitors. Intramedullary hematomas of long bones have been described in α2-plasmin inhibitor or fibrinogen deficiencies. Spleen fracture with consequent hemoperitoneum has been reported in patients with fibrinogen deficiency. Rectus muscle sheath hematoma may occur in patients with factor VII (FVII)or FX deficiency. Acute or subacute intestinal obstruction may be caused by intramural wall hematomas in hemophilia and von Willebrand (vW)-disease. Physicians should always keep in mind that a congenital hemorrhagic disorder may cause bleeding in any tissue of the body and therefore alter the normal clinical features of a given disease.
Collapse
Affiliation(s)
- Antonio Girolami
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
| | - Silvia Vettore
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
| | - Elisabetta Ruzzon
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
| | - Giulia Berti de Marinis
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
| | - Fabrizio Fabris
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
| |
Collapse
|
11
|
Iwase A, Goto M, Manabe S, Hirokawa W, Kobayashi H, Nakahara T, Takikawa S, Kotani T, Sumigama S, Tsuda H, Nakayama T, Suzuki N, Matsushita T, Kikkawa F. Successful fertility management of a patient with factor V deficiency: planned transfusion of fresh frozen plasma under infertility treatment. Fertil Steril 2011; 95:2124.e5-7. [DOI: 10.1016/j.fertnstert.2011.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 12/27/2010] [Accepted: 01/05/2011] [Indexed: 11/16/2022]
|
12
|
DADHWAL V, DEKA D, VAID A, DHAR A, BAHADUR A. Abscess in bilateral ovarian haematomas in a girl with factor X deficiency, necessitating oopherectomy. Haemophilia 2010; 17:e243. [DOI: 10.1111/j.1365-2516.2010.02387.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Hackethal A, Ionesi-Pasacica J, Kreis D, Litzlbauer D, Tinneberg HR, Oehmke F. Feasibility of laparoscopic management of acute haemoperitoneum secondary to ruptured ovarian cysts in a haemodynamically unstable patient. MINIM INVASIV THER 2010; 20:46-9. [DOI: 10.3109/13645706.2010.497001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Hoffman R, Brenner B. Corpus Luteum Hemorrhage in Women with Bleeding Disorders. WOMENS HEALTH 2009; 5:91-5. [DOI: 10.2217/17455057.5.1.91] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Bleeding into the corpus luteum following ovulation rarely has clinical significance in healthy women, but may lead to life-threatening hemorrhage in women with congenital or acquired bleeding disorders. Women who are at an increased risk for corpus luteum hemorrhage (CLH) can be divided in two categories; first, those taking anticoagulants because of a thrombotic disorder; and second, women with congenital bleeding disorders. The management and prevention of CLH is still unsettled and the literature dealing with this problem is based on case reports only. This review focuses on the pathophysiology, clinical presentation, diagnosis and treatment options of an acute bleeding event and prevention modalities of CLH in women with bleeding disorders.
Collapse
Affiliation(s)
- Ron Hoffman
- Ron Hoffman, MD, Thrombosis & Haemostasis Unit, POB 9602, Rambam, Health Care Campus, Haifa, Israel, Tel.: +972 4854 3520, Fax: +972 4865 3886,
| | - Benjamin Brenner
- Benjamin Brenner, Bat Galim, Haifa, Thrombosis & Haemostasis Unit, Rambam, Health Care Campus, Israel, Tel.: +972 4854 3520, Fax: +972 4854 3886,
| |
Collapse
|