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Kaya Z. Bernard-Soulier Syndrome: A Review of Epidemiology, Molecular Pathology, Clinical Features, Laboratory Diagnosis, and Therapeutic Management. Semin Thromb Hemost 2024. [PMID: 39191409 DOI: 10.1055/s-0044-1789184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Bernard-Soulier syndrome (BSS) is an inherited platelet function disorder caused by mutations in the genes that encode the glycoprotein (GP) Ibα and GPIbβ subunits, as well as the GPIX subunit in the GPIbIX complex, which is located on the platelet surface and has roles in platelet adhesion and activation. Patients with autosomal recessively inherited biallelic BSS have a homozygous or compound heterozygous expression in the GPIbα, GPIbβ, and GPIX subunits of the GPIbIX complex. Patients with autosomal dominantly inherited monoallelic BSS have a heterozygous expression in only the GPIbα and GPIbβ subunits of the GPIbIX complex. To date, no BSS mutations in the GP5 gene have been reported. Patients with biallelic form are usually diagnosed at a young age, typically with mucocutaneous bleeding, whereas monoallelic forms are generally identified later in life and are frequently misdiagnosed with immune thrombocytopenic purpura (ITP). In biallelic BSS, giant platelets in the peripheral blood smear, absence of ristocetin-induced platelet aggregation (RIPA) using light transmission aggregometry (LTA), and complete loss of GPIbIX complex in flow cytometry are observed, whereas in monoallelic forms, genetic diagnosis is recommended due to the presence of large platelets in the peripheral blood smear, decreased or normal RIPA response in LTA, and partial loss or normal GPIbIX complex in flow cytometry. Platelet transfusion is the main therapy but recombinant factor VIIa is advised in alloimmunized patients, and allogeneic stem cell transplantation is suggested in refractory cases. Antifibrinolytics and oral contraceptives are utilized as supplementary treatments. Finally, differentiation from ITP is critical due to differences in management. Thus, BSS should be kept in mind in the presence of individuals with chronic persistent thrombocytopenia, positive family history, unresponsive ITP treatment, macrothrombocytopenia, and absence of RIPA response.
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Affiliation(s)
- Zühre Kaya
- Department of Pediatrics, Unit of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
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2
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Bavinck AP, Heerde WV, Schols SEM. Point-of-Care Testing in Patients with Hereditary Disorders of Primary Hemostasis: A Narrative Review. Semin Thromb Hemost 2024. [PMID: 38950596 DOI: 10.1055/s-0044-1787976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
Inherited disorders of primary hemostasis, such as von Willebrand disease and congenital platelet disorders, can cause extensive, typically mucocutaneous bleeding. Assays to diagnose and monitor these disorders, such as von Willebrand factor activity assays and light transmission aggregometry, are performed in specialized hemostasis laboratories but are commonly not available in local hospitals. Due to the complexity and relative scarcity of these conventional assays, point-of-care tests (POCT) might be an attractive alternative in patients with hereditary bleeding disorders. POCTs, such as thromboelastography, are increasingly used to assess hemostasis in patients with acquired hemostatic defects, aiding clinical decision-making in critical situations, such as during surgery or childbirth. In comparison, the use of these assays in patients with hereditary hemostasis defects remains relatively unexplored. This review aims to give an overview of point-of-care hemostasis tests in patients with hereditary disorders of primary hemostasis. A summary of the literature reporting on the performance of currently available and experimental POCTs in these disorders is given, and the potential utility of the assays in various use scenarios is discussed. Altogether, the studies included in this review reveal that several POCTs are capable of identifying and monitoring severe defects in the primary hemostasis, while a POCT that can reliably detect milder defects of primary hemostasis is currently lacking. A better understanding of the strengths and limitations of POCTs in assessing hereditary defects of primary hemostasis is needed, after which these tests may become available for clinical practice, potentially targeting a large group of patients with milder defects of primary hemostasis.
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Affiliation(s)
- Aernoud P Bavinck
- Department of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Waander van Heerde
- Department of Hematology, Radboud University Medical Centre, Hemophilia Treatment Centre Nijmegen-Eindhoven-Maastricht, Nijmegen, The Netherlands
| | - Saskia E M Schols
- Department of Hematology, Radboud University Medical Centre, Hemophilia Treatment Centre Nijmegen-Eindhoven-Maastricht, Nijmegen, The Netherlands
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Abdul‐Kadir R, Gomez K. Reproductive health and hemostatic issues in women and girls with congenital factor VII deficiency: A systematic review. J Thromb Haemost 2022; 20:2758-2772. [PMID: 36073900 PMCID: PMC9828586 DOI: 10.1111/jth.15872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Congenital factor VII (FVII) deficiency is an inherited bleeding disorder, with heterogenous bleeding symptoms. Women with FVII deficiency face hemostatic challenges during menstruation, ovulation, and childbirth. This systematic review evaluated prevalence and management of bleeding symptoms associated with gynecological and obstetric issues in women with FVII deficiency. METHODS Databases (BIOSIS Previews, Current Contents Search, Embase, and MEDLINE) were searched for studies reporting FVII deficiency and gynecological or obstetric issues in women. Articles were screened using Joanna Briggs Institute checklists and relevant data extracted. RESULTS One hundred fourteen women were identified from 62 publications. Forty-six women had severe deficiency (FVII:C < 5% or <5 IU/dl). Heavy menstrual bleeding (HMB) was the most common bleeding symptom (n = 94; 82%); hospitalization and urgent medical/surgical interventions for acute HMB episodes were required in 16 women (14%). Seven women reported ovarian bleeding (6%); other bleeding symptoms varied. Patient management was inconsistent and included hemostatic and hormonal treatments. Only four women (7%) reporting vaginal bleeding during pregnancy. Postpartum hemorrhage (PPH) occurred following 12/45 deliveries (27%; 5 [42%] requiring blood transfusion) and was not necessarily prevented by prophylaxis (8 women). CONCLUSION Women with congenital FVII deficiency have an increased risk of HMB, ovarian bleeding, and PPH, impacting quality of life. Recognition of a bleeding disorder as the cause is often delayed. Management of bleeding complications is heterogeneous due to lack of treatment guidelines. Harmonizing severity classification of FVII deficiency may help standardize treatment strategies and development of specific guidelines for these women.
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Affiliation(s)
- Rezan Abdul‐Kadir
- Katharine Dormandy Haemophilia Centre and Department of Obstetrics & GynaecologyRoyal Free HospitalLondonUK
| | - Keith Gomez
- Haemophilia Centre and Thrombosis UnitRoyal Free London NHS Foundation TrustLondonUK
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EVALUATION OF HEMOSTASIS PARAMETERS IN ADOLESCENT GIRLS PRESENTING WITH MENOMETRORRHAGIA AND COMPARISON WITH HEALTHY ADOLESCENTS. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1161870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: This study aims to investigate the presence of acquired and hereditary coagulation in adolescent girls presenting with increased menstrual bleeding.
Method: The study consisted of 63 adolescent female patients (15.4±1.5 years) who applied to the pediatric clinic of our hospital due to increased menstrual bleeding, did not have any acute or chronic disease, did not use any medication in the last 14 days, and were of the same age and gender as the study group. 74 healthy adolescents were taken as the healthy control group (15.5±1.5 years). Platelet count, all basal and advanced coagulation tests, platelet aggregation, and secretion tests were studied for each case included in the study.
Results: When basal and advanced coagulation tests, platelet aggregation, and secretion tests were examined, no significant difference was found between the study and the healthy control group. On the other hand, in our study group with heavy menstrual bleeding, 4 (6.3%) patients were found to have impaired hemostasis (2 patients with type 1 von Willebrand disease, one patient with immune thrombocytopenic purpura, and one patient with mild factor VIII deficiency).
Conclusion: Various hemostasis disorders, especially von Willebrand disease, could be detected in the group with heavy menstrual bleeding.
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Screening hemostatic defects in Saudi University students with unexplained menorrhagia: a diagnosis, which could be missed. Blood Coagul Fibrinolysis 2021; 32:278-284. [PMID: 33741756 DOI: 10.1097/mbc.0000000000001033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bleeding disorders are a common cause of unexplained menorrhagia in adolescents. However, there is lack of information provided on Arab girls. To estimate the prevalence of coagulation factor deficiencies and platelet dysfunction among Saudi university students with unexplained menorrhagia. In this cross sectional study, 463 adolescent girls surveyed for having heavy menses for further evaluation of underlying bleeding tendencies using screening standardized questionnaire. Only 109 girls out of the total 463 girls reported menorrhagia and were included in the evaluation. All girls with menorrhagia were evaluated by Pictorial blood assessment chart (PBAC) for precise evaluation of menstrual blood loss (PBAC score >100), had underwent pelvic ultrasonography and screening of hemostatic abnormalities (complete blood count, PFA-100, PT, aPTT, vWF:RCo, vWF:Ag, coagulation factors assay). On the basis of the score of PBAC more than 100, 25.6% (28/109) of adolescent women (age ranged: 17-25 years old) had confirmed menorrhagia. In 30.8% of them, an ultimate diagnosis of bleeding tendency or hemostatic abnormality was detected [five cases of probable von Willebrand disease (vWD) or low level of vWF:Ag and/or vWF:RCo, two cases of probable platelet dysfunction, and one case of factorV (FV) deficiency]. Anemia was found in 39.28% (11/28) of them; however, only 4 (36%) had received iron supplements. Our study demonstrated that hemostatic defects are not uncommon in Saudi adolescent women presenting with menorrhagia but mostly unrecognized and untreated. It is probably advisable to screen women with menorrhagia for these defects.
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Umarami RBR, Roqaiya M, Quadri MA. Efficacy of Habbul aas (fruits of Myrtus communis) in menorrhagia: a single blinded randomized standard control study. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2020; 18:123-130. [PMID: 32845864 DOI: 10.1515/jcim-2018-0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/16/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Menorrhagia can be defined as heavy uterine bleeding which comes at regular intervals or uterine bleeding extending more than seven days during menses which has become a considerable problem for females, causing discomfort, anxiety, and poor quality of life. In this study we aimed to compare the effect of Myrtus communis fruits with tranexamic acid in the treatment of menorrhagia. METHODS In this prospective patient blinded standard controlled study, 40 patients of menorrhagia were randomly assigned to receive either test drug (powdered M. communis fruits) or active control drug (tranexamic acid) for first five days of menstrual cycle consecutively for two cycles. The primary outcome measure was reduction in heavy flow during menses determined by pictorial blood loss assessment chart (PBAC), while improvements in quality of life (QOL) by using short form-36 questionnaire and increase in hemoglobin percentage were kept as secondary outcome measures. RESULTS Both the groups were similar at baseline. Test and control drugs significantly reduced the PBAC score during treatment cycles with p-value <0.001 and these changes were not significantly different between the groups. During second treatment cycle significant difference was found in PBAC score (p = 0.024) between the groups. After treatment significant improvement in hemoglobin percentage was noted and marked improvement in overall quality of life was observed in both the groups. CONCLUSION These data suggest that M. communis fruits can be an effective alternate in reducing heavy menstrual bleeding. There is need to confirm these results by designing a trial on large number of patients. TRIAL REGISTRATION NO CTRI/2017/09/009937.
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Affiliation(s)
- Rayeesa Banu R Umarami
- Dept. of Niswan wa Qabala, Luqman Unani Medical College Hospital and Research Centre, Naubag, Vijayapur, Karnataka, India
| | - Mariyam Roqaiya
- Dept. of Niswan wa Qabala, Luqman Unani Medical College Hospital and Research Centre, Naubag, Vijayapur, Karnataka, India
| | - Mohd Aqil Quadri
- Dept. of Niswan wa Qabala, Luqman Unani Medical College Hospital and Research Centre, Naubag, Vijayapur, Karnataka, India
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Punt MC, Schuitema PCE, Bloemenkamp KWM, Kremer Hovinga ICL, van Galen KPM. Menstrual and obstetrical bleeding in women with inherited platelet receptor defects-A systematic review. Haemophilia 2020; 26:216-227. [PMID: 32004416 PMCID: PMC7155109 DOI: 10.1111/hae.13927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Women with inherited platelet receptor defects (IPRD) may have an increased risk of heavy menstrual bleeding (HMB) and postpartum haemorrhage (PPH). AIM To present a systematic overview of the literature on the prevalence and management of menstrual and obstetrical bleeding in women with IPRD. METHODS Electronic databases were searched for original patient data on the prevalence and management of HMB and PPH in women with known IPRD or who were being investigated for IPRD. RESULTS Sixty-nine papers (61 case reports/series and 8 cohort studies) were included. Overall, studies were rated as 'poor quality'. The included cohort studies reported HMB in 25% (13/52) of women with Bernard-Soulier syndrome and in 22.1% (34/154) of women with Glanzmann thrombasthenia. In total, 164 deliveries in women with IPRD were described. Excessive bleeding occurred in 16.9% (11/65) of deliveries described in the largest cohort. PPH occurred in 63.2% (55/87) of deliveries described in case reports/series. PPH occurred in 73.7% (14/19) of deliveries that were not covered by prophylaxis compared with 54.2% (32/59) of deliveries that were (OR = 2.36, 95% CI 0.75-7.40). Neonatal bleeding complications were reported in 10.0% (8/80) of deliveries. In all (6/6) deliveries with neonatal bleeding complications wherein the presence of alloantibodies was investigated, either antiplatelet or anti-HLA antibodies were detected. DISCUSSION/CONCLUSION Menstrual and particularly obstetrical bleeding problems frequently occur in women with IPRD, based on small case reports and series of poor quality. International collaboration, preferably on prospective studies, is needed to improve clinical management of women-specific bleeding in IPRD.
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Affiliation(s)
- Marieke C. Punt
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
| | - Pauline C. E. Schuitema
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
| | - Kitty W. M. Bloemenkamp
- Division Woman and BabyDepartment of ObstetricsBirth Centre Wilhelmina’s Children HospitalUniversity Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
| | | | - Karin P. M. van Galen
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
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Magnay JL, O'Brien S, Gerlinger C, Seitz C. Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review. BMC WOMENS HEALTH 2020; 20:24. [PMID: 32041594 PMCID: PMC7011238 DOI: 10.1186/s12905-020-0887-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/16/2020] [Indexed: 12/15/2022]
Abstract
Background Pictorial blood loss assessment charts (PBACs) represent the most widely used method to assess menstrual blood loss (MBL) in clinical trials. The aims of this review were to: (1) determine the diagnostic accuracy of PBACs that have been validated against the reference alkaline hematin technique; (2) categorize the pitfalls of using obsolete and nonvalidated charts; (3) provide guidelines for development of a new PBAC or use of an existing chart to measure MBL in clinical trials; and (4) consider the feasibility of using pictorial charts in primary care. Methods A literature review was conducted using Embase and MEDLINE databases. The review identified reports of women with self-perceived or actual heavy menstrual bleeding (HMB), bleeding disorders, abnormal uterine bleeding, leiomyomata (uterine fibroids) or endometriosis, and women undergoing treatment for HMB, as well as those with normal menstrual periods. Data were reviewed from studies that focused on the development and validation of PBACs and from those that used derivative noncertified charts to assess HMB. Results Nine studies reported validation of PBAC scoring systems against the alkaline hematin technique. Across these studies, the sensitivity was 58–97%, the specificity was 7.5–95.5%, the positive and negative likelihood ratios were 1.1–13.8 and 0.14–0.56, respectively, and the diagnostic odds ratio was 2.6–52.4. The cut-off score above which the diagnosis of HMB was made ranged from 50 to 185. Several modifications of these PBACs were used in other studies; however, objective confirmation of their validity was not reported. Overall, there was widespread inconsistency of chart design, scoring systems, diagnostic cut-off limits and post-treatment outcome measures. Conclusions PBACs are best suited to the controlled and specific environment of clinical studies, where clinical outcome parameters are defined. The current lack of standardization precludes widespread use of the PBAC in primary care. Review registration number PROSPERO international prospective register of systematic reviews: CRD42016030083.
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Affiliation(s)
- Julia L Magnay
- Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK
| | - Shaughn O'Brien
- Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK.,Department of Obstetrics & Gynaecology, Keele University School of Medicine, Stoke-on-Trent, UK
| | - Christoph Gerlinger
- Bayer AG, Building P300, 13342, Berlin, Germany.,Gynaecology, Obstetrics and Reproductive Medicine, University of Saarland Medical School, Homburg, Saar, Germany
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Elmahmoudi H, Achour M, Belhedi N, Ben Neji H, Zahra K, Meddeb B, Gouider E. The Glanzmann's Thrombasthenia in Tunisia: A Cohort Study. J Hematol 2017; 6:44-48. [PMID: 32300391 PMCID: PMC7155826 DOI: 10.14740/jh330e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/10/2017] [Indexed: 12/28/2022] Open
Abstract
Background The Glanzmann’s thrombasthenia (GT) is a rare autosomal-recessive bleeding disorder with uncommon neonatal revelation. It is due to abnormalities of quantitative and/or qualitative αIIbβ3 integrin. This cell adhesion receptor is essential for platelet aggregation and allows the formation of a hemostatic plug if the vessel is damaged by injury. The clinical picture of GT is variable, with mucocutaneous bleeding due to non-functional platelets. Management requires a good expertise in bleeding disorders. We describe the clinical and the epidemiological data of GT in Aziza Othmana Hospital Hemophilia Center. Methods This was a retrospective study of all patients with GT monitored and treated in our hemophilia center during the period of 2011 - 2015. Results Twenty-seven patients among the 35 patients included in our hemophilia center registry were studied. The most common sign encountered is the gingival bleeding. In our women cohort, one completed her pregnancy. The consanguinity is present with a frequency of 62%. Treatments used depending on the case are tranexamic acid, platelet transfusion, packed red blood cells and rFVIIa, respectively. Conclusion GT is relatively frequent in Tunisia and especially in the North of the country which can be explained by the high consanguinity in our population.
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Affiliation(s)
- Hejer Elmahmoudi
- UR14ES11, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,National Center for Nuclear Science and Technology, Sidi Thabet, Tunis, Tunisia
| | - Meriem Achour
- UR14ES11, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Hemophilia Treatment Center, Aziza Othmana Hospital, Tunis, Tunisia
| | - Nejla Belhedi
- UR14ES11, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hend Ben Neji
- UR14ES11, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Kaouther Zahra
- UR14ES11, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Hemophilia Treatment Center, Aziza Othmana Hospital, Tunis, Tunisia
| | - Balkis Meddeb
- UR14ES11, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Emna Gouider
- UR14ES11, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Hemophilia Treatment Center, Aziza Othmana Hospital, Tunis, Tunisia
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Abstract
: Hemophilia A carriers have an abnormal X chromosome with a molecular abnormality of FVIII gene. These carriers, long considered to be free of bleeding risk, could have the same symptoms as mild hemophiliacs. This study aim to assess bleeding risk of hemophilia A carriers monitored at the Clinical Hematology Department of Dakar. This is a prospective study of a period of 6 months including 22 hemophilia A carriers aged between 8 and 48 years. Hemophilia carriers were recruited using the genealogical tree of hemophiliacs followed in the service. Their diagnosis was carried out by long range PCR and Sanger sequencing method searching the molecular abnormality responsible for hemophilia in their family. Bleeding risk was determined using a questionnaire consisting of different bleeding symptoms quoted from -1 to 4 according to the severity. Total of different values allow to determine the bleeding score which was pathological if it was greater than or equal to 1. Medium age was 22.5 years (8-48) (SD = 9.28). Four hemophilia A carriers (18.1%) presented bleeding symptoms and had a bleeding score at least 1 (P = 0.02). Menorrhagia was predominant (13.6%) followed by epistaxis (9%), gingivorrhagia (9%), and prolonged bleeding after tooth extraction (9%). Factor VIII level was lower in hemophilia carriers who presented bleeding (42 ± 8.61 UI/l) versus hemophilia carriers without bleeding (100 ± 50.95 UI/l) (P = 0.001). There was no significant correlation between bleeding occurrence and age (P = 0.81), activated patial thromboplastin time value (P = 0.97) and FVIII/Von Willebrand Factor ratio (P = 0.12). One in five hemophilia carriers presented bleeding and the questionnaire was effective to identify hemophilia carriers who had a risk of bleeding.
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Kushwaha R, Kumar A, Mishra KL, Sankhwar PL, Singh R. Haemostatic Disorder in Women with Unexplained Menorrhagia: A Tertiary Care Centre Experience from Northern India. J Clin Diagn Res 2017; 11:EC46-EC49. [PMID: 28658773 DOI: 10.7860/jcdr/2017/25722.9928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/20/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Menorrhagia is a common gynaecological problem and its cause remains unexplained in a significant proportion of females. AIM The present study was done to diagnose a wide range of haemostatic disorders which can give rise to menorrhagia in women of adolescent, postadolescent and perimenopausal age group. MATERIALS AND METHODS A total of 1100 women presenting to gynaecological emergency with complaints of menorrhagia underwent comprehensive evaluation. After excluding local pelvic pathology and hormonal disorders as a cause of menorrhagia 104 women were included in this study. Screening investigations including bleeding time, prothrombin time, activated partial thromboplastin time, platelet count and morphology were done. The following diagnostic investigations were carried out as and when required. Platelet aggregation tests using adenosine diphosphate and ristocetin, platelets function tests, specific factor analysis as and when required. RESULTS Age of patients ranged from 13 years to 46 years. Eighteen patients had menorrhagia since menarche. Seven patients had family history of abnormal bleeding. Twenty three patients were found to have systemic haemostatic disorder (10 patients of Von Willebrand Disease (vWD), seven of Glanzmann-Thrombasthenia, one of Bernard- Soulier syndrome and five of immune thrombocytopenic purpura). CONCLUSION From this study it is concluded that systemic haemostatic disorders are found in substantial number of women presenting with menorrhagia. Hence, after excluding organic/hormonal cause, haemostatic disorders should be considered before taking patient for invasive surgical procedures.
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Affiliation(s)
- Rashmi Kushwaha
- Associate Professor, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kumar
- Professor and Head, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kusum Lata Mishra
- Research Assistant, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pushp Lata Sankhwar
- Professor, Department of Obstetric and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Renu Singh
- Professor, Department of Obstetric and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Hacioglu S, Karabulut A, Sari I, Keskin A. Haemostatic disorders in reproductive age women with menorrhagia and effects on quality of life. J OBSTET GYNAECOL 2016; 36:1041-1045. [DOI: 10.1080/01443615.2016.1196168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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13
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Severe anemia from heavy menstrual bleeding requires heightened attention. Am J Obstet Gynecol 2015; 213:97.e1-97.e6. [PMID: 25935784 DOI: 10.1016/j.ajog.2015.04.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 03/24/2015] [Accepted: 04/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of the study was to analyze the behaviors of women that resulted in menstrually related severe anemia (hemoglobin <5 g/dL) from a single public hospital serving indigent women. STUDY DESIGN This was a retrospective cohort study of all women identified as having been treated at Harbor-UCLA Medical Center for excessive menstruation (International Classification of Diseases, ninth revision, codes 285.9, 6256.2) and hemoglobin values less than 5 g/dL in the 6 years from 2008 to 2013. RESULTS Approvals were obtained from the Human Subjects and Research Committees. This search identified 271 women with those 2 diagnoses; 122 were excluded because their severe anemia had nonmenstrual causes. The remaining 149 women had 168 episodes with hemoglobin levels below 5 g/dL attributed to chronic excessive menstrual bleeding. Mean age was 41 years (range, 19-55 years). Mean body mass index was 28.9 kg/m(2) (range, 18-57 kg/m(2)); 58.2% were actively bleeding at presentation, and 90.4% reported chronic excessive blood loss. Two thirds recognized heavy bleeding that had persisted for more than 6 months without seeking help. However, 7.8% described their bleeding as normal, and 40.5% had received at least 1 previous transfusion. Mean nadir hemoglobin was 4.15 g/dL (range, 1.6-4.9 g/dL). Mean corpuscular volume was 62.2 fL (range, 47.7-99.8 fL) and mean corpuscular hemoglobin concentration was 29.2 g/dL (range, 25.7-33.6 g/dL). Nearly a quarter had reactive thrombocytosis, which might have created a hypercoagulable state. Bleeding was ultimately attributed to leiomyoma in 47.9%; cancer was detected in 4.8%. A total of 33.9% were discharged without being offered any therapy to prevent subsequent bleeding; 3.0% declined any medical therapy; 35.1% were lost to follow-up prior to receiving effective therapy; and 26.8% had multiple subsequent transfusions before seeking/receiving definitive treatments. CONCLUSION Even when faced with potentially life-threatening anemia because of chronic, excessive menstrual blood loss, some women are not impressed with the serious nature of their problem. Women will benefit from recognizing the health consequences of chronic excessive blood loss. Chronic excessive blood loss should be treated as both an urgent and potentially recurrent problem; physicians should address this clinical concern proactively.
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Gursel T, Biri A, Kaya Z, Sivaslıoglu S, Albayrak M. The frequency of menorrhagia and bleeding disorders in university students. Pediatr Hematol Oncol 2014; 31:467-74. [PMID: 24684279 DOI: 10.3109/08880018.2014.886316] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE Menorrhagia is an important health problem in women of reproductive age. The aims of this study were to assess the prevalence of menorrhagia and hemostatic abnormalities associated with menorrhagia in university students. METHODS The pictorial blood assessment chart (PBAC) was used to identify students with menorrhagia. Those with a PBAC score > 100 were examined by pelvic ultrasound and laboratory tests including complete blood count, levels of clotting factors, von Willebrand factor antigen, and ristocetin cofactor activity and Platelet Function Analyser-100 (PFA-100). Platelet aggregation was studied in students with prolonged PFA-100 closure time. RESULTS Menorrhagia was identified in 82 (21.8%) of 376 students. Six of 82 students who had pelvic pathologies were excluded. Eleven (14.5%) of the remaining 76 students were found to have bleeding disorders, including von Willebrand disease in five (6.5%), platelet function disorder in four (5.2%), and clotting factor deficiencies in two (2.6%). CONCLUSIONS Menorrhagia is a common but mostly unrecognized and untreated problem among university students. Underlying bleeding disorders are not rare and require comprehensive hemostatic evaluation for identification.
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Affiliation(s)
- Turkiz Gursel
- Department of Pediatrics, Medical School of Gazi University, Ankara, Turkey
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