ITSH article 2.1

Bleeding disorders, such as Von Willebrand disease (VWD), platelet function disorder (PFD), thrombocytopenia, and clotting factor deficiencies, are more prevalent among adolescent girls with heavy menstrual bleeding (HMB), according to a study presented at RCOG World Congress 2018.

“It is important to identify bleeding disorders in the adolescent female population because the obstetric and gynaecologic morbidity goes beyond troublesome heavy periods … [as] they are at increased risk of surgical and obstetric haemorrhage,” according to study lead author Dr Brooke O’Brien from the Queensland Paediatric and Adolescent Gynaecology (PAG) Service at the Children’s Health Queensland Hospital and Health Service, Brisbane, Australia.

Using data from the Queensland PAG Service between July 2007 and 2017, the researchers retrospectively analysed 124 adolescents with HMB (average age 14 years and 3 months), of whom 62.1 percent (n=77) were screened for bleeding disorder and 86.3 percent (n=107) underwent an iron deficiency and/or anaemia screening. [RCOG 2018, abstract KO6055]

Overall, a 35 percent prevalence of bleeding disorder was observed in patients with HMB, and treated with hormonal therapies (n=96 percent), tranexamic acid (n=87 percent), iron therapy (n=70 percent), and combined oral contraceptive pill (n=61 percent).

“HMB is a common gynaecological complaint among adolescents … A significant proportion of adolescent girls with HMB referred to a PAG clinic will have a bleeding disorder, and the prevalence in this study is consistent with the literature,” O’Brien noted.

Among HMB patients with bleeding disorder, results showed that VWD was the most common type of bleeding disorder, mainly type 1 VWD at 30 percent and low VWD at 22 percent, followed by other inherited platelet disorder at 19 percent, dense body deficiency at 15 percent, thrombocytopenia at 11 percent, and factor deficiency at 3 percent.

Of the 49.5 percent (n=53) patients diagnosed with iron deficiency and/or anaemia, a 70 percent higher incidence of bleeding disorder was noted. Two of the patients with bleeding disorder had a blood transfusion due to HMB-related episodes.

O’Brien recommended that “severe bleeding episodes may benefit from directed therapies, such as desmopressin or clotting factor concentrates, and these agents may be valuable in perioperative prophylaxis and treatment of surgical and obstetric haemorrhage,” but highlighted that these should be prescribed under the supervision of the treating haematologist depending on the condition.

“A higher level of awareness of these conditions, especially VWD and PFD, is needed, and close collaboration between gynaecologists and haematologists in a specialised tertiary centre should be established in the management of these patients. Accurate and early recognition of bleeding disorders in the adolescent is critical for the management of bleeding complications and optimization of therapy for HMB,” she added.