Adölesanlarda Anormal Uterin Kanamaya Hematolog Gözüyle Yaklaşım
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Original Article
P: 92-97
April 2023

Adölesanlarda Anormal Uterin Kanamaya Hematolog Gözüyle Yaklaşım

J Curr Pediatr 2023;21(1):92-97
1. Gazi Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Hematoloji ve Onkoloji Bilim Dalı, Ankara, Türkiye
2. Afyonkarahisar Sağlık Bilimleri Üniversitesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Pediatri Bilim Dalı, Afyonkarahisar, Türkiye
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Received Date: 06.11.2022
Accepted Date: 02.03.2023
Publish Date: 14.04.2023
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ABSTRACT

Introduction:

Abnormal uterine bleeding (AUK) is a term used for changes in menstrual bleeding pattern, duration, or amount. In adolescent girls, it is associated with the immature hypothalamo-pituitary-ovarian axis, bleeding disorders, infections, endocrine disorders, systemic diseases, vagina-cervix-uterus and problems related to the ovary and drugs. There are different approaches between different disciplines in this assessment. In our study, we aimed to share our results and contribute to the hematological approach to these cases by retrospectively evaluating the abnormal uterine bleeding examination and treated cases in Afyon Health Sciences University Department of Pediatric Hematology.

Materials and Methods:

Between July 2016 and September 2019, patients over 12 years admitted to the Afyonkarahisar University of Health Sciences Department of Pediatric Hematology who had hemoglobin value <12 grams/dL and 60-80 mL bleeding in normal menstrual period (3-6 pads/day or 10-15 pads/cycle), menstrual cycle lasting longer than 8 days, and menstrual cycle repeated more than 21-28 days were included in the study and their records were analyzed retrospectively. The demographic features, admittion complaints, consultations, treatments applied and the results were documented and evaluated.

Results:

A total of 39 subjects were enrolled in the study. The mean age of the patients was 16.2±1.5 (13.2-21.5), the mean age at menarche was 12.4±1.1 (8-14). Hb <8 g/dL in 53.8% (n=21) of patients, hb 8-10 g/dL in 23% (n=9) and 10-12 g/dL in 23% (n=9) and von Willebrand Type 1 was detected in one patient.

Conclusion:

Abnormal uterine bleeding is an important cause of anemia in adolescent girls. It is necessary to conduct investigations for etiology and bleeding disorders especially von Willebrand disease, in differential diagnosis. The communication of different disciplines and the knowledge of other disciplines about the approach to the subject for effective treatment of abnormal uterine bleeding plays an important role in decreasing hospital admissions and increasing the success of treatment.

References

1
Munro MG, Critchley HO, Fraser IS, Committee FMD, Haththotuwa R, Kriplani A, et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynecol Obstet 2018;143:393-408.
2
Esen İ, Oğuz B, Serin HM. Menstrual characteristics of pubertal girls: a questionnaire-based study in Turkey. J Clin Res Pediatr Endocrinol 2016;8:192-6.
3
Deligeoroglou E, Karountzos V, Creatsas G. Abnormal uterine bleeding and dysfunctional uterine bleeding in pediatric and adolescent gynecology. Gynecol Endocrinol 2013;29:74-8.
4
LaCour DE, Long DN, Perlman SE. Dysfunctional uterine bleeding in adolescent females associated with endocrine causes and medical conditions. J Pediatr Adolesc Gynecol 2010;23:62-70.
5
Strickland J, Gibson EJ, Levine SB. Dysfunctional uterine bleeding in adolescents. J Pediatr Adolesc Gynecol 2006;19:49-51.
6
Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health 2013;1:e16-25.
7
Camaschella C. Iron deficiency. Blood 2019;133:30-9.
8
Knol HM, Mulder AB, Bogchelman DH, Kluin-Nelemans HC, van der Zee AG, Meijer K. The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities. Am J Obstet Gynecol 2013;209:202.e1-7.
9
Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency anemia in low-and middle-income countries. Blood 2013;121:2607-17.
10
Munro MG; FIGO Committee on Menstrual Disorders. Abnormal uterine bleeding: A well-travelled path to iron deficiency and anemia. Int J Gynecol Obstet 2020;150:275-7.
11
Shankar M, Lee CA, Sabin CA, Economides DL, Kadir RA. von Willebrand disease in women with menorrhagia: a systematic review. BJOG 2004;111:734-40.
12
Dilley A, Drews C, Miller C, Lally C, Austin H, Ramaswamy D, et al. von Willebrand disease and other inherited bleeding disorders in women with diagnosed menorrhagia. Obstet Gynecol 2001;97:630-6.
13
Munro MG, Lukes AS, Abnormal Uterine Bleeding and Underlying Hemostatic Disorders Consensus Group. Abnormal uterine bleeding and underlying hemostatic disorders: report of a consensus process. Fertil Steril 2005;84:1335-7.
14
Kanbur NO, Derman O, Kutluk T, Gürgey A. Coagulation disorders as the cause of menorrhagia in adolescents. Int J Adolesc Med Health 2004;16:183-5.
15
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;32:122-7.
16
Kulp JL, Mwangi CN, Loveless M. Screening for coagulation disorders in adolescents with abnormal uterine bleeding. J Pediatr Adolesc Gynecol 2008;21:27-30.
17
Miller C, Philipp C, Stein S, Kouides P, Lukes A, Heit J, et al. The spectrum of haemostatic characteristics of women with unexplained menorrhagia. Haemophilia 2011;17:e223-9.
18
Slap GB. Menstrual disorders in adolescence. Best Pract Res Clin Obstet Gynaecol 2003;17:75-92.
19
Kostopoulou E, Anagnostis P, Bosdou JK, Spiliotis BE, Goulis DG. Polycystic ovary syndrome in adolescents: pitfalls in diagnosis and management. Curr Obes Rep 2020;9:193-203.
20
Attia AH, Youssef D, Hassan N, El-Meligui M, Kamal M, Al-Inany H. Subclinical hyperthyroidism as a potential factor for dysfunctional uterine bleeding. Gynecol Endocrinol 2007;23:65-8.
21
Fraser IS, McCarron G. Randomized trial of 2 hormonal and 2 prostaglandin-inhibiting agents in women with a complaint of menorrhagia. Aust N Z J Obstet Gynaecol 1991;31:66-70.
22
Lethaby A, Wise MR, Weterings MA, Rodriguez MB, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev 2019;2:CD000154.