Ayşe Esra TAPCİ, Serçin TAŞAR, Bulent ALİOGLU, Yıldız DALLAR BİLGE, Nermin DİNDAR BADEM

Menometroraji ile Başvuran Ergen Kızlarda Hemostaz Parametrelerinin Değerlendirilmesi ve Sağlıklı Ergenler ile Karşılaştırılması

Amaç: Bu çalışmada menstrüel kanamasında artış ile başvuran adolesan kızlarda edinsel ve kalıtsal pıhtılaşma varlığının araştırılması ve benzer yaş gruplarından sağlıklı adolesan kızlarla hemostaz testlerinin karşılaştırılması amaçlandı. Yöntem: Çalışmaya hastanemiz çocuk polikliniğine adet kanaması artışı nedeniyle başvuran, akut veya kronik hastalığı olmayan, son 14 gün içinde herhangi bir ilaç kullanmamış 63 adolesan kadın (15.4±1.5 yıl) dahil edildi. Kontrol grubu olarak, çalışma grubu ile benzer yaş ve cinsiyette olarak 74 sağlıklı ergen (15.5±1.5 yıl) alındı. Çalışmaya dahil edilen her olgu için trombosit sayısı, tüm bazal ve ileri pıhtılaşma testleri, trombosit agregasyonu ve sekresyon testleri çalışıldı. Bulgular: Bazal ve ileri pıhtılaşma testleri, trombosit agregasyon ve sekresyon testleri incelendiğinde ağır adet kanaması olan çalışma grubu ile sağlıklı kontrol grubu arasında anlamlı fark bulunmadı. Öte yandan ağır adet kanaması olan çalışma grubumuzda 4 (%6.3) hastada hemostaz bozukluğu (2 tip 1 von Willebrand hastalığı olan hasta, bir hasta immün trombositopenik purpuralı ve bir hastada hafif faktör VIII eksikliği) saptandı. Sonuç: Çalışma ve sağlıklı kontrol grupları arasında hemostaz testleri açısından anlamlı bir fark olmadığı belirtilmelidir. Ancak ağır adet kanaması olan grupta başta von Willebrand hastalığı olmak üzere çeşitli hemostaz bozuklukları saptanabilmektedir

Anahtar Kelimeler:

anomal uterin kanama, koagülasyon bozuklukları, von Willebrand hastalığı

Evaluation of Hemostasis Parameters in Adolescent Girls Presenting with Menometrorrhagia and Comparison with Healthy Adolescents

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.

Keywords:

: Abnormal uterine bleeding, coagulation disorders, von Willebrand disease,

PDF

___

1. Haamid F, Sass AE, Dietrich JE. Heavy Menstrual Bleeding in Adolescents. J Pediatr Adolesc Gynecol 2017; 30:335-340.
2. Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. 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 Gynaecol Obstet. 2018 Dec;143(3):393-408.
3. Chi C, Pollard D, Tuddenham EG, and Kadir RA. Menorrhagia in adolescents with inherited bleeding disorders. Journal of Pediatric and Adolescent Gynecology 2010; 23: 215-222.
4. Hillard PJA. Menstruation in young girls: A clinical perspective. Obstetrics and Gynecology 2002; 99: 655-662.
5. Cromer B. Abnormal Uterine Bleeding. Kliegman R, ed. Nelson Textbook of Pediatrics. 19th edition. Elsevier/Saunders 2011: 688-690.
6. Jayasinghe Y, Moore P, Donath S, Campbell J, Monagle P, and Grover S. Bleeding disorders in teenagers presenting with menorrhagia. Australian and New Zealand Journal of Obstetrics and Gynaecology 2005; 45: 439-443.
7. Pereira J, Quiroga T, and Mezzano D. Laboratory assessment of familial, nonthrombocytopenic mucocutaneous bleeding: A definitive diagnosis is often not possible. Seminars in Thrombosis and Hemostasis 2008; 34: 654-662.
8. Bevan JA, Maloney KW, Hillery CA, Gill JC, Montgomery RR, and Scott JP. Bleeding disorders: A common cause of menorrhagia in adolescents. The Journal of Pediatrics 2001; 138: 856-861.
9. Oral E, Cağdaş A, Gezer A, Kaleli S, Aydin Y, and Öçer F. Hematological abnormalities in adolescent menorrhagia. Archives of Gynecology and Obstetrics 2002; 266: 72-74.
10. Ahuja SP and Hertweck SP. Overview of bleeding disorders in adolescent females with menorrhagia. Journal of Pediatric and Adolescent Gynecology 2010; 23: 15-21.
11. ACOG Committee on Practice Bulletins--American College of Obstetricians Gynecologists. ACOG practice bulletin: Management of anovulatory bleeding. 2001; 72: 263-271.
12. Zia A, Rajpurkar M. Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding. Thromb Res 2016; 143:91-100.
13. 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; 32:122-127.
14. Ellis M and Beyth Y. Abnormal vaginal bleeding in adolescence as the presenting symptom of a bleeding diathesis. Journal of Pediatric and Adolescent Gynecology. 1999; 12: 127-131.
15. Kadir RA, Economides DL, Sabin CA, Owens D and Lee CA. Frequency of inherited bleeding disorders in women with menorrhagia. The Lancet 1998; 351: 485-489.
16. Kılıç SÇ, Sarper N, Zengin E, and Gelen SA. Screening bleeding disorders in adolescents and young women with menorrhagia. Turkish Journal of Hematology 2013; 30: 168.9-11.
17. Rodeghiero F, Castaman G and Dini E. Epidemiological investigation of the prevalence of von Willebrand’s disease. Blood 1987; 69: 454-459.
18. Edlund M, Blombäck M, von Schoultz B, and Andersson O. On the value of menorrhagia as a predictor for coagulation disorders. American Journal of Hematology 1996; 53: 234-238.
19. Halimeh S. Menorrhagia and bleeding disorders in adolescent females. Hämostaseologie 2012; 32:45.
20. James A. Women and bleeding disorders. Haemophilia 2010; 16: 160-167.- Paper R. Gynecological complications in women with bleeding disorders. Treatment of Hemophilia 2004; 5.
21. Saxena R, Gupta M, Gupta P, Kashyap R, Choudhry V, and Bhargava M. Inherited bleeding disorders in Indian women with menorrhagia. Haemophilia 2003; 9: 193-196.