Bleeding disorders in teenagers presenting with menorrhagia
Jayasinghe, Y.; Moore, P.; Donath, S.; Campbell, J.; Monagle, P.; Grover, S.
Australian and New Zealand Journal of Obstetrics and Gynaecology 45(5): 439-443
2005
ISSN/ISBN: 0004-8666 PMID: 16171484 DOI: 10.1111/j.1479-828x.2005.00470.xDocument Number: 265871
To assess the prevalence of bleeding disorders and establish the clinical variables that are predictive of a bleeding disorder in adolescent women. A retrospective audit of all patients who had coagulation tests following presentation with menorrhagia. Inpatient and outpatients of a tertiary adolescent gynaecology service. Subjects aged 9-19 years with menorrhagia who had coagulation tests performed, and who did not have a known bleeding disorder prior to presentation were included. A bleeding screen was performed to assess prevalence of bleeding disorders in the population. Variables that were investigated as predictive of a bleeding disorder included clinical history, family history, and haematological indices of blood loss. The prevalence of an inherited bleeding disorder was 10.4%. The only statistically significant predictor was a family history of bruising and bleeding. Menstrual history was not predictive. Severity of menstrual loss was not predictive of a bleeding disorder, as a significant cause of teenage metrostaxis is due to anovulatory dysfunctional uterine bleeding. The authors recommend that a careful personal and family history of bruising and bleeding be taken in all teenagers who present de novo with menorrhagia. Routine screening in a primary care setting is impractical, but should be mandatory in all patients with a positive family history.