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Bleeding disorders in heavy menstrual bleeding
family history of bleeding symptoms or established BD was present in 21% and 6.5%, respectively. Family histo- ry of gynecologic or obstetric bleeding was present in 60%: 57% (n=114) with HMB alone; 1.5% (n=3) with HMB and post-partum hemorrhage (PPH) (n=3), and 1.5% (n=3) had only PPH. Of the first-degree relatives with HMB, 38% underwent hysterectomy for HMB (n=44) and 2% underwent endometrial ablation (n=2) to control HMB. Thirty-six percent (n=72) had iron deficiency ane- mia, 29% (n=57) had iron deficiency alone, and overall iron deficiency was documented in 65% (n=129). Participants with anovulatory HMB had a higher BMI (66.7% vs. 36%) and increased frequency of refractory HMB (34% vs. 19%), ED visits (42 % vs. 25%), hospital- izations (28% vs. 17%), and pRBC (24% vs. 14%) admin-
istration for HMB compared to those with ovulatory pat- tern bleeding.
Frequency and types of bleeding disorders and additional bleeding symptoms
Overall, 33% (n=67) of adolescents were diagnosed with a BD. Among those with BD, there were no differ- ences in the frequency of BD in the anovulatory and the ovulatory HMB groups (31% vs. 36%; P=0.45). Low vWF levels were detected in 57% (n=38 of 67); 25% (n=17 of 67) were diagnosed with vWD (type 1=13, type 2=4), 13.5% (n=9 of 67) with QPD, and two participants were found to have coagulation factor deficiencies (one with mild FVIII deficiency (FVIII:C= 29%) and mild FXIII defi- ciency (FXIII: 40%). One participant, referred for HMB
Table 1. Baseline characteristics of the entire study cohort and according to menstrual bleeding pattern.
All patients Anovulatory HMB Ovulatory HMB (N=200) (N=100) (N=100)
n(%) n(%) n(%)
Age, y Ethnicity
Hispanic
Non-Hispanic
Race
White Black Other
BMI, kg/m2
Normal weight Overweight/Obese
Age at menarche, y
Years since menarche
Time to HMB, y
Age at first bleed
Refractory HMB$ Presentation to ED for HMB@
≥ 2 visits
Hospitalizations for HMB
pRBC
Parenteral Iron
PBAC at study entry*#
ISTH-BAT*
FMH of bleeding or BD
FMH of gynecologic or obstetric bleeding Hypermobility
Hemoglobin, g/L
Ferritin, ng/mL
TSH, mIU/L
BD diagnosis
15 (10-19)
56 (28) 144 (72)
131 (65)
41 (20·5)
28 (14)
23·3 (14·5-55)
110 (55)
90 (45)
12 (9-15)
3 (1-4)
0·5 (0-5)
12 (2-17)
53 (26·5)
67 (33.5)
47 (23.5)
19 (9·5)
45 (22·5)
38 (84)
76 (38)
386 (243)
3.5 (1·3)
55 (27·5)
120 (60)
20(20)
11·8 (3·4-16·4)
8 (0·9-78)
1·5 (1·2-8·4)
67(33)
14 (10-18)
33 (33) 67 (67)
70 (70) 13 (13) 17 (17) 24·4 (17-55) 45 (45)
55 (55)
12 (9-15)
3 (1-4)
0·5 (0-5) 12 (2-16) 34 (34)
42 (42)
26 (26)
15 (15)
28 (28)
24 (86)
36 (36) 427 (274) 3.4 (1·3) 28 (28)
55 (55) 9(23) 11·7 (3·9-15) 10·2 (0·9 – 70) 1·7 (0·5-8·4) 31(31)
15 (11-19)
23 (23) 77(77)
61(61)
28 (28)
11 (11) 22·9 (14·5-44) 65 (65)
35 (35)
12 (9-15)
3 (1-4) 0·4 (0-5) 12 (2-17) 19 (19)
25 (25)
21 (21)
4 (4)
17 (17)
14 (82)
40 (40) 345 (201) 3.5 (1·3) 27 (27)
65 (65) 11(17) 11·8 (3·4-16·4) 7·2 (1-98) 1·4 (1·2-5·1) 36(36)
≤ 1 visit
Values are medians with interquartile ranges except normally distributed variables marked with an asterisk; mean and standard deviations are reported. BMI: body mass index; ED: emergency department; HMB: heavy menstrual bleeding; ISTH-BAT: International Society of Thrombosis Haemostasis-Bleeding Assessment Tool; pRBC: packed red blood cells; PBAC: pictorial blood assessment chart;TSH: thyroid-stimulating hormone; y: years. Statistically significant differences between the anovulatory and ovulatory groups were found for refractory HMB,presentation to ED and PBAC @ # $P=0.01.
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