O'Brien Brooke, Mason Jane, Kimble Rebecca
Statewide Paediatric and Adolescent Gynaecology Service, Royal Brisbane and Women's Hospital and Lady Cilento Children's Hospital, Brisbane, Queensland, Australia; University of Queensland, Faculty of Medicine, Brisbane, Queensland, Australia.
Queensland Haemophilia Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
J Pediatr Adolesc Gynecol. 2019 Apr;32(2):122-127. doi: 10.1016/j.jpag.2018.11.005. Epub 2018 Nov 22.
Heavy menstrual bleeding (HMB) is a common gynecological complaint among young women with up to 40% having experienced HMB. Bleeding disorders are increasingly being recognized in adolescents and young adults with HMB. The aim of this study was to determine the prevalence of bleeding disorders in adolescents with HMB, among patients who presented to the Queensland Statewide Paediatric and Adolescent Gynaecology Service between July 2007 and July 2017. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The study was a retrospective review of 124 female adolescents aged 8 to 18 years with HMB who presented to the Queensland Paediatric and Adolescent Gynaecology Service, Brisbane, Australia. The primary outcome measure was diagnosis of a bleeding disorder, with secondary outcomes including iron deficiency and/or anemia and treatment modalities.
Screening for bleeding disorders was performed in 77/124 (62.1%) of patients with HMB. Twenty-seven adolescents were diagnosed with a bleeding disorder, giving a prevalence of 27/124 (21.7%) in those with HMB, and 27/77 (35%) with HMB who were screened. Of these 35%, von Willebrand disease was the most common bleeding disorder, found in 14/27 (51.6%), followed by inherited platelet function disorders diagnosed in 9/27 (33.3%), thrombocytopenia (inherited or acquired) in 3/27 (11.1%), and Factor IX deficiency in 1/27 (3.7%). Iron deficiency and/or anemia was diagnosed in 53/107 (49.5%) of patients with HMB who were screened for this, and 19/27 (70.3%) of those diagnosed with a bleeding disorder.
Adolescents with HMB who present to a tertiary pediatric and adolescent gynecology service should be screened for bleeding disorders, because of the considerably high prevalence in this at-risk population.
月经过多（HMB）是年轻女性常见的妇科问题，高达40%的女性曾经历过月经过多。出血性疾病在患有月经过多的青少年和年轻成年人中越来越受到重视。本研究的目的是确定2007年7月至2017年7月期间就诊于昆士兰州全州儿科和青少年妇科服务机构的患有月经过多的青少年中出血性疾病的患病率。设计、设置、参与者、干预措施及主要结局指标：本研究是对124名年龄在8至18岁、患有月经过多且就诊于澳大利亚布里斯班昆士兰儿科和青少年妇科服务机构的女性青少年进行的回顾性研究。主要结局指标是出血性疾病的诊断，次要结局包括缺铁和/或贫血以及治疗方式。
对124例月经过多患者中的77例（62.1%）进行了出血性疾病筛查。27名青少年被诊断患有出血性疾病，在患有月经过多的患者中患病率为27/124（21.7%），在接受筛查的月经过多患者中为27/77（35%）。在这35%中 von Willebrand病是最常见的出血性疾病，在14/27（51.6%）中发现，其次是遗传性血小板功能障碍，在9/27（33.3%）中诊断出，血小板减少症（遗传性或获得性）在3/27（11.1%）中，以及因子IX缺乏症在1/27（3.7%）中。对接受该检查的月经过多患者中的53/107（49.5%）以及被诊断患有出血性疾病的患者中的19/27（70.3%）诊断出缺铁和/或贫血。
由于在这一高危人群中患病率相当高，因此就诊于三级儿科和青少年妇科服务机构的患有月经过多的青少年应接受出血性疾病筛查。
