Yang Huadi, Xu Xuqun, Jiang Xuelu, Yao Zhitao
Department of Gynecology and Obstetrics, Zhejiang Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2019 Apr;98(17):e15156. doi: 10.1097/MD.0000000000015156.
In women, menorrhagia associated with aplastic anemia (AA) is secondary to thrombocytopenia and can be acute and severe. Endometrial ablation or hysterectomy has been reported to achieve beneficial results. However, serious limitations and long-term complications exist. We report this clinical case series with the aim of sharing our experiences and exploring a safe and effective way to treat abnormal uterine bleeding (AUB) AA women with future fertility desire.
The 3 young patients aged 25 to 29 years old suffered from AUB secondary to AA.
They were diagnosed with AA by bone marrow biopsy and presented with symptoms and signs of AUB without other identified causations.
When the platelet count was between 3010 /L∼5010 /L after a blood transfusion, each patient received a hysteroscopic resection of endometrial functional layer and was fitted a levonorgestrel-releasing intra-uterine system (LNG-IUS) in uterine cavity following the surgery.
All the patients recovered without incident and were discharged in clinically stable conditions.
In conclusion, AUB secondary to AA can be acute and severe. Hemostasis is more difficult due to progressive pancytopenia. For young women with future fertility desire, LNG-IUS following hysteroscopic resection of endometrial functional layer is a safe and effective way against endometrial ablation or hysterectomy.
在女性中，再生障碍性贫血（AA）相关的月经过多继发于血小板减少症，可能是急性且严重的。据报道，子宫内膜切除术或子宫切除术可取得有益效果。然而，存在严重的局限性和长期并发症。我们报告这个临床病例系列，旨在分享我们的经验，并探索一种安全有效的方法来治疗有生育意愿的AA女性的异常子宫出血（AUB）。
3名年龄在25至29岁的年轻患者患有继发于AA的AUB。
她们通过骨髓活检被诊断为AA，并出现AUB的症状和体征，且无其他明确病因。
输血后血小板计数在30×10⁹/L至50×10⁹/L之间时，每位患者接受了宫腔镜下子宫内膜功能层切除术，并在术后在宫腔内放置了左炔诺孕酮宫内节育系统（LNG-IUS）。
所有患者均顺利康复，出院时临床状况稳定。
总之，继发于AA的AUB可能是急性且严重的。由于进行性全血细胞减少，止血更加困难。对于有生育意愿的年轻女性，宫腔镜下子宫内膜功能层切除术后放置LNG-IUS是一种安全有效的替代子宫内膜切除术或子宫切除术的方法。
