Clinical and laboratory characteristics of adolescents with platelet function disorders and heavy menstrual bleeding

Experimental Hematology & Oncology

James A French²  Nancy Duffy²  William T Gunning¹  Teresa Pfaff-Amesse³  Lawrence S Amesse² 

[1] Department of Pathology, University of Toledo College of Medicine, Dayton, OH, USA;Division of Pediatric Hematology & Oncology, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, OH, USA;Division of Reproductive Endocrinology and Infertility, Department of OB-GYN, Section of Pediatric-Adolescent Gynecology, Wright State University Boonshoft School of Medicine, Dayton, OH, USA

关键词: δ-Storage Pool Deficiency (δ-SPD);    Menorrhagia;    Heavy menstrual bleeding;    Adolescents;    Platelet function disorders;   

Others  :  812563
DOI  :  10.1186/2162-3619-2-3

 received in 2012-11-26, accepted in 2013-01-19,  发布年份 2013

【 摘 要 】

Background

Platelet function disorders (PFDs) have emerged as an important etiology of heavy menstrual bleeding (HMB) in adolescents. However, neither clinical nor laboratory data have been methodically analyzed in this population subset. The objective of this study was to evaluate these parameters in order to distinguish characteristics of the disorder that in turn will lead to earlier diagnosis and therapy initiation.

Methods

Retrospective review of medical records from postmenarcheal adolescents with documented PFDs referred to a hemophilia treatment center and university faculty practices for bleeding diatheses with their clinical and laboratory data evaluated.

Results

Of 63 teens with documented PFDs, HMB was the most common clinical manifestation of PFD (43; 68.3%). Of these, 37 (86%) were diagnosed with PFD either at or after menarche with the diagnosis based on HMB symptoms alone. Only 6 (14%) were diagnosed with a PFD prior to menarche, based on associated bleeding, i.e., epistaxis, ecchymosis, and all developed HMB after menstruation onset. Interestingly, 20 girls were diagnosed with a PFD prior to menarche and of these, only 6 (30%) went on to develop HMB after pubertal transition, while the majority (14; 70%) did not. The average age-at-PFD diagnosis was 14.5yrs, significantly differing from the 10.9yrs average age-at-PFD diagnosis in their counterparts that, after menarche, did not develop HMB (P<.01) Blood type O occurred significantly more frequently (76%) than national norms (P <.037). Incidence of δ-Storage Pool deficiency (δ-SPD) was significantly higher (74%) than their non-HMB cohorts (45%) (P <.007). Coagulation and von Willebrand factor studies were all normal. Abnormal closure times and aggregation studies were observed in 42% and 60%, respectively, of tested girls. In 25.6% for whom standard platelet studies were normal, electron microscopy detected reduced platelet δ-granules numbers (δ-SPD).

Conclusions

Adolescents with PFDs and HMB appear to be clinically distinct from their non-HMB counterparts. This group of girls is characterized by HMB the major bleeding symptom, significantly high incidences of blood group O and the δ-SPD with a PFD diagnosed well after menarche. High false negative standard platelet function study results indicate additional diagnostic strategies, particularly for δ-SPD, should be considered.

【 授权许可】

   
2013 Amesse et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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