Abstract
Hundreds of adolescents are hospitalized in the United States yearly with anemia due
to heavy menstrual bleeding (HMB). Limited data exist regarding how these patients
are evaluated and how many are diagnosed with a bleeding disorder. The aim of this
study was to determine the prevalence of bleeding disorders in adolescents hospitalized
for HMB. Secondary aims included identification of risk factors for severe anemia
leading to hospitalization and the hematology assessment. This was a retrospective
cohort study of patients aged 9 to 21 years hospitalized for HMB and anemia at a tertiary
care children's hospital from January 1, 2000, to December 31, 2017. A total of 118
girls hospitalized for HMB and anemia were included. Almost 30% of patients were African
American. Hematology involvement did not occur in 42% of patients. Sixty patients
completed bleeding disorder testing and 57% (34/60) were diagnosed with a bleeding
disorder. Most patients diagnosed with von Willebrand disease (VWD) tested while hospitalized
and anemic had VW levels <100%A but 9/25 (36%) girls not evaluated by Hematology also
had VW levels <100%. Despite an established Inpatient Coagulation Consult service,
many adolescents hospitalized with HMB did not receive an appropriate evaluation for
bleeding disorders. African Americans were disproportionately hospitalized for HMB.
VW levels are elevated with HMB and severe anemia, but levels <100 seem to be predictive
of VWD in this setting. Further research is needed to determine optimal timing of
bleeding disorder evaluation, but many adolescents hospitalized for HMB may have an
underlying bleeding disorder.
Keywords
pediatric hemostasis - von Willebrand disease - menorrhagia - hemophilia
