A total of 105 patients comprised our population during this study period (Table 1). Patients included females Selleck RG-7204 aged 8–12 years (17%), 13–15 years (46%) and 16–18 years (37%). The referral catchment of the clinic was large, with 44% of patients residing within the same county as the clinic (Franklin County, OH, USA), 28% in contiguous counties and 28% in non-contiguous counties. Thirty-one patients (39%) were referred by paediatricians, 27 (34%) by family physicians
and 18 (23%) by gynaecologists. Sixty-two per cent of patients seen at our clinic were diagnosed with a bleeding disorder, including PSPD (36%), vWD (9%), other platelet function defect (PFD, 8%), Ehlers-Danlos syndrome (EDS, 7%) and combined bleeding BAY 80-6946 cell line disorders (2%). The combined bleeding
disorder patients included one patient with vWD and PSPD and another patient with EDS and PSPD. Overall, 65/105 (62%) of patients were evaluated with platelet EM. Of the patients with an eventual diagnosis of PSPD by EM, the average level of delta granules per platelet was 2.7 with a standard deviation of 0.7. Regardless of the underlying cause for HMB, overall, patients reported considerable impairment. Sixty-three (60%) patients reported periods lasting greater than 7 days and 59 (56%) reported using more than one form of protection (such as use of two pads or a pad and tampon) at the same time. Nearly half of all patients (48%) missed school while menstruating. More than one-third of females (37%) had iron deficiency anaemia. Using a modified Ruta Menorrhagia Severity Scale, comparison of the bleeding profiles for females with and without a disorder of haemostasis revealed only three factors that were significantly different (Table 2), including the patient’s perceived regularity of her periods (P = 0.02), description of period flow (P = 0.04) and the number of days
of each period that the bleeding was ‘heavy’ (P = 0.007). Young women with bleeding disorders were more likely to report these ‘irregular’ menstrual cycles, more likely to describe their menses as ‘heavy’ or ‘very heavy’ and more likely to report ≥4 days of heavy bleeding with each cycle. All other bleeding symptoms evaluated on the questionnaire were similar between the two populations. The main treatment modality for patients presenting with HMB was hormonal therapy (70%), typically a combined oestrogen-progestin oral contraceptive pill. Patients diagnosed with vWD, platelet function defects or Ehlers-Danlos syndrome all underwent formal DDAVP challenges and haemostatic therapies, such as DDAVP and/or tranexamic acid, were utilized in 51% of total cases. Our institutional experience demonstrates that the frequency of undiagnosed bleeding disorders, specifically platelet function defects, is substantial among adolescents presenting with HMB.