Menorrhagia due to Bernard-Soulier syndrome and its successful treatment by thermal balloon endometrial ablation

Menstrual and obstetrical bleeding in women with inherited platelet receptor defects-A systematic review

Introduction

Women with inherited platelet receptor defects (IPRD) may have an increased risk of heavy menstrual bleeding (HMB) and postpartum haemorrhage (PPH).

Aim

To present a systematic overview of the literature on the prevalence and management of menstrual and obstetrical bleeding in women with IPRD.

Methods

Electronic databases were searched for original patient data on the prevalence and management of HMB and PPH in women with known IPRD or who were being investigated for IPRD.

Results

Sixty‐nine papers (61 case reports/series and 8 cohort studies) were included. Overall, studies were rated as ‘poor quality’. The included cohort studies reported HMB in 25% (13/52) of women with Bernard‐Soulier syndrome and in 22.1% (34/154) of women with Glanzmann thrombasthenia. In total, 164 deliveries in women with IPRD were described. Excessive bleeding occurred in 16.9% (11/65) of deliveries described in the largest cohort. PPH occurred in 63.2% (55/87) of deliveries described in case reports/series. PPH occurred in 73.7% (14/19) of deliveries that were not covered by prophylaxis compared with 54.2% (32/59) of deliveries that were (OR = 2.36, 95% CI 0.75‐7.40). Neonatal bleeding complications were reported in 10.0% (8/80) of deliveries. In all (6/6) deliveries with neonatal bleeding complications wherein the presence of alloantibodies was investigated, either antiplatelet or anti‐HLA antibodies were detected.

Discussion/Conclusion

Menstrual and particularly obstetrical bleeding problems frequently occur in women with IPRD, based on small case reports and series of poor quality. International collaboration, preferably on prospective studies, is needed to improve clinical management of women‐specific bleeding in IPRD.

Bernard Soulier Syndrome: 10 years' experience at a tertiary care hospital

Objective:

To determine clinical manifestations and laboratory findings in patients with BSS diagnosed through platelet aggregometry followed in a tertiary care hospital in Lahore, Pakistan.

Methods:

The retrospective study comprised patients who presented in Hematology and Transfusion Medicine Department of The Children Hospital & Institute of Child Health, Lahore with the relevant diagnosis from 2006 to 2013. The result of all the patients were collected on a predesigned proforma. Medical data was scrutinized to collect age, gender, clinical findings along with results of complete blood count, bleeding time and platelet aggregation studies for the diagnosis of Bernard Soulier Syndrome.

Results:

Among 49 patients, 26 patients were females and 23 males. The mean age of the patients was 5±2.5 years. 81% had a family history of consanguinity. The most common presenting symptom included epistaxis seen in 73.4% patients. Complete blood count demonstrated decreased platelets in 85.7% of patients ranging from 20 X 10⁹/L to 130 X 10⁹/L. Anemia was seen in 67.3% and 93.8% had prolonged bleeding time. Peripheral blood smears demonstrated giant platelets in all patients. The majority of patients 65.3% had mild bleeding episodes. Platelet aggregation studies showed normal aggregation with ADP, Collagen and Epinephrine in 100% of our patients whereas all showed no response of aggregation with Ristocetin.

Conclusion:

Our data is consistent with other reports regarding clinical presentation of BSS, but we report large number of BSS patients from our area, emphasizing significance to provide diagnostic services in Pakistan to find out exact magnitude of disease.

Successful use of balloon ablation to treat menorrhagia complicating aplastic anemia

BACKGROUND

Aplastic anemia (AA) complicated by menorrhagia is treated with transfusion and hormonal therapy. When bleeding is life-threatening, balloon endometrial ablation can safely be used to treat menorrhagia in selected patients.

CASE

A 56-year-old postmenopausal woman was diagnosed with AA after several weeks of menorrhagia and pancytopenia. She became heavily alloimmunized after extensive platelet transfusion. During treatment with antithymocyte globulin, vaginal bleeding increased and the platelet count fell to 1,000/microl on supportive measures. After bleeding stopped with use of intravenous Premarin, she was examined in the operating room. There, a clot was removed and appeared to be a uterine caste; hemostasis continued. Transvaginal ultrasound revealed a normal endometrial contour and thin endometrium; endometrial histology was benign. After she completed antithymocyte globulin and her platelet count could be maintained over 30,000/microl with matched platelets, endometrial ablation was performed without any complications.

CONCLUSION

Thermal balloon endometrial ablation is an effective alternative to hysterectomy for women with persistent menorrhagia and AA when supportive measures fail. Prior to endometrial ablation, evaluation should ensure normal endometrial contour and histology, and that sufficient blood products are available to maintain platelet counts above 30,000/microl during the healing process.

Thermal Balloon Ablation in Patients with Multiple Morbidity: 3-Year Follow-up

STUDY OBJECTIVE

To evaluate the effectiveness of a thermal uterine balloon therapy system in a specific group of patients with multiple morbidity.

DESIGN

Retrospective cohort analysis (Canadian Task Force classification II-2).

SETTING

Department of Obstetrics and Gynecology in two university teaching hospitals.

PATIENTS

Seventy women with severe systemic disease (American Association of Anesthesiologists physical status score >/= III) and severe menorrhagia.

INTERVENTION

Uterine balloon therapy under local anesthesia and 3 years of follow-up.

MEASUREMENTS AND MAIN RESULTS

The women had a mean age of 44.3 years (range, 24-76). After treatment, 25.7% of the patients had no bleeding, 45.7% hypomenorrhea, and 21.4% normal menstrual flow. The procedure was repeated successfully for one patient, and five failures (7.1%) were observed. The blood count values differed significantly (p <.001) before and after balloon therapy.

CONCLUSION

Uterine balloon therapy is a suitable and useful option for women with severe uterine bleeding and concomitant severe systemic nongynecologic disease.