Platelet Disorders Douglas Triplett
Genesio Murano, Rodger L. Bick in Basic Concepts of Hemostasis and Thrombosis, 2019
von Willebrand’s syndrome represents a heterogenous group of patients — genetically, pathophysiologically, and clinically.35 Following von Willebrand’s original description, it quickly became apparent that the frequency of this disorder was greater than that of classic hemophilia A. The clinical picture is dominated by cutaneous and mucosal bleeding, although in the severely affected patients hemarthroses and dissecting intramuscular hematomas may develop.36 Serious hemorrhages due to traumatic injuries or following surgical procedures represent a significant hazard in many patients.37 Early in life, epistaxis is the most common symptom. Bleeding from the gums is also prominent, and shedding of deciduous teeth is often accompanied by troublesome bleeding. Menorrhagia occurs regularly and occasionally patients may have severe post partum hemorrhage, which may be fatal. Gastrointestinal bleeding and hematuria have also been described. Recently, an association between von Willebrand’s syndrome and hereditary hemorrhagic telangiectasia has been emphasized.38 In these patients, gastrointestinal hemorrhage is a prominent clinical feature.
Menstrual Periods, Heavy and/or Irregular (Menorrhagia/Metrorrhagia)
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Heavy menstrual bleeding is a subjective symptom which hampers a woman’s physical, emotional, social, and material quality of life. Any treatment should aim to improve quality of life. The menstrual loss consists of blood, but can include other tissue and secretions. Objectively, periods are considered to be heavy if there is more than 80 mL blood loss per month, which will result in iron-deficiency anaemia. The diagnosis of heavy menstrual bleeding is of necessity a self-diagnosis, although even mild anaemia (haemoglobin <12 g) is a good indication of the severity. Sleep disturbance, clots, and flooding all provide some indication that menstruation is excessive. Heavy bleeding is the second most common cause for hospital referrals, and up to one-third of women may consult their primary care physician about this symptom.
Menstrual disorders and blood dyscrasias in adolescents
Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo in Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Management of heavy menstrual bleeding in the setting of a bleeding disorder can include both hormonal (i.e., combined therapies or progestin-only therapies) and nonhormonal treatment (i.e., aminocaproic acid or tranexamic acid weight-based), with many patients requiring dual therapy (Table 14.4).3,4 Optimal outcomes are achieved when patients are treated in a multidisciplinary setting with both a hematologist and clinician with adolescent gynecology expertise.21 In patients who have a known bleeding disorder prior to menarche, it is important to have an action plan in place for when their first menses occur to prevent significant anemia and potential hospitalization.22
Ultrasound assessment of uterine morphology in menorrhagia: case control study
Published in Journal of Obstetrics and Gynaecology, 2020
Menorrhagia is defined as abnormally heavy or prolonged menstrual bleeding affecting a woman’s quality of life. Previously, Chen et al. (2015) defined menorrhagia as total menstrual blood loss (MBL) exceeding 80 mL per cycle or menses lasting longer than 7 days. This definition represents clinically significant increased MBL greater than two standard deviations above average. Its application, however, is impractical outside of a research setting and has been largely superseded by the former. Deuholm et al. (2001) and George and Bourne (2003) both stated that about 30% of women describe heavy menstruation; however, subjective assessment of menstrual blood loss according to studies performed by Sheil and Turner (1996) and Deuholm et al. (2001) does not always correlate with clinically-measured blood loss volumes.
Reframing “The Patient's Best Interest”: The Burden of The Caregiver
Published in The American Journal of Bioethics, 2018
Rebecca Lunstroth, Rhashedah Ekeoduru
Menorrhagia, or heavy menstrual bleeding, can occur due to hormone imbalance, ovarian dysfunction, uterine fibroids, polyps, adenomyosis, an intrauterine device (IUD), cancer, bleeding disorders, medications (anti-inflammatory medications, blood thinners, etc.), and other medical conditions. Menorrhagia can cause severe blood loss, resulting in symptomatic or asymptomatic anemia. It can also cause severe pain. Based on the reports from her mother and the primary care physician (PCP), Julia has a moderate degree of menorrhagia and therefore would not be an immediate surgical candidate. If first (nonsurgical anti-inflammatory drugs [NSAIDs] etc.), second (tranexamic acid, oral contraceptives), and third (hormonal intrauterine device [IUD]) line therapies fail, then surgery can be considered. Standard of care dictates that childbearing is complete and/or there are no future plans to become pregnant. The decision to undertake surgical correction must be accompanied by comprehensive informed consent regarding the surgical risks and benefits and the potential severity of adverse outcomes (Apgar et al. 2007).
A comparison of the pregnancy outcomes between ultrasound-guided high-intensity focused ultrasound ablation and laparoscopic myomectomy for uterine fibroids: a comparative study
Published in International Journal of Hyperthermia, 2020
Guangping Wu, Rong Li, Min He, Yuanfang Pu, Jishu Wang, Jinyun Chen, Hongbo Qi
Inclusion criteria were as follows: (1) women who desire fertility or a pregnancy plan; (2) women who have a regular sexual life and do not use contraception postoperatively; (3) women with symptomatic fibroids confirmed by an imaging examination and with any of the following indications for intervention: (a) enlarged uterus (uterine volume equal to or larger than that at 10 week’s gestation); (b) menorrhagia and/or secondary anemia; (c) pelvic pain, frequent urination, or constipation; (4) women who had fewer than three fibroids with an individual diameter larger than 2 cm, as visualized by pelvic ultrasonography; and (5) women who chose to be treated with USgHIFU ablation and had fibroids clearly detected by ultrasonography. For patients with abdominal surgical scars, the range of the blurred image caused by acoustic attenuation should be <10 mm.
Related Knowledge Centers
- Danazol
- Menstruation
- Cancer
- Anovulation
- Abnormal Uterine Bleeding
- Hypothyroidism
- Reproductive System
- Oral Contraceptive Pill
- Tranexamic Acid
- Hormonal Intrauterine Device