Skip to main content
SpringerLink
Log in

Management of Abnormal Bleeding in the Adolescent

  • Reference work entry
  • First Online:
Handbook of Gynecology

  • 416 Accesses

Abstract

Heavy menstrual bleeding is the most common sign of an acquired or inherited bleeding disorder in females. For many young women, the manifestations of an inherited bleeding disorder do not surface until menarche, which can lead to a delay in diagnosis. Besides heavy menstrual bleeding, patients can have menstrual pain from bleeding into the corpus luteum, bleeding from trauma or procedures, easy bruising, and gastrointestinal bleeding. An undiagnosed bleeding disorder can lead to severe blood loss, chronic iron deficiency, and unnecessary surgical procedures, such as a hysterectomy. Therefore, identifying a possible bleeding disorder in these young women is crucial to allow an initiation of targeted therapy. Management of bleeding will depend on the diagnosis, as well as the severity and bleeding location. Many adolescent females with menorrhagia can be successfully managed with a combination of hormonal control and/or antifibrinolytics. Depending on the diagnosis, treatment can also include coagulation factor replacement, blood product transfusion, as well as specific therapies for acquired bleeding disorders, such as intravenous immune globulin, plasmapheresis, or corticosteroids.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 999.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 999.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Acharya SS, Dimichele DM. Rare inherited disorders of fibrinogen. Haemophilia. 2008;14(6):1151–8.

    Article  CAS  PubMed  Google Scholar 

  • Acharya SS, Coughlin A, Dimichele DM. G. North American rare bleeding disorder study. Rare bleeding disorder registry: deficiencies of factors II, V, VII, X, XIII, fibrinogen and dysfibrinogenemias. J Thromb Haemost. 2004;2(2):248–56.

    Article  CAS  PubMed  Google Scholar 

  • Blanchette VS, Key NS, Ljung LR, Manco-Johnson MJ, van den Berg HM, Srivastava A. F. I. X. Subcommittee on factor Viii, S. rare coagulation disorders of the, T. Standardization Committee of the International Society on and hemostasis. Definitions in hemophilia: communication from the SSC of the ISTH. J Thromb Haemost. 2014;12(11):1935–9.

    Article  CAS  PubMed  Google Scholar 

  • British Committee for Standards in Haematology General Haematology Task, F. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol. 2003;120(4):574–96.

    Article  Google Scholar 

  • Cooper N, Bussel J. The pathogenesis of immune thrombocytopaenic purpura. Br J Haematol. 2006;133(4):364–74.

    Article  CAS  PubMed  Google Scholar 

  • Crawley JT, Zanardelli S, Chion CK, Lane DA. The central role of thrombin in hemostasis. J Thromb Haemost. 2007;5(Suppl 1):95–101.

    Article  CAS  PubMed  Google Scholar 

  • Dhawan A. Acute liver failure in children and adolescents. Clin Res Hepatol Gastroenterol. 2012;36(3):278–83.

    Article  PubMed  Google Scholar 

  • Escolar G, Diaz-Ricart M, Cases A. Uremic platelet dysfunction: past and present. Curr Hematol Rep. 2005;4(5):359–67.

    CAS  PubMed  Google Scholar 

  • Fujikawa K, Suzuki H, McMullen B, Chung D. Purification of human von Willebrand factor-cleaving protease and its identification as a new member of the metalloproteinase family. Blood. 2001;98(6):1662–6.

    Article  CAS  PubMed  Google Scholar 

  • Gale AJ. Continuing education course #2: current understanding of hemostasis. Toxicol Pathol. 2011;39(1):273–80.

    Article  PubMed  Google Scholar 

  • Halimeh S, Rott H, Kappert G. PBAC score: an easy-to-use tool to predict coagulation disorders in women with idiopathic heavy menstrual bleeding. Haemophilia. 2016;22(3):e217–20.

    Article  CAS  PubMed  Google Scholar 

  • Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol. 1990;97(8):734–9.

    Article  CAS  PubMed  Google Scholar 

  • Israels SJ, El-Ekiaby M, Quiroga T, Mezzano D. Inherited disorders of platelet function and challenges to diagnosis of mucocutaneous bleeding. Haemophilia. 2010;16(Suppl 5):152–9.

    Article  CAS  PubMed  Google Scholar 

  • Israels SJ, Kahr WH, Blanchette VS, Luban NL, Rivard GE, Rand ML. Platelet disorders in children: a diagnostic approach. Pediatr Blood Cancer. 2011;56(6):975–83.

    Article  PubMed  Google Scholar 

  • James AH. Women and bleeding disorders. Haemophilia. 2010;16(Suppl 5):160–7.

    Article  PubMed  Google Scholar 

  • James AH, Ragni MV, Picozzi VJ. Bleeding disorders in premenopausal women: (another) public health crisis for hematology? Hematol Am Soc Hematol Educ Program. 2006;2006:474–85.

    Article  Google Scholar 

  • Kadir RA, Economides DL, Sabin CA, Owens D, Lee CA. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet. 1998;351(9101):485–9.

    Article  CAS  PubMed  Google Scholar 

  • Kaw D, Malhotra D. Platelet dysfunction and end-stage renal disease. Semin Dial. 2006;19(4):317–22.

    Article  PubMed  Google Scholar 

  • Khamees D, Klima J, O’Brien SH. Population screening for von Willebrand disease in adolescents with heavy menstrual bleeding. J Pediatr. 2015;166(1):195–7.

    Article  PubMed  Google Scholar 

  • Kirtava A, Crudder S, Dilley A, Lally C, Evatt B. Trends in clinical management of women with von Willebrand disease: a survey of 75 women enrolled in haemophilia treatment centres in the United States. Haemophilia. 2004;10(2):158–61.

    Article  CAS  PubMed  Google Scholar 

  • Knol HM, Kemperman RF, Kluin-Nelemans HC, Mulder AB, Meijer K. Haemostatic variables during normal menstrual cycle. A systematic review. Thromb Haemost. 2012;107(1):22–9.

    Article  CAS  PubMed  Google Scholar 

  • Konkle BA. Acquired disorders of platelet function. Hematol Am Soc Hematol Educ Program. 2011;2011:391–6.

    Article  Google Scholar 

  • Kouides PA. Bleeding symptom assessment and hemostasis evaluation of menorrhagia. Curr Opin Hematol. 2008;15(5):465–72.

    Article  PubMed  Google Scholar 

  • Levy GG, Nichols WC, Lian EC, Foroud T, McClintick JN, McGee BM, Yang AY, Siemieniak DR, Stark KR, Gruppo R, Sarode R, Shurin SB, Chandrasekaran V, Stabler SP, Sabio H, Bouhassira EE, Upshaw JD Jr, Ginsburg D, Tsai HM. Mutations in a member of the ADAMTS gene family cause thrombotic thrombocytopenic purpura. Nature. 2001;413(6855):488–94.

    Article  CAS  PubMed  Google Scholar 

  • Mariani G, Bernardi F. Factor VII deficiency. Semin Thromb Hemost. 2009;35(4):400–6.

    Article  PubMed  Google Scholar 

  • Mills HL, Abdel-Baki MS, Teruya J, Dietrich JE, Shah MD, Mahoney D Jr, Yee DL, Srivaths LV. Platelet function defects in adolescents with heavy menstrual bleeding. Haemophilia. 2014;20(2):249–54.

    Article  CAS  PubMed  Google Scholar 

  • O’Brien SH. Common management issues in pediatric patients with mild bleeding disorders. Semin Thromb Hemost. 2012;38(7):720–6.

    Article  PubMed  Google Scholar 

  • Pai M, Hayward CP. Diagnostic assessment of platelet disorders: what are the challenges to standardization? Semin Thromb Hemost. 2009;35(2):131–8.

    Article  CAS  PubMed  Google Scholar 

  • Palla R, Peyvandi F, Shapiro AD. Rare bleeding disorders: diagnosis and treatment. Blood. 2015;125(13):2052–61.

    Article  CAS  PubMed  Google Scholar 

  • Peake IR, Lillicrap DP, Boulyjenkov V, Briet E, Chan V, Ginter EK, Kraus EM, Ljung R, Mannucci PM, Nicolaides K, et al. Haemophilia: strategies for carrier detection and prenatal diagnosis. Bull World Health Organ. 1993;71(3–4):429–58.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Philipp CS, Faiz A, Heit JA, Kouides PA, Lukes A, Stein SF, Byams V, Miller CH, Kulkarni R. Evaluation of a screening tool for bleeding disorders in a US multisite cohort of women with menorrhagia. Am J Obstet Gynecol. 2011;204(3):209 e201–7.

    Article  Google Scholar 

  • Plug I, Mauser-Bunschoten EP, Brocker-Vriends AH, van Amstel HK, van der Bom JG, van Diemen-Homan JE, Willemse J, Rosendaal FR. Bleeding in carriers of hemophilia. Blood. 2006;108(1):52–6.

    Article  CAS  PubMed  Google Scholar 

  • Psaila B, Petrovic A, Page LK, Menell J, Schonholz M, Bussel JB. Intracranial hemorrhage (ICH) in children with immune thrombocytopenia (ITP): study of 40 cases. Blood. 2009;114(23):4777–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rae C, Furlong W, Horsman J, Pullenayegum E, Demers C, St-Louis J, Lillicrap D, Barr R. Bleeding disorders, menorrhagia and iron deficiency: impacts on health-related quality of life. Haemophilia. 2013;19(3):385–91.

    Article  CAS  PubMed  Google Scholar 

  • Rodeghiero F, Castaman G, Dini E. Epidemiological investigation of the prevalence of von Willebrand’s disease. Blood. 1987;69(2):454–9.

    Article  CAS  PubMed  Google Scholar 

  • Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, Bussel JB, Cines DB, Chong BH, Cooper N, Godeau B, Lechner K, Mazzucconi MG, McMillan R, Sanz MA, Imbach P, Blanchette V, Kuhne T, Ruggeri M, George JN. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386–93.

    Article  CAS  PubMed  Google Scholar 

  • Ruggeri ZM. The role of von Willebrand factor in thrombus formation. Thromb Res. 2007;120(Suppl 1):S5–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Seligsohn U. Factor XI deficiency in humans. J Thromb Haemost. 2009;7(Suppl 1):84–7.

    Article  CAS  PubMed  Google Scholar 

  • Seravalli V, Linari S, Peruzzi E, Dei M, Paladino E, Bruni V. Prevalence of hemostatic disorders in adolescents with abnormal uterine bleeding. J Pediatr Adolesc Gynecol. 2013;26(5):285–9.

    Article  CAS  PubMed  Google Scholar 

  • Sokkary NA, Venkateswaran L, Dietrich JE, Teruya J. Platelet function disorders and menorrhagia in adolescents: a review of laboratory diagnosis. J Pediatr Adolesc Gynecol. 2012;25(4):233–7.

    Article  PubMed  Google Scholar 

  • van Ommen CH, Peters M. The bleeding child. Part I: primary hemostatic disorders. Eur J Pediatr. 2012;171(1):1–10.

    Article  PubMed  Google Scholar 

  • Vo KT, Grooms L, Klima J, Holland-Hall C, O’Brien SH. Menstrual bleeding patterns and prevalence of bleeding disorders in a multidisciplinary adolescent haematology clinic. Haemophilia. 2013;19(1):71–5.

    Article  CAS  PubMed  Google Scholar 

  • Witmer CM, Lambert MP, O’Brien SH, Neunert C. Multicenter cohort study comparing U.S. management of inpatient pediatric immune thrombocytopenia to current treatment guidelines. Pediatr Blood Cancer. 2016;63(7):1227–31.

    Article  PubMed  Google Scholar 

  • Wolberg AS, Mast AE. Tissue factor and factor VIIa – hemostasis and beyond. Thromb Res. 2012;129(Suppl 2):S1–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Young G, Wicklund B, Neff P, Johnson C, Nugent DJ. Off-label use of rFVIIa in children with excessive bleeding: a consecutive study of 153 off-label uses in 139 children. Pediatr Blood Cancer. 2009;53(2):179–83.

    Article  PubMed  Google Scholar 

  • Youssef WI, Salazar F, Dasarathy S, Beddow T, Mullen KD. Role of fresh frozen plasma infusion in correction of coagulopathy of chronic liver disease: a dual phase study. Am J Gastroenterol. 2003;98(6):1391–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Julie Jaffray

  2. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA

    Kristina Haley

Authors
  1. Julie Jaffray
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristina Haley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julie Jaffray .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Donna Shoupe

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Jaffray, J., Haley, K. (2023). Management of Abnormal Bleeding in the Adolescent. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-031-14881-1_84

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-14881-1_84

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-14880-4

  • Online ISBN: 978-3-031-14881-1

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation