Table 2.
Overview of published prevalence studies of bleeding disorders in adolescents with heavy menstrual bleeding (HMB)
| Lead authors |
Study design/ Study setting |
Study population |
Year (Study Period) |
n | Age | BD frequency (%) |
VW D (n) |
PFD (n) |
Clotting factor deficiency (n) |
Fibrinolytic disorders (n) |
Definition of BD | Limitations |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Gursel and Albayrak | Cross sectional/ University students selected by survey | Adolescents with PBAC scores >100 | 2014 | 76 | 17–25 | 14.5 | 5 | 4 | 2 (FXI and FVII deficiencies) | NT | -VWF:Ag and/or VWF: RCo <45 for O and <50 for non-O blood types -Decreased platelet aggregation to ADP and/or collagen |
-Platelet aggregation performed without release |
| Diaz and Srivaths | Retrospectiv e/Young Women’s BD clinic | Adolescents referred for HMB | 2014 (20092011) | 131 | 10–14 | 21 | −7–32 with low VW F | 11 | 2 | 1* (PAI-1 deficiency) | -VWF:Ag and/or VWF:RCo <30 -2 abnormalities in platelet aggregation and/or secretion |
-Clotting factors and fibrinolytic protein testing when deemed necessary |
| Rodriguez and Simmons | Retrospectiv e/primary care, hematology clinics; inpatient or outpatient | Adolescents referred for HMB | 2013 | 160 | 10–19 | 16 | 12 | 10 | Not described | NA | Not provided | |
| Seravalli and Bruni | Retrospectiv e/Pediatric and Adolescent Gynecology Clinic | Adolescents referred for HMB | 2013 (20072011) | 113 | 11–20 | 48 | 15 | 20 | 14 | NA | Not provided | Platelet aggregation performed without release |
| Vo and O’Brien | Retrospective/Young Women’s BD clinic | Adolescents referred for HMB | 2012 (20092011) | 105 | 8–18 | 62 | 9 | -36 PSPD -8 other PFDs |
NT | NT | -VWF:Ag and/or VWF:RCo <40 -PSPD: ≤ 3.68 granules per platelet -Other PFD: not clearly defined |
-Platelet aggregation was not performed uniformly -Diagnosis of PFD based mainly on platelet EM |
| Mikhail and Kouides | Retrospectiv e/ Hemophilia Treatment Center or Hematology outpatient clinic | Adolescents referred for HMB | 2007 (20012004) | 61 | 11–19 | 41 | 36 | 7 | NT | NT | -VWF: RCo < 40% and/or VWF: Ag <50% PFD: dec in agg to one or more agonists < 2SD of local lab range and /or abnormal PFA |
-Platelet aggregation was not performed uniformly -Platelet aggregation performed without release |
| Jayasinghe and Grover | Retrospectiv e/ Inpatient outpatient gynecology clinic | Adolescents referred for HMB | 2005 (2001–2003) | 10 | 9–19 | 10.4 | 5 | 8 | NT | NT | -VWF: RCo < and/or VWF: Ag below local lab reference range. -PFD: Abnormalities to ADP, collagen, ristocetin, or epinephrine |
|
| Philipp and Saidi | Prospective/ Outpatient primary care clinic | Adolescents referred for HMB | 2005 (1999–2004) | 25 | ≤ 19 | 56 | 4 | 44 | 8 | NT | Clear definitions of BD not provided | |
| Bevan and Scott | Retrospective/ED, urgent care, inpatient | Adolescents referred for HMB | 2001 (1990–1998) | 71 | 10–19 | 11 | 2 | 6 | NT | NT | -VWF: RCo or VWF: Ag <45% -Platelet agg. < 50% with ADP, collagen, TRAP, ristocetin and AA |
-9 cases had ITP -Only 14 girls in this series had hemostatic evaluation performed. |
| Oral and Ocer | Retrospective/Inpatient | Adolescents hospitalized for HMB | 2001 (1988–1995) | 25 | 11–17 | 8 | 2 | NT | NT | NT | Clear definitions of BD not provided | An additional 4 cases were diagnosed with ITP |
| Smith and Hertzberg | Retrospective/Inpatient | Adolescents hospitalized for HMB | 1998 (1979–1995) | 37 | 10–20 | 13 | 5 | NT | NT | NT | Clear definitions of BD not provided | |
| Claessens and Cowell | Retrospective/Inpatient | Adolescents hospitalized for HMB | 1981 (1971–1981) | 59 | 19 | 3 | 2 | NT | NT | Clear definitions of BD not provided |
BD, bleeding disorder; NT, not tested; PBAC, pictorial blood assessment chart; VWF, von Willebrand factor; Ag, antigen; RCo, ristocetin co factor activity; ADP, adenosine diphosphate; PAI-1, plasminogen activator-1 activity; PSPD, platelet storage pool disorder; PFD, platelet functional disorders; EM, electron microscopy; TRAP, thrombin receptor activation peptide; AA, arachidonic acid; ITP, immune thrombocytopenia.