Table 3.

General principles for AUB management in the setting of thrombocytopenia

Assess pregnancy status before initiating therapy, especially, if there is clinical concern that thrombocytopenia is possibly secondary to SLE or that the use of possible anti-biologics such as Rituximab may be needed. Assess and document menstrual bleeding pattern (frequency, duration, flow, and volume) prior to presumed onset of thrombocytopenia. Determine if AUB or HMB predates thrombocytopenia. Consider hormonal suppression or regulation at the time of thrombocytopenia diagnosis, especially if there is a history of AUB or HMB prior to thrombocytopenia. Assess severity of thrombocytopenia and hematology parameters (hemoglobin and ferritin) at the time AUB or HMB is reported. Determine underlying cause of thrombocytopenia and if current severity of thrombocytopenia would be improved by/responsive to platelet transfusion. Treat underlying cause of thrombocytopenia as indicated by standard of care for each underlying entity. Initiate treatment for AUB based on personal preference and needs. Consider a multidisciplinary, collaborative management approach, with inclusion of gynecology or adolescent medicine for improved patient outcomes AUB, abnormal uterine bleeding; SLE, systemic lupus erythematosus; HMB, heavy menstrual bleeding