title: Bleeding disorders: A common cause of menorrhagia in adolescents.
abstract: OBJECTIVE
  To determine the frequency of underlying bleeding disorders in adolescents with menorrhagia.
  
  
  METHODS
  We retrospectively reviewed the charts of all girls, aged 10 to 19 years, who presented to our children's hospital for inpatient or outpatient evaluation of menorrhagia between January 1990 and November 1998.
  
  
  RESULTS
  At presentation, 9 of the 71 girls (13%) had thrombocytopenia (platelet count <150,000/microL; range, 5000-106,000/microL). The most common causes for thrombocytopenia were immune thrombocytopenic purpura (n = 5) and myelosuppression caused by chemotherapy (n = 2). Of 14 girls who underwent a more detailed hemostatic evaluation, 8 were given a diagnosis of a hereditary coagulation disorder: 6 had platelet function defects and 2 had type 1 von Willebrand disease. Excessive menstrual bleeding commonly results in anemia. One half of the total group had anemia (hemoglobin <12.0 g/dL). Seven girls (10%) had potentially life-threatening anemia (hemoglobin <5.0 g/dL).
  
  
  CONCLUSIONS
  Acquired and congenital bleeding disorders are common causes of menorrhagia in adolescent girls. Severe anemia is a frequent complication of menorrhagia. We recommend that adolescents without thrombocytopenia who present with menorrhagia receive a comprehensive hemostatic evaluation, including testing for von Willebrand disease and platelet function defects.
authors.affiliation: Department of Pediatrics, Section of Pediatric Hematology and Oncology, Medical College and Children's Hospital of Wisconsin, Milwaukee, WI 53201-2178, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Bevan
authors.forename: K W
authors.initials: KW
authors.lastname: Maloney
authors.forename: C A
authors.initials: CA
authors.lastname: Hillery
authors.forename: J C
authors.initials: JC
authors.lastname: Gill
authors.forename: R R
authors.initials: RR
authors.lastname: Montgomery
authors.forename: J P
authors.initials: JP
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D000328:Adult; D000747:Anemia, Hypochromic / Q000150:complications; D001791:Blood Platelet Disorders / Q000150:complications; D002648:Child; D005260:Female; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D008595:Menorrhagia / Q000209:etiology*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000150:complications; D014842:von Willebrand Diseases / Q000150:complications