Intrauterine balloon tamponade as a treatment for immune thrombocytopenic purpura-induced severe uterine bleeding.
OBJECTIVE
To report our experience of applying balloon tamponade in the treatment of intrauterine bleeding in two patients with immune thrombocytopenic purpura (ITP). Immune thrombocytopenic purpura is a well-known hematologic autoimmune disease. The uterus may be a major site of bleeding in patients with ITP. Halting bleeding is imperative to reduce blood loss and platelet consumption and to allow medical treatment to increase platelet count. Balloon tamponade has been described as an effective method to control bleeding in a variety of clinical situations; it is an effective and accessible modality, requiring no analgesia or anesthesia, and helps facilitate continuous monitoring of uterine bleeding.


METHODS
Report of two cases.


METHODS
Obstetrics and gynecology department in a tertiary care center in Jerusalem, Israel.


METHODS
Two patients with ITP with severe uterine bleeding refractory to treatment with estrogen and IV IgG.


METHODS
Intrauterine balloon tamponade.


METHODS
Cessation of uterine bleeding, appearance of complications.


RESULTS
Insertion of balloon tamponade successfully controlled bleeding in both cases. The patient in case 1 subsequently had persistent hypomenorrhea. The patient in case 2 had abdominal pain and suspected pelvic inflammation.


CONCLUSIONS
Our presented cases demonstrate that uterine bleeding can be controlled successfully in patients with ITP with an intrauterine balloon. This novel application raises many technical issues, such as the appropriate filling pressures and duration of treatment. Possible risks, such as endometrial injury, still remain to be resolved and mandate future clinical research.
Hamani
Yaron
Y
Department of Obstetrics and Gynecology, Division of Obstetrics, Hadassah Medical Center, Hebrew University, Jerusalem, Israel. yhamani@gmail.com
Ben-Shachar
Inbar
I
Kalish
Yossef
Y
Porat
Shay
S
D000328:Adult; D005260:Female; D006801:Humans; D007154:Immune System Diseases / Q000150:complications / Q000628:therapy; D011696:Purpura, Thrombocytopenic / Q000150:complications / Q000628:therapy*; D012720:Severity of Illness Index; D058738:Uterine Balloon Tamponade; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy*; D055815:Young Adult