Management of uterine bleeding during hematopoietic stem cell transplantation.
BACKGROUND
Hematopoietic stem cell transplant is an effective treatment strategy for a variety of hematologic disorders, but patients are at risk for dysfunctional coagulation and abnormal bleeding. Gynecologists are often consulted before transplant for management of abnormal uterine bleeding, which may be particularly challenging in this context.


METHODS
A premenopausal woman with MonoMAC (a rare adult-onset immunodeficiency syndrome characterized by monocytopenia and Mycobacterium avium complex infections resulting from mutations in GATA2, a crucial gene in early hematopoiesis) presented with pancytopenia, evolving leukemia, and recent strokes, necessitating anticoagulation. During preparation for hematopoietic stem cell transplant, she experienced prolonged menorrhagia requiring transfusions. Surgical therapy was contraindicated, and medical management was successful only when combined with balloon tamponade.


CONCLUSIONS
Balloon tamponade may be a potentially life-saving adjunct to medical therapy for control of uterine hemorrhage before hematopoietic stem cell transplant.
Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Stephanie E
SE
Purisch
Dana
D
Shanis
Christa
C
Zerbe
Melissa
M
Merideth
Jennifer
J
Cuellar-Rodriguez
Pamela
P
Stratton
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D003280:Contraceptives, Oral, Synthetic / Q000627:therapeutic use; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D050989:GATA2 Transcription Factor / Q000235:genetics; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000150:complications / Q000628:therapy; D060828:Induction Chemotherapy / Q000009:adverse effects*; D007889:Leiomyoma / Q000150:complications; D016729:Leuprolide / Q000627:therapeutic use*; D008525:Medroxyprogesterone / Q000627:therapeutic use*; D008595:Menorrhagia / Q000139:chemically induced / Q000628:therapy*; D020521:Stroke / Q000150:complications; D058738:Uterine Balloon Tamponade; D014594:Uterine Neoplasms / Q000150:complications
D018931:Antineoplastic Agents, Hormonal; D003280:Contraceptives, Oral, Synthetic; D004967:Estrogens; D050989:GATA2 Transcription Factor; C494711:GATA2 protein, human; D016729:Leuprolide; D008525:Medroxyprogesterone