Diagnosis of Bleeding Disorders in Adolescents Hospitalized for Heavy Menstrual Bleeding

Hundreds of adolescents are hospitalized in the United States yearly with anemia due to heavy menstrual bleeding (HMB). Limited data exist regarding how these patients are evaluated and how many are diagnosed with a bleeding disorder. The aim of this study was to determine the prevalence of bleeding disorders in adolescents hospitalized for HMB. Secondary aims included identification of risk factors for severe anemia leading to hospitalization and the hematology assessment. This was a retrospective cohort study of patients aged 9 to 21 years hospitalized for HMB and anemia at a tertiary care children's hospital from January 1, 2000, to December 31, 2017. A total of 118 girls hospitalized for HMB and anemia were included. Almost 30% of patients were African American. Hematology involvement did not occur in 42% of patients. Sixty patients completed bleeding disorder testing and 57% (34/60) were diagnosed with a bleeding disorder. Most patients diagnosed with von Willebrand disease (VWD) tested while hospitalized and anemic had VW levels <100%A but 9/25 (36%) girls not evaluated by Hematology also had VW levels <100%. Despite an established Inpatient Coagulation Consult service, many adolescents hospitalized with HMB did not receive an appropriate evaluation for bleeding disorders. African Americans were disproportionately hospitalized for HMB. VW levels are elevated with HMB and severe anemia, but levels <100 seem to be predictive of VWD in this setting. Further research is needed to determine optimal timing of bleeding disorder evaluation, but many adolescents hospitalized for HMB may have an underlying bleeding disorder.