Endocrine Abstracts

JOINT2149

Introduction: Abnormal Uterine Bleeding (AUB) is a frequent cause of visits to the emergency department and a major reason for concern among adolescents and their families. The most common cause of AUB, in otherwise healthy adolescents, is anovulatory cycles, owing to immature hypothalamic-pituitary-ovarian axis, although 5–36% of adolescents who present with heavy menstrual bleeding, have an underlying bleeding disorder (BD). The most common form of BDs is von Willebrand Disease, reflecting 13% of adolescents with AUB. Von Willebrand disease affects 1% of the general population, it is a hereditary hemorrhagic disease with autosomal dominant transmission (except type 3). The clinical signs vary depending on the severity of the form, it can be (mucocutaneous hemorrhage, bruising, epistaxis, gingival bleeding, AUB, etc.), type 3 is only affected by hematomas and hemarthroses. The diagnosis is made based on the dosage of the circulating vWF/F VIII complex.

Materials and Methods: In our specialized pediatric endocrinology consultation we collected 5 patients whose reason for consultation was AUB during their menarche and which recurred during subsequent cycles. We analyzed the biological and progressive clinical characteristics of the patients.

Results: The age of our patients was between 12 and 13 and a half years old. In the antecedents we identify the notion of benign epistaxis, small bleedings during dental extractions, 2 patients whose mothers had presented a delivery hemorrhage, notions of epistaxis in siblings, one patient had no pathological history. The exploration shows a normal primary hemostasis assessment, the diagnosis was confirmed by the measurement of the vWF/F Vlll complex. We hospitalized 3 of the 5 patients for blood transfusions; only one required an infusion of Von Willebrand factor (vWF), symptomatic treatment with a hemostatic aim was also used (anti-fibrinolytic type Tranexamic acid), as well as iron treatment and estrogen-progestogen treatment for most patients.

Conclusion: Von Willebrand disease is a common etiology of hemostasis disorders which can result in AUB in young adolescents; establishing a diagnosis as well as the management of these adolescents must involve an entire multidisciplinary team (pediatrician, hematologist and gynecologist, the etiological treatment (vWF) is to be discussed depending on the severity of the form and it is only systematic in severe forms, particularly type 3.