Endocrine Abstracts

JOINT1442

Background: Abnormal uterine bleeding (AUB) is a frequent and potentially severe condition in adolescents, leading to anemia and impacting quality of life. While AUB is commonly attributed to anovulatory cycles, bleeding disorders may underlie a significant proportion of cases, warranting precise identification to optimize management.

Aim: This study investigated the prevalence and types of coagulation disorders in adolescents with AUB and identified potential clinical and biochemical predictors of these disorders.

Methods: A prospective longitudinal cohort study was conducted on 130 female adolescents (10–17 years) with AUB referred to a Tertiary Pediatric Hospital from 2012 to 2022. Patients with prior coagulopathy or endocrinopathy were excluded. Collected data included medical history, bleeding tendencies, laboratory tests and pelvic ultrasounds. Anemia was categorized as mild (Hb:10–12 g/dl), moderate (8–10 g/dl), or severe (<8 g/dl). A potential clinical risk score of bleeding disorder was identified.

Results: Among 130 female adolescents, 89% experienced AUB within 2 years of menarche (mean age: 11.6 ± 1.4 years). Anemia was found in 56%, with 42.4% of which, severe. Coagulation disorders were identified in 15.4% (n = 20), including von Willebrand disease (50%), thrombocytopenia (10%), and coagulation factor deficiencies (40%), predominantly Factor VII deficiency. Ferritin levels were significantly more reduced in the coagulation disorder group (11.8 ± 11.3 ng/dl VS 21.6 ± 18.6 ng/dl; P < 0.005). A personal history of bleeding at sites other than menorrhagia (20% vs 0.9%) and a family history of bleeding disorder (20% vs 0.9%) were more frequently reported in the coagulation disorder group compared to adolescents without bleeding disorders. A composite score, called the AUB-BDA-Score (Abnormal Uterine Bleeding - Bleeding Disorders Adolescent Score), was developed based on the statistically significant risk factors found. This score is calculated as the sum of three variables:.

1. Personal history of bleeding at other sites (0 = absent, 1 = present);.

2. Family history of bleeding disorders (0 = absent, 1 = present);.

3. Ferritin levels <12 ng/mL (0 = no, 1 = yes).

A score of 3 suggests the need of investigating a potential bleeding disorder.

Conclusions: In our cohort, the 15.4% of adolescents with AUB had a bleeding disorder, with von Willebrand disease and factor VII deficiency being the most prevalent. Predictors included bleeding history, family history of bleeding and ferritin levels below 12 ng/mL. The proposed AUB-BDA-Score needs to be verified in further studies in order to enhance diagnostic precision and improve patient outcomes.