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Differences in bleeding phenotype and provider interventions in postmenarchal adolescents when compared to adult women with bleeding disorders and heavy menstrual bleeding
Author(s) -
Srivaths L. V.,
Zhang Q. C.,
Byams V. R.,
Dietrich J. E.,
James A. H.,
Kouides P. A.,
Kulkarni R.
Publication year - 2018
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/hae.13330
Subject(s) - medicine , interquartile range , psychological intervention , young adult , pediatrics , odds ratio , logistic regression , cross sectional study , obstetrics , psychiatry , pathology
Due to lack of patient/health care provider awareness causing delayed diagnosis, the bleeding phenotype and provider interventions in adolescents with heavy menstrual bleeding ( HMB ) and bleeding disorders ( BD ) may be different when compared to adults. Aim The aim of this study was to compare/characterize bleeding phenotype and provider interventions in postmenarchal adolescents < 18 years and premenopausal adults ≥ 18 years with HMB and BD . Methods Patient demographics, BD , and provider interventions/therapy details for HMB were compared between both age groups enrolled in the Centers for Disease Control and Prevention ( CDC ) Female Universal Data Collection ( UDC ) surveillance project in United States hemophilia treatment centres. Cross‐sectional descriptive analyses including frequency distributions, summary statistics, bivariate and logistic regression analyses were performed. Results Of 269 females (79 adolescents; median age 16 years, interquartile range ( IQR ) = 2; 190 adults; median age 27 years, IQR = 13) evaluated, BD distribution was similar in both groups. Compared to adolescents, adults more often had family history of bleeding (Adjusted odds ratios [ AOR ] = 2.6, 1.3‐5.6), delay in diagnosis ( AOR = 2.5, 1.2‐4.9), bleeding with dental procedures ( AOR = 2.0, 1.0‐4.0), gastrointestinal bleeding ( AOR = 4.6, 1.0‐21.9), anaemia ( AOR = 2.7, 1.4‐5.2), utilized desmopressin less often ( AOR = 0.4, 0.2‐0.8) and underwent gynaecologic procedure/surgery more frequently ( AOR = 5.9, 1.3‐27.3). Conclusion Bleeding phenotypes of adolescents and adults with HMB and BD were different with more frequent bleeding complications, anaemia, gynaecologic procedures/surgeries, less desmopressin use and more delay in diagnosing BD in adults. Longitudinal studies are needed to determine whether improved patient/provider awareness and education will translate to early diagnosis and timely management of BD / HMB in adolescents that may prevent/reduce future haematologic/gynaecologic complications.