PB0694 - Heavy menstrual bleeding is a common, underrecognized issue in at risk adolescents with immune thrombocytopenia and inherited platelet disorders.

Background: : Immune thrombocytopenia (ITP) and inherited platelet disorders (IPD), including platelet function disorders (PFD) and congenital thrombocytopenia syndromes (CTS) have a varied bleeding phenotype. In individuals who menstruate, underappreciation of heavy menstrual bleeding (HMB) may lead to iron deficiency anemia (IDA) and lower health related quality of life (QoL).

Aims: Determine the frequency and severity of HMB in a cohort of at-risk individuals with ITP, PFD, and CTS to identify opportunities to improve care.

Methods: A retrospective chart review was performed at a tertiary care pediatric institution using the electronic health record. Institutional Review was determined exempt. Individuals age >10 years and female biological sex were considered at risk for HMB. Individuals were classified as having HMB if they had any of: bleeding requiring change in protection > every 2 hours, bleeding through protection or having the sensation of flooding, bleeding lasting >5 days or bleeding affecting QoL. Data were analyzed using descriptive statistics.

Results: In patients with IPD, 42/122 patients were at risk for HMB. Of those patients, 22/42 (52%) patients had HMB and 3 required admission to the pediatric intensive care unit (PICU). 12/42 (28%) had evident IDA. HMB was treated with antifibrinolytics in 21/22 patients and hormonal therapy in 15/22 patients. In ITP, 65/298 patients were at risk, of which 44/65 (67%) reported HMB with 12 (18%) requiring hospitalization or emergency department evaluation, 2 admitted to the PICU, and 51 (78%) with iron deficiency. Treatment included ITP-directed long-term therapy (N=24) and hormonal therapy (N=16). There were no thrombotic events.

Conclusion(s): HMB is common in IPD and ITP, occurring in over 50% of at risk patients and resulting in high rates of hospitalization (including PICU admission) and IDA. Clinicians should be aware of and address this important issued in patients with ITP and IPD.