Abstract 1327

Poster Board I-349

Outpatient evaluation of hemostasis for women with menorrhagia and/or other bleeding symptoms can be unrevealing. A candidate etiology in some of these patients may be platelet (PL) dense granule (DG) deficiency, a heterogeneous bleeding diathesis characterized by variable abnormalities in platelet aggregation and decreased DG number and/or decreased DG volume by electron microscopy (EM) and image analysis.

Objective

To determine the correlation between menorrhagia and the number and volume of platelet DGs in a cohort of women participating in a multi-center menorrhagia treatment study (British J Haem 145(2):212-220, 2009).

Patients and Methods

The diagnosis of menorrhagia was determined using a semi-objective pictorial blood assessment chart (PBAC) necessitating a score of >100. The menorrhagia patients were compared to control subjects, evaluated as paired subjects on the same day. A total of 29 pairs were studied. Patients were eligible only if gynecological exam was normal. All patients were tested for other underlying hemostatic defects. Hemostatic disorders included: a platelet function disorder in 7/29 (24%), a coagulation factor deficiency 2/29 (7%) and von Willebrand disease 1/29 (3%).

Results

The mean age of the menorrhagia group was 35 ± 6.07 years. These patients had an average PBAC score of 454 ± 302.6 Patients were found to have a mean of 2.910 ± 1.207 DG/PL compared to 4.617 ± 1.13 DG/PL for the control group (p-value <0.001 by t test). The mean difference between the two groups was found to be 1.707, and the 95% confidence interval on the difference was found to be [1.096, 2.318]. DG volume was also determined using image analysis. The mean volume for the menorrhagia group was found to be 5.93 ± 3.68 × 106 fL. The mean volume for the control group was 10.04 ± 3.31 × 106 fL (p-value <0.001 by t test). The difference between the two values was found to be 4.11 with a 95% confidence interval on the difference of [2.266, 5.947].

Conclusions

Patients with menorrhagia with and without other hemostatic defects, had fewer platelet DGs than the control group. In addition, the aggregate DG volume/PL was significantly reduced in menorrhagia patients compared to the control group. These findings suggest that the menorrhagia experienced by some women is associated with platelet DG deficiency. Further study is needed in determining the significance of these findings.

Disclosures

No relevant conflicts of interest to declare.

Topics:
menorrhagia, platelet storage pool deficiency, granules, blood coagulation disorders, digeorge syndrome, fluorides, bleeding diathesis, blood platelet disorders, coagulation factor deficiency syndrome, gynecological examination

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
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