|
1
|
Seidizadeh O, Aliabad GM, Mirzaei I, Yaghoubi S, Abtin S, Valikhani A, Naderi M. Prevalence of hemorrhagic ovarian cysts in patients with rare inherited bleeding disorders. Transfus Apher Sci 2022:103636. [PMID: 36635175 DOI: 10.1016/j.transci.2022.103636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In comparison with the general population, women with bleeding disorders are more prone to develop obstetrical and gynecological problems. However, no comprehensive evaluation has investigated the prevalence of hemorrhagic ovarian cysts (HOCs) in rare bleeding disorders (RBDs). In this study, we sought to determine the prevalence of HOCs in a large cohort of Iranian patients with RBDs. METHODS A total of 210 symptomatic patients suspected of HOCs with RBD were included. The median age of the study population was 24 years. Patients were diagnosed with fibrinogen disorders (n = 7, 3%), factor (F) II (n = 4, 2%), FV (n = 28, 13%), FVII (n = 4, 2%), FX (n = 6, 3%), FXIII (n = 122, 58%), combined FV and FVIII (n = 8, 4%), Glanzmann's thrombasthenia (n = 10, 5%), and von Willebrand disease (VWD) type 3 (n = 21, 10%). RESULTS Following further clinical and ultrasound examinations of these 210 patients, 68 (32.4%) were confirmed with a diagnosis of HOCs. Of which, FXIII deficiency with 46 cases (67.6%), followed by VWD type 3 (6 cases, 8.8%) showed the highest number. Other coagulation defects associated with HOCs were including fibrinogen deficiency (n = 2, 3%), FII (n = 2, 3%), FV (n = 4, 6%), FVII (n = 2, 3%), FX (n = 1, 1.5%), combined FV and FVIII (n = 2, 3%), and Glanzmann's thrombasthenia (n = 3, 4.5%). CONCLUSION This study found a high prevalence of HOCs in patients with RBDs, indicating the importance of early diagnosis and optimal management of obstetric and gynecological complications in these patients.
Collapse
Affiliation(s)
- Omid Seidizadeh
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Ghasem Miri Aliabad
- Medical school, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ilia Mirzaei
- Medical school, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Sima Abtin
- Zabol University of Medical Sciences, Hamoon-City Health Centre, Teiymour-Abad Village, Iran
| | - Amir Valikhani
- Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Majid Naderi
- Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran; Department of pediatrics, Children and Adolescent Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
| |
Collapse
|
|
2
|
Corpus luteum hemorrhage with acquired hemophilia A: a case report and literature review. BMC Womens Health 2022; 22:418. [PMID: 36221134 PMCID: PMC9552471 DOI: 10.1186/s12905-022-02000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background The rupture of the corpus luteum (CL) may occur at all stages of a woman’s reproductive life. Bleeding of the ruptured CL varies from self-limiting hemorrhage to massive hemoperitoneum, causing the shock and subsequent emergency surgery. But hemoperitoneum secondary to ruptured CL is a rare complication and situation for women with bleeding disorders. Case presentation We here describe a case of severe CL hemorrhage with factor VIII deficiency. We chose conservative management instead of surgery for the abnormal hemostatic condition. With blood product and factor concentrate support, conservative management was successful in avoiding surgery in the episode of bleeding. Conclusion Gynecologist should be alert for the patients with abnormal hemostatic condition. Selective patients presenting with CL hemoperitoneum association with bleeding disorders may undergo conservative management and avoid the risk of surgery.
Collapse
|
|
3
|
Gan LW, Li QC, Yu ZL, Zhang LL, Liu Q, Li Y, Ou ST. Abdominal hemorrhage after peritoneal dialysis catheter insertion: A rare cause of luteal rupture: A case report. World J Clin Cases 2021; 9:6510-6514. [PMID: 34435019 PMCID: PMC8362553 DOI: 10.12998/wjcc.v9.i22.6510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abdominal hemorrhage is a complication of peritoneal dialysis catheter (PDC) insertion that cannot be neglected, and its causes are mainly related to surgical injury. This article reports a case of massive abdominal hemorrhage that was caused by a rare rupture of corpus luteum shortly after PDC during the initiation of peritoneal dialysis (PD) insertion.
CASE SUMMARY A 37-year-old woman was surgically placed a Tenckhoff catheter because of end-stage renal disease. On the third postoperative day, the color of the abdominal drainage fluid was pink, and deepened gradually. It turned pale after initiating conservative treatment. On the tenth postoperative day, the color of the abdominal drainage fluid suddenly turned dark red, and the color progressively deepened. The patient’s hemoglobin dropped from 88 g/L to 57 g/L. Abdominal computed tomography (CT) indicated abdominal effusion and a high-density shadow in the abdominal cavity. The surgeon performed a laparotomy and found that the corpus luteum had ruptured on the right side and a left ovarian blood body had formed. The gynecologist repaired the ovary and performed a bilateral oophoroplasty. After the operation, the patient stopped bleeding and hemodialysis was temporarily stopped. PD was resumed after half a month. The patient’s condition improved, and she was discharged 14 d after the laparotomy.
CONCLUSION If abdominal hemorrhage occurs in women of childbearing age after PDC insertion, luteal rupture should be considered as the cause.
Collapse
Affiliation(s)
- Lin-Wang Gan
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou 646000, Sichuan Province, China
| | - Qian-Cheng Li
- Department of Respiratory, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Zhao-Lan Yu
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou 646000, Sichuan Province, China
| | - Li-Ling Zhang
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou 646000, Sichuan Province, China
| | - Qi Liu
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou 646000, Sichuan Province, China
| | - Ying Li
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou 646000, Sichuan Province, China
| | - San-Tao Ou
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou 646000, Sichuan Province, China
| |
Collapse
|
|
4
|
Pulappadi VP, Manchanda S, Sk P, Hari S. Identifying corpus luteum rupture as the culprit for haemoperitoneum. Br J Radiol 2021; 94:20200383. [PMID: 32822245 DOI: 10.1259/bjr.20200383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Corpus luteum rupture presenting as acute abdomen is an underdiagnosed condition. Though a self-limiting entity, its differentiation from other causes is essential to prevent unnecessary surgical procedures. The radiologist should be aware of the possibility of a ruptured haemorrhagic ovarian cyst in a female of reproductive age group presenting with pelvic pain and a large amount of haemorrhagic ascites. Imaging characteristically reveals a thick-walled cystic structure in the adnexa with internal echoes, focal discontinuity or irregularity of its wall with haemoperitoneum. While sonography is usually indicative of corpus luteum rupture, cross-sectional imaging (CT/MRI) can be used to confirm the diagnosis.
Collapse
Affiliation(s)
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Pritviraj Sk
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Hari
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
|
5
|
Medvediev MV, Malvasi A, Gustapane S, Tinelli A. Hemorrhagic corpus luteum: Clinical management update. Turk J Obstet Gynecol 2020; 17:300-309. [PMID: 33343977 PMCID: PMC7731611 DOI: 10.4274/tjod.galenos.2020.40359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/18/2020] [Indexed: 12/01/2022] Open
Abstract
Hemorrhagic corpus luteum (HCL) is an ovarian cyst formed after ovulation and caused by spontaneous bleeding into a corpus luteum (CL) cyst. When HCL rupture happens, a hemoperitoneum results. Clinical symptoms are mainly due to peritoneal irritation by the blood effusion. The differential diagnosis is extensive and standard management is not defined. The authors elaborated a comparison of the differential diagnosis and therapeutic modalities from the laparoscopic approach to nonsurgical, medical options because hemorrhage from HCL is often self-limiting. The authors reviewed all data implicated with the development of HCL, trying to give homogeneity to literature data. The authors analyzed extensive literature data and subdivided the medical approach into many topics. The wait-and-see attitude avoids unnecessary laparoscopic surgery using supportive therapies (antifibrinolytic, analgesics, liquid infusion, transfusions and antibiotic prophylaxis). Surgical therapy: operative management should be laparoscopic, with surgical options such as luteumectomy, ovarian wedge-shaped excision or oophorectomy. Prevention: the possibility to preserve fertility is essential, mainly in patients with bleeding disorders or undergoing anticoagulant therapy; therefore, they need estro-progestinics or GnRH analogues to prevent ovulation and avoid further episodes of HCL. This review will aid physicians in making an early diagnosis of HCL, to avoid unnecessary surgery, and use the most effective treatment.
Collapse
Affiliation(s)
- Mykhailo V Medvediev
- Dnipropetrovsk Medical Academy of Health Ministry of Ukraine, Dnipropetrovsk, Ukrain
| | - Antonio Malvasi
- Santa Maria Hospital, Gvm Care and Research, Clinic of Obstetrics and Gynaecology, Bari, Italy
| | - Sarah Gustapane
- Veris Delli Ponti Hospital, Clinic of Obstetrics and Gynecology, Scorrano, Lecce, Italy
| | - Andrea Tinelli
- Veris Delli Ponti Hospital, Chief of Clinic of Obstetrics and Gynecology, Scorrano, Lecce, Italy
| |
Collapse
|
|
6
|
Öner N, Gürsel T, Kaya Z, Keskin EY, Koçak Ü, Albayrak M, Yenicesu I, Apak BB, Işık M. Inherited coagulation disorders in Turkish children: A retrospective, single-center cohort study. Transfus Apher Sci 2020; 59:102728. [PMID: 31980335 DOI: 10.1016/j.transci.2020.102728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/04/2019] [Accepted: 12/23/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aims to investigate the distribution, clinical characteristics and outcome of inherited coagulation disorders (ICD) in Turkish children. SUBJECTS AND METHODS Data from all children (age<18 years) with ICD examined in our center were retrospectively reviewed. RESULTS There were 403 children with ICD (233 males and 170 females) with a median age of four years at diagnosis. The percentages of von Willebrand disease (vWd), hemophilia and rare bleeding disorders (RBD) were 40 %, 34 % and 26 %, type-1, type-2 and type-3 vWd were 63 % 17 % and 20 %, hemophilia A and B were 84 % and 16 %, and severe, moderate and mild hemophilia were 48 %, 30 % and 22 %, respectively. Factor VII and FXI deficiencies were the most prevalent, comprising 56 % and 22 % of all children with RBD, respectively. Parental consanguinity rates were 72 % in type-3 vWd and 61 % in severe RBD. The overall prevalence of gastrointestinal bleedings was 4.5 % (18/403), intracranial bleeding (ICB) was 4.96 % (20/403), mortality from ICB was 30 % (6/20) and the overall mortality rate was 1.49 % (6/403). No life-threatening bleeding was seen during regular prophylaxis. Chronic arthropathy prevalence in severe hemophilia was 8 % with primary prophylaxis and 53 % with demand therap. Inhibitor prevalence was 14 % in hemophilia-A and 5 % in hemophilia-B. CONCLUSIONS These data show that vWd is the most common ICD, type-3 vWd and RBD are prevalent due to frequent consanguineous marriages and diagnosis of ICD is substantially delayed in Turkish children. Prophylactic replacement therapy prevents occurrence of life-threatening bleedings and reduces the development of hemophilic arthropathy.
Collapse
Affiliation(s)
- Nergiz Öner
- Pediatric Hematology Specialist, University of Health Sciences, Dr Sami Ulus Children's Hospital, Ankara, Turkey.
| | - Türkiz Gürsel
- the Pediatric Hematology Unit of the Department of Pediatrics, Medical School of Gazi University, Ankara, Turkey
| | - Zühre Kaya
- the Pediatric Hematology Unit of the Department of Pediatrics, Medical School of Gazi University, Ankara, Turkey
| | - Ebru Yılmaz Keskin
- the Pediatric Hematology Unit of the Department of Pediatrics, Medical School of Süleyman Demirel University, Isparta, Turkey
| | - Ülker Koçak
- the Pediatric Hematology Unit of the Department of Pediatrics, Medical School of Gazi University, Ankara, Turkey
| | - Meryem Albayrak
- the Pediatric Hematology Unit of the Department of Pediatrics, Medical School of Kırıkkale University, Kırıkkale, Turkey
| | | | - Burcu Belen Apak
- the Pediatric Hematology Unit of the Department of Pediatrics, Medical School of Başkent University, Ankara, Turkey
| | - Melek Işık
- Pediatric Hematology Specialist, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training And Research Hospital, Ankara, Turkey
| |
Collapse
|
|
7
|
Spiliopoulos D, Kadir RA. Congenital Factor X deficiency in women: A systematic review of the literature. Haemophilia 2019; 25:195-204. [DOI: 10.1111/hae.13729] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Dimitrios Spiliopoulos
- Katharine Dormandy Haemophilia Centre, Department of Obstetrics & Gynaecology Royal Free Hospital London UK
| | - Rezan A. Kadir
- Katharine Dormandy Haemophilia Centre, Department of Obstetrics & Gynaecology Royal Free Hospital London UK
| |
Collapse
|
|
8
|
Deffieux X, Thubert T, Huchon C, Demoulin G, Rivain AL, Faivre E, Trichot C. [Complications of presumed benign ovarian tumors]. ACTA ACUST UNITED AC 2013; 42:816-32. [PMID: 24210240 DOI: 10.1016/j.jgyn.2013.09.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The main risk factor of adnexal torsion is a previous adnexal torsion (LE3). There is no clinical, biological or radiological sign that may exclude the diagnosis of adnexal torsion (LE3). The presence of flow at color Doppler imaging does not allow exclusion of the diagnosis (LE2). An emergent laparoscopy is recommended for adnexal untwisting (Grade B), except in postmenopausal women where oophorectomy is recommended (grade C). A persistent black color of the adnexa after untwisting is not an indication for systematic oophorectomy (grade C), since a functional recovery is possible (LE3). Ovariopexy is not routinely recommended following adnexal untwisting (grade C). The clinical signs of intra-cystic hemorrhage and those of rupture of the corpus luteum are not specific (LE4). MRI is not recommended to confirm the diagnosis of intra-cystic hemorrhage (grade C). Malignant transformation of an ovarian cyst is very rare. The presence of a benign ovarian cyst is not associated with an increased risk of ovarian cancer at long-term follow-up (LE2). For these women, an ultrasound follow-up is not recommended (grade C). Dermoid ovarian cyst containing nerve tissue can trigger the production of pathogenic auto-antibody-anti-NMDA, leading to encephalitis. A high proportion of thyroid tissue in a mature teratoma (struma ovarii) may cause hyperthyroidism.
Collapse
Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud, 91405 Orsay, France.
| | | | | | | | | | | | | |
Collapse
|
|
9
|
Faraj W, Alaeddine M, Haydar A, Khalife M. Spontaneous intraperitoneal haemorrhage from short gastric artery avulsion secondary to forceful retching. BMJ Case Rep 2013; 2013:bcr-2012-008250. [PMID: 23813991 DOI: 10.1136/bcr-2012-008250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Spontaneous intraperitoneal haemorrhage can occur in any age group. It is defined as presence of free blood in the peritoneal cavity which can results from a non-traumatic and non-iatrogenic cause. Common causes are visceral, coagulopathy related and vascular. The clinical presentation is usually non-specific; it can vary from mild abdominal pain to a shock status. We report a very rare case of a 17-year-old male patient who presented to our institution with spontaneous intraperitoneal bleeding secondary to avulsion of one of the short gastric artery following forceful retching.
Collapse
Affiliation(s)
- Walid Faraj
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | | | | | | |
Collapse
|
|
10
|
Girolami A, Vettore S, Ruzzon E, Marinis GBD, Fabris F. Rare and Unusual Bleeding Manifestations in Congenital Bleeding Disorders. Clin Appl Thromb Hemost 2011; 18:121-7. [DOI: 10.1177/1076029611416638] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Epistaxis, superficial and deep hematomas, hemarthrosis, gastrointestinal bleeding, hematuria represent the most frequent hemorrhagic events in congenital coagulation disorders. Occasionally, bleeding manifestations occur in unusual sites or are peculiar. A clotting defect may alter the clinical aspect of skin conditions or infections (hemorrhagic scabies or varicella). Hemobilia may occur as a complication of transjugular liver biopsy in hemophilia or Bernard-Soulier syndrome. Hemarthrosis of small joints of feet and hands occur in patients with hemophilia treated with protease inhibitors. Intramedullary hematomas of long bones have been described in α2-plasmin inhibitor or fibrinogen deficiencies. Spleen fracture with consequent hemoperitoneum has been reported in patients with fibrinogen deficiency. Rectus muscle sheath hematoma may occur in patients with factor VII (FVII)or FX deficiency. Acute or subacute intestinal obstruction may be caused by intramural wall hematomas in hemophilia and von Willebrand (vW)-disease. Physicians should always keep in mind that a congenital hemorrhagic disorder may cause bleeding in any tissue of the body and therefore alter the normal clinical features of a given disease.
Collapse
Affiliation(s)
- Antonio Girolami
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
| | - Silvia Vettore
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
| | - Elisabetta Ruzzon
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
| | - Giulia Berti de Marinis
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
| | - Fabrizio Fabris
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
| |
Collapse
|
|
11
|
Iwase A, Goto M, Manabe S, Hirokawa W, Kobayashi H, Nakahara T, Takikawa S, Kotani T, Sumigama S, Tsuda H, Nakayama T, Suzuki N, Matsushita T, Kikkawa F. Successful fertility management of a patient with factor V deficiency: planned transfusion of fresh frozen plasma under infertility treatment. Fertil Steril 2011; 95:2124.e5-7. [DOI: 10.1016/j.fertnstert.2011.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 12/27/2010] [Accepted: 01/05/2011] [Indexed: 11/16/2022]
|
|
12
|
Hackethal A, Ionesi-Pasacica J, Kreis D, Litzlbauer D, Tinneberg HR, Oehmke F. Feasibility of laparoscopic management of acute haemoperitoneum secondary to ruptured ovarian cysts in a haemodynamically unstable patient. MINIM INVASIV THER 2010; 20:46-9. [DOI: 10.3109/13645706.2010.497001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
|
13
|
Hoffman R, Brenner B. Corpus Luteum Hemorrhage in Women with Bleeding Disorders. WOMENS HEALTH 2009; 5:91-5. [DOI: 10.2217/17455057.5.1.91] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Bleeding into the corpus luteum following ovulation rarely has clinical significance in healthy women, but may lead to life-threatening hemorrhage in women with congenital or acquired bleeding disorders. Women who are at an increased risk for corpus luteum hemorrhage (CLH) can be divided in two categories; first, those taking anticoagulants because of a thrombotic disorder; and second, women with congenital bleeding disorders. The management and prevention of CLH is still unsettled and the literature dealing with this problem is based on case reports only. This review focuses on the pathophysiology, clinical presentation, diagnosis and treatment options of an acute bleeding event and prevention modalities of CLH in women with bleeding disorders.
Collapse
Affiliation(s)
- Ron Hoffman
- Ron Hoffman, MD, Thrombosis & Haemostasis Unit, POB 9602, Rambam, Health Care Campus, Haifa, Israel, Tel.: +972 4854 3520, Fax: +972 4865 3886,
| | - Benjamin Brenner
- Benjamin Brenner, Bat Galim, Haifa, Thrombosis & Haemostasis Unit, Rambam, Health Care Campus, Israel, Tel.: +972 4854 3520, Fax: +972 4854 3886,
| |
Collapse
|
|
14
|
DADHWAL V, DEKA D, GHOSH B, MITTAL S. Recurrent ovarian haemorrhage in a girl with congenital factor X deficiency. Haemophilia 2008; 14:853-5. [DOI: 10.1111/j.1365-2516.2008.01782.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
|
15
|
Girolami A, Lombardi AM, Candeo N, Scarparo P, Paternoster A. Control of ovulation-induced hemoperitoneum by oral contraceptives in a patient with congenital hypoprothrombinemia and in another with congenital factor V deficiency. Acta Haematol 2008; 119:236-40. [PMID: 18583905 DOI: 10.1159/000141782] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 04/11/2008] [Indexed: 11/19/2022]
Abstract
Hemoperitoneum is a serious and often life-threatening bleeding manifestation. This is particularly true for women who carry congenital bleeding disorders. We describe here a hemoperitoneum occurring in 1 patient with congenital prothrombin deficiency and another with congenital factor V deficiency. Both patients have been followed by us for many years. The patient with prothrombin deficiency underwent laparoscopy but was treated consecutively with whole blood, plasma transfusions and 1,000 units of prothrombin complex concentrates. Response was good and she was then placed on oral contraceptives (OC) which prevented any recurrence. The patient with factor V deficiency presented several episodes of ovulation-related bleeding which required hospitalization and fresh frozen plasma transfusions. On the fifth occasion, the patient had to undergo surgery, and a left oophorectomy was carried out. After this last episode, she was also placed on OC which were very effective in preventing further recurrences. Both patients tolerated the medications very well which, in addition, were able to control menometrorrhagia with a consequent decrease over time in transfusional needs. OC are the treatment of choice in congenital bleeding disorders to control both the menorrhagia and, more importantly, ovulation-related hemoperitoneum.
Collapse
Affiliation(s)
- A Girolami
- Department of Medical and Surgical Sciences, Northeastern Italy Association for the Study of Coagulation Disorders, Padua, Italy.
| | | | | | | | | |
Collapse
|
|
16
|
Girolami A, Scandellari R, Scapin M, Vettore S. Congenital Bleeding Disorders of the Vitamin K‐Dependent Clotting Factors. VITAMINS & HORMONES 2008; 78:281-374. [DOI: 10.1016/s0083-6729(07)00014-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
|
17
|
Gupta N, Dadhwal V, Deka D, Jain SK, Mittal S. Corpus luteum hemorrhage: rare complication of congenital and acquired coagulation abnormalities. J Obstet Gynaecol Res 2007; 33:376-80. [PMID: 17578371 DOI: 10.1111/j.1447-0756.2007.00540.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Women taking anticoagulants or those with a clotting factor deficiency are at increased risk of corpus luteum rupture due to coagulation abnormalities and three such cases are described here. Case 1 was a 35-year-old woman with prosthetic mitral valve replacement who was on anticoagulant therapy, in whom hemoperitoneum secondary to ruptured corpus luteum was seen. Emergency laparotomy revealed 1.2 L of massive hemoperitoneum. Left salpingo-oophorectomy was performed. Case 2 was two episodes of hemoperitoneum from luteal cyst rupture in a young patient with the rare congenital factor X deficiency. This patient was managed conservatively with fresh frozen plasma and blood transfusion. This is the first case of congenital factor X deficiency manifested as luteal rupture to be managed conservatively. Case 3 was two episodes of hemoperitoneum from luteal cyst rupture in a patient with antiphospholipid antibody syndrome who was on oral anticoagulants. Laparotomy was done twice with left salpingo-oophorectomy in the first instance and partial excision of the right ovary in the second instance. Hemoperitoneum secondary to rupture of the corpus luteum should be considered in the differential diagnosis of acute abdominal pain in women with congenital and acquired coagulation deficiencies.
Collapse
Affiliation(s)
- Nupur Gupta
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
| | | | | | | | | |
Collapse
|
|
18
|
Gupta N, Aggarwal S, Deka D, Mittal S. Haemoperitoneum from corpus luteal rupture in a patient with protein S deficiency receiving anticoagulant therapy. Arch Gynecol Obstet 2007; 276:659-60. [PMID: 17713778 DOI: 10.1007/s00404-007-0441-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
|
|
19
|
Lucey BC, Varghese JC, Anderson SW, Soto JA. Spontaneous hemoperitoneum: a bloody mess. Emerg Radiol 2007; 14:65-75. [PMID: 17342463 DOI: 10.1007/s10140-007-0594-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Accepted: 02/16/2007] [Indexed: 01/13/2023]
Abstract
Spontaneous hemoperitoneum may be a life-threatening occurrence. It most frequently presents with acute abdominal pain. Computed tomography (CT) is the most commonly used modality in the initial work up of these patients, but sonography and magnetic resonance imaging (MRI) play a role in the diagnosis. The etiology is varied, yet may be broadly classified into gynecologic, hepatic, splenic, vascular, and coagulopathic causes. This review will describe the common imaging findings of spontaneous hemoperitoneum, as it presents through the emergency room, and will detail the underlying causes and significance of spontaneous hemoperitoneum.
Collapse
Affiliation(s)
- Brian C Lucey
- Department of Radiology, Boston VA Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA.
| | | | | | | |
Collapse
|
|
20
|
Payne JH, Maclean RM, Hampton KK, Baxter AJ, Makris M. Haemoperitoneum associated with ovulation in women with bleeding disorders: the case for conservative management and the role of the contraceptive pill. Haemophilia 2007; 13:93-7. [PMID: 17212732 DOI: 10.1111/j.1365-2516.2006.01399.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Haemoperitoneum secondary to ruptured corpus luteum is a rare complication for women on anticoagulants and with certain congenital bleeding disorders. A surgical approach is often taken, leading to oophorectomy in many cases. We describe three patients presenting with haemoperitoneum in association with factor VII deficiency, factor X deficiency and sitosterolaemia. In two of the patients, recurrent episodes occurred prior to introduction of the oral contraceptive pill. Conservative management with blood product and factor concentrate support was successful in avoiding surgery in three of the five episodes of bleeding. These cases demonstrate that preservation of ovarian function is possible with a conservative approach and recurrent episodes may be prevented by suppression of ovulation.
Collapse
Affiliation(s)
- J H Payne
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
| | | | | | | | | |
Collapse
|
|
21
|
Abstract
Spontaneous hemoperitoneum is an uncommon cause of acute abdominal pain. When it occurs, it may be catastrophic. There are a myriad of causes for spontaneous hemoperitoneum and an underlying cause should always be looked for if the patient survives the initial event. This article describes the imaging findings of spontaneous hemoperitoneum and discusses the relative merits of multiple imaging modalities used for the diagnosis of the hemoperitoneum and an underlying cause. In addition, we outline the etiology of spontaneous hemoperitoneum, which includes hepatic, splenic, gynecologic, and vascular causes, and bleeding disorders.
Collapse
Affiliation(s)
- Brian C Lucey
- Division of Body Imaging, Department of Radiology, Boston University Medical Center, Boston, MA 02118, USA.
| | | | | |
Collapse
|
|
22
|
Yilmaz S, Demircioğlu F, Türker M, Oren H, Cakmakçi H, Irken G. An extremely uncommon complication of ITP: spontaneous rupture of an ovarian follicle cyst and massive intra-abdominal bleeding. J Pediatr Hematol Oncol 2006; 28:755-6. [PMID: 17114964 DOI: 10.1097/01.mph.0000243653.41185.3f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Idiopathic thrombocytopenic purpura usually presents with minor bleeding such as petechia and purpura. Rarely, life-threatening events as intracranial and intra-abdominal bleedings can be seen. We would like to present a rare case diagnosed as idiopathic thrombocytopenic purpura, presenting with abdominal pain and paleness. In this 17-year-old female patient, extensive abdominal sensitivity was revealed on physical examination and massive intra-abdominal hemorrhage secondary to distended ovarian follicle rupture was seen on ultrasonography and abdominal computed tomography. The case was treated successfully with intravenous immunoglobin, thrombocyte suspension, and pulse methylprednisolone.
Collapse
Affiliation(s)
- Sebnem Yilmaz
- Department of Pediatric Hematology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | | | | | | | | | | |
Collapse
|
|
23
|
James AH. More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders. Haemophilia 2005; 11:295-307. [PMID: 16011580 DOI: 10.1111/j.1365-2516.2005.01108.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In women, menorrhagia may be the most common manifestation of a bleeding disorder, but it is not the only reproductive tract abnormality that women with bleeding disorders experience. Women with bleeding disorders appear to be at an increased risk of developing haemorrhagic ovarian cysts and possibly endometriosis. As they grow older, they may be more likely to manifest conditions, which present with bleeding such as fibroids, endometrial hyperplasia and polyps. Women with bleeding disorders are more likely to undergo a hysterectomy and are more likely to have the operation at a younger age. During pregnancy, they may be at greater risk of miscarriage and bleeding complications. At the time of childbirth, women with bleeding disorders appear to be more likely to experience postpartum haemorrhage, particularly delayed or secondary postpartum haemorrhage. Vaginal or vulvar haematomas, extremely rare in women without bleeding disorders, are not uncommon. While women with bleeding disorders are at risk for the same obstetrical and gynaecological problems that affect all women, they appear to be disproportionately affected by conditions that manifest with bleeding.
Collapse
Affiliation(s)
- A H James
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
| |
Collapse
|