Use of intrauterine balloon tamponade in successful conservative management of life threatening menorrhagia in a patient with idiopathic thrombocytopenic purpura and severe anemia

Authors

  • Rekha Agrawal Department of Obstetrics and Gynaecology, Lilavati Hospital and Research Centre, Bandra (W), Mumbai, Maharashtra, India
  • Hemant Shintre Department of Obstetrics and Gynaecology, Lilavati Hospital and Research Centre, Bandra (W), Mumbai, Maharashtra, India
  • Bindu Rani Department of Obstetrics and Gynaecology, Lilavati Hospital and Research Centre, Bandra (W), Mumbai, Maharashtra, India
  • Krishna Agrawal Department of Obstetrics and Gynaecology, Lilavati Hospital and Research Centre, Bandra (W), Mumbai, Maharashtra, India
  • Aniruddh Agrawal Topiwala National Medical College, Dr. A. L. Nair Road, Mumbai Central, Mumbai 400008, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20170420

Keywords:

Bakri balloon, Deep venous thrombosis, Fibroid, Immune thrombocytopenia, Menorrhagia, Uterine artery embolization

Abstract

A 45-year-old woman was brought into the emergency ward of a tertiary care hospital. The patient gave a history of excess bleeding and passage of clots per vaginum since the past 15 days. The patient had a history of severe headaches, body ache, giddiness and vomiting. She was diagnosed with idiopathic thrombocytopenic purpura (ITP) and severe anemia six months before this incidence. The authors performed a diagnostic pelvic and transvaginal ultrasound and reported the presence of uterine fibroids. They determined that these fibroids had aggravated the bleeding which was caused by ITP. The diagnosis of ITP coupled with severe anemia prevented the authors from using the traditional approach of a hysterectomy in such a case. She was administered tranexamic acid, testosterone enanthate, blood, intravenous immunoglobulins, steroids and platelets transfusion. Uterine artery embolization (UAE) was tried for arresting menorrhagia, but was unsuccessful. Finally, a Bakri® balloon, normally used for management of post-partum hemorrhage (PPH), was inserted and retained for 48 hrs.. The bleeding gradually ceased and significant improvements in hematocrit and platelet count were observed. However, the patient then suffered from a deep vein thrombosis (DVT) in the lower extremity, which was treated with low molecular weight heparin (LMWH), a thrombectomy and an Inferior vena cava Filter. Patient was advised a hysterectomy to curb her symptoms, however, she was too exhausted of surgical procedures and refused. Therefore, the authors decided to employ the use of Selective Estrogen Receptor Molecule Therapy (SERM). 3-months post-intervention, patient is thriving and stable.

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References

Kadir RA, Economides DL, Sabin CA, Owens D, Lee CA. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet. 1998;351(9101):485-9.

Bevan JA, Maloney KW, Hillery CA, Gill JC, Montgomery RR, Scott JP. Bleeding disorders: A common cause of menorrhagia in adolescents. J Pediatr. 2001;138(6):856-61.

Dilley A, Drews C, Lally C, Austin H, Barnhart E, Evatt B. A survey of gynecologists concerning menorrhagia: perceptions of bleeding disorders as a possible cause. J Womens Health Gend Based Med. 2002;11(1):39-44.

Ewenstein BM. The pathophysiology of bleeding disorders presenting as abnormal uterine bleeding. Am J Obstet Gynecol. 1996;175(3 Pt 2):770-7.

Fraser IS, Bonnar J, Peyvandi F. Requirements for research investigations to clarify the relationships and management of menstrual abnormalities in women with hemostatic disorders. Fertil Steril. 2005;84(5):1360-5.

Meirow D, Rabinovici J, Katz D, Or R, Shufaro Y, Ben-Yehuda D. Prevention of severe menorrhagia in oncology patients with treatment-induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate. Cancer. 2006;107(7):1634-41.

Ibrahim R, Alhilli JA, Cooper TT, Dashkova I, Guy J, Gandhi A, et al. Idiopathic thrombocytopenia with iron deficiency anemia. Clinical medicine insights Blood disorders. 2013;6:1-5.

Morris VK, Spraker HL, Howard SC, Ware RE, Reiss UM. Severe thrombocytopenia with iron deficiency anemia. Pediatric hematology and oncology. 2010;27(5):413-9.

Ibrahim R, Khan A, Raza S, Kafeel M, Dabas R, Haynes E, et al. Triad of iron deficiency anemia, severe thrombocytopenia and menorrhagia-a case report and literature review. Clinical medicine insights Case reports. 2012;5:23-7.

Patel KV, Harris TB, Faulhaber M, Angleman SB, Connelly S, Bauer DC, et al. Racial variation in the relationship of anemia with mortality and mobility disability among older adults. Blood. 2007;109(11):4663-70.

Schafer AI. Thrombocytosis. The New England journal of medicine. 2004;350(12):1211-9.

Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115(2):168-86.

Parker WH, Iacampo K, Long T. Uterine rupture after laparoscopic removal of a pedunculated myoma. Journal of minimally invasive gynecology. 2007;14(3):362-4.

Munro MG, Critchley HO, Broder MS, Fraser IS, Disorders FWGoM. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2011;113(1):3-13.

Naoulou B, Tsai MC. Efficacy of tranexamic acid in the treatment of idiopathic and non-functional heavy menstrual bleeding: a systematic review. Acta obstetricia et gynecologica Scandinavica. 2012;91(5):529-37.

Vilos GA, Allaire C, Laberge PY, Leyland N, Special C, Vilos AG, et al. The management of uterine leiomyomas. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2015;37(2):157-81.

Goldrath MH. Uterine tamponade for the control of acute uterine bleeding. American journal of obstetrics and gynecology. 1983;147(8):869-72.

Hamani Y, Ben-Shachar I, Kalish Y, Porat S. Intrauterine balloon tamponade as a treatment for immune thrombocytopenic purpura-induced severe uterine bleeding. Fertility and sterility. 2010;94(7):2769 e13-5.

Kistangari G, McCrae KR. Immune thrombocytopenia. Hematology/oncology clinics of North America. 2013;27(3):495-520.

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Published

2017-01-31

How to Cite

Agrawal, R., Shintre, H., Rani, B., Agrawal, K., & Agrawal, A. (2017). Use of intrauterine balloon tamponade in successful conservative management of life threatening menorrhagia in a patient with idiopathic thrombocytopenic purpura and severe anemia. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6(2), 761–765. https://doi.org/10.18203/2320-1770.ijrcog20170420

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Section

Case Reports