Platelet Disorders in the Adolescent Female

Platelet disorders in the adolescent female are comprised of congenital and acquired platelet disorders associated with a decrease in platelet number and/or abnormality in platelet function. Bleeding symptoms in patients with platelet disorders most commonly involve skin and mucous membrane bleeding. In females with platelet disorders, heavy menstrual bleeding is the most common bleeding symptom. In adolescents presenting for evaluation, a complete history of bleeding symptoms including menstrual history, history of excessive bleeding with dental and surgical procedures, family history of bleeding symptoms and diagnosed bleeding disorders, and medication history should be obtained. Bleeding assessment and screening tools may be useful. Available laboratory testing for platelet disorders in addition to platelet count includes light and electron microscopy, platelet aggregometry and secretion assays, flow cytometric analysis, and point-of-care tests. Molecular diagnostic testing can provide confirmatory testing. Management varies depending on the severity of the bleeding symptoms and may include antifibrinolytic agents, recombinant VIIa, DDAVP, and platelet transfusions. Hormonal agents may be required for management of heavy menstrual bleeding in adolescent females with platelet disorders. Thrombopoietin mimetics are useful in raising the platelet count in acute and chronic ITP and in congenital MYH9-related platelet disorders. Identification and management of iron deficiency anemia is important in adolescent females with platelet disorders.