A significant majority (86 ) were diagnosed with a PFD at or PubMed ID…

g., epistaxis, ecchymosis, etc. (P<.01) Overall, only 30 of patients diagnosed with a PFD prior to menarche subsequently manifested HMB after pubertal transition, and all had the -SPD, while a large majority (70 ) did not develop HMB after menarche (42mo median follow-up). Significant differences between age-at-PFD diagnoses may in part reflect bleeding severity. Individuals with severe bleeding symptoms often present early in childhood, suggesting patients that did not manifest HMB PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/14960617 after menarche presented with more severe bleeding that led to earlier evaluation and diagnosis [28]. Some may have had family members with positive bleeding histories, prompting earlier evaluation. However, owing to the heterogeneity of PFDs, it is possible that some may not have manifested as severe bleeding symptoms as other patients with de novo PFD diagnoses, but without positive familial bleeding histories. Additionally, our HMB teens shared a similar high prevalence of family bleeding tendencies and yet were diagnosed with a PFD at anAmesse et al. Experimental Hematology Oncology 2013, 2:3 http://www.ehoonline.org/content/2/1/Page 7 ofTable 4 Types of platelet defects identified in postmenarcheal adolescentsPlatelet Defect -SPD Combined -SPD + Aspirin-like defect Combined --SPD Aspirin-like defect Platelet function disorder, NFC Combined PFD and type I, VWD Heavy Menstrual Bleeding (n=43) 32 (74) 1 ( 2) 1 ( 2) 4 ( 9) 4 ( 9) 1 ( 2) Non-Heavy (S)-3-(tert-Butoxycarbonyl)-2,2-dimethyloxazolidine-4-carboxylic acid Menstrual Bleeding (n=20) 9 (45) 1 ( 5) 0 6 (30) 4 (20) 0 Pvalue 0.007 >.05 >.05 >.05 >.05 >.05 Odds Ratio (95 CI) 4.62 (1.47,14.5)=alpha; -SPD=dense granule Storage Pool deficiency; NFC=not further classified; VWD=von Willebrand Disease. Data are presented as n ( ).older age. Hemostatic challenges did not appear to influence earlier PFD diagnoses as evidenced by similar intergroup surgery-associated bleeding histories, particularly childhood tonsillectomies and adenoidectomies. Treatment regimens, such as desmopressin acetate, tranexamic acid, etc., may have prevented HMB. However, therapeutic intervention does not explain the existence in our study of a subset of young girls diagnosed with a PFD prior to menarche (14 ) that developed HMB after transitioning into puberty. Indeed, similar findings were recently 2-Bromobenzothiazole-6-carboxylic acid methyl ester reported in a study by Chi et al. in which the diagnosis of a bleeding disorder was known in 64 of young females prior to their presentation with menorrhagia, yet they developed HMB despite instruction to take tranexamic acid when menses began [14]. The long (mean) 1.8-year interval between menarcheto-HMB onset was at variance with prior studies on menorrhagia that reported HMB occurring predominately at or within the first year of menarche in patients with bleeding disorders [4,6,7,9]. Indeed, Chi et al. reported HMB onset occurred at menarche in 90 of adolescents affected with bleeding disorders [14]. Adolescents with PFDs that clinically manifested HMB have not been exclusively analyzed until the present report. It is possible that differences in the menarche-to-HMB interval may be related in part to prior studies intermixing data from PFD patients with data from subjects affected with disparate bleeding disorders, thus obscuring the actual temporal relationship [4,5,7,14]. Of interest, PFD adolescents th.