Undiagnosed bleeding disorder, hysteroscopy

43-year-old lady for Hysteroscopy/D&C


  • Asthma and upper airway dysfunction – stable disease, well-controlled with inhaled therapies and regular respiratory review
  • Cannabis smoker – daily


  • Abnormal uterine bleeding – menorrhagia for 3/52 each month, using 6+ pads per day
  • Bleeding significantly affecting QoL; unable to work, take children swimming.
  • Fe-deficiency, no anaemia. 3 monthly iron infusions.
  • Positive bleeding history – epistaxis x2 per week. Gum bleeding when brushes teeth.
  • International Society of Thrombosis and Haemostasis (ISTH) Bleeding score = 4 

Description automatically generated
  • Normal range is <4 in adult males, <6 in adult females and ❤ in children


Preoperative interventions required?

  • Discussed with haematology registrar, unusual pathology results; Factor VIII levels and antigens supra-normal indicating vWD unlikely
  • Normal Full Blood Count, APTT slightly raised at 39
  • Interestingly, lupus anticoagulant and fibrinogen were raised which would indicate a propensity for clotting rather than bleeding
  • Urgent Haematology appointment organised – unlikely to occur preoperatively. Public outpatient system under pressure at present
  • Consensus that it would be reasonable to proceed with above procedure

Surgical Options

  • Discussed with Gynaecology Fellow, agreed it is important to address bleeding while awaiting further haematology review
  • Options for Mirena will be presented to patient as a short-term management


  • Proceed to surgery
  • Haematology review pending