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
- 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
- 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