Management of Menorrhagia Associated With Chemotherapy-Induced Thrombocytopenia in Women With Hematologic Malignancy

Jill S. Bates, Pharm.D., M.S.; Larry W. Buie, Pharm.D.; C. Brock Woodis, Pharm.D.

Disclosures

Pharmacotherapy. 2011;31(11):1092-1110. 

In This Article

Menorrhagia in Platelet Refractory Patients

Patients receiving chemotherapy often receive many platelet transfusions and are at risk for platelet alloimmunization. This will ultimately result in platelet refractoriness and the inability for patients to experience an increase in their platelet counts after a platelet transfusion. Human leukocyte antigen–matched platelets may be necessary to avoid platelet destruction; however, they may not always be available for the patient. In patients experiencing heavy bleeding during gynecologic and obstetric intervention, as well as other types of serious bleeding events, rFVIIa has been shown to be effective at restoring hemostasis.[72]

A case report of a 24-year-old woman with Glanzmann thrombasthenia refractory to highdose oral contraceptives, tranexamic acid, and platelet transfusion illustrates the responsiveness to rFVIIa in this situation.[73] The patient was admitted to the hospital after 10 days of uncontrollable menses. She had been using a daily oral contraceptive pill, drospirenon 3 mg and ethinyl estradiol 0.03 mg. On examination, she was pale, her hemoglobin level was 7.4 g/dl, and her platelet count was 234 × 10 3/mm 3. Her oral contraceptive dose was increased to 3 tablets/day, and she was given 4 units of packed red blood cells. She failed to respond to platelet transfusions, and rFVIIa therapy was started every 2 hours at 90 μg/kg. Her vaginal bleeding was controlled within 14 hours (six doses of rFVIIa were given). No thromboembolic events were documented. The patient was given a GnRH analog to attempt to prevent future bleeding.

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