ABSTRACT

Blood loss in the normal menstrual cycle is self-limited due to the action of platelets and fibrin. Individuals with thrombocytopenia or coagulation deficiency may have excessive menstrual bleeding. Coagulation disorders are the most common inherited cause of menorrhagia among young girls. The incidence of coagulopathy in puberty menorrhagia may be found in 12 to 33%. We present here a rare case of a 24 year old girl having menorrhagia since menarche secondary to coagulopathy in liver disease and portal hypertension. A brief review of literature is given along with references. Coagulopathy secondary to liver dysfunction presents with raised thrombin time, d-dimer and fibrinogen degradation products, hypo or dysfibrinogenemia with platelet function defects, raised prothrombin time, d-dimer and fibrinogen degradation products. Hypo or dysfibrinogenemia with platelet function defects, raised prothrombin time and aPTT have been described in the presence of normal liver enzymes. The contributory factors for defective hemostasis in portal hypertension are attributed to decreased synthesis of procoagulant and anticoagulant proteins, impaired clearance of activated coagulation factors, nutritional deficiency (vitamin K and folate) synthesis of functionally abnormal fibrinogen with splenomegaly due to sequestrational thrombocytopenia and qualitative platelet defects. In portal hypertension more than 80% of the platelet pool is sequestered in spleen, platelet count rarely falls below 30,000/mm3 and spontaneous bleeding is uncommon. Bleeding can be fatal in young girls at menarche if not previously diagnosed. Treatment is rewarding and prognosis good provided platelet transfusion is available.

Keywords: Puberty menorrhagia, platelet dysfunction, coagulation disorders, liver disease