Vaginal bleeding in women with leukemia.

Abstract

6577 Background: Vaginal bleeding (VB) in premenopausal women with leukemia may require transfusions which cause additional morbidity. This study investigates the frequency of VB in women with leukemia admitted to Brigham & Women’s Hospital and reports strategies used in managing VB. Methods: Retrospective chart review of first leukemia admissions for chemotherapy between 1/1/03 and 1/1/08. 114 women ages 18-44 were identified. Exclusion criteria included bleeding diatheses, pregnancy, and hysterectomy. Patients were compared based on presence or absence of VB as documented in the medical record. Results: 69 of 114 patients (60.5%) developed VB (Table). There was no significant difference in the rate of VB among acute (n=95) and chronic (n=19) leukemia patients. Patients with VB had significantly more packed red blood cell and platelet transfusions and a longer length of stay which did not reach statistical significance. Of 69 patients with VB, 53 (76.8%) received therapy for VB. 24 patients received OCPs alone, 10 leuprolide acetate, 12 leuprolide and OCPs, and 7 other combination therapy. Of patients with VB 21/53 (39.6%) received prophylactic therapy, 23/ 53 (43.4%) received therapy for treatment, and the timing of therapy was unclear in the remaining 9/53 (17%). VB stopped in only 28 of 53 (52.8%) patients receiving therapy. It was unclear which therapy was most effective in preventing or managing VB. Only 39 of 69 (56.6%) patients with VB had a recorded last menstrual period so the proportion of VB due to expected menstruation was unknown. 8 of 45 (17.8%) patients without VB received hormonal treatment for prevention of VB. Conclusions: VB occurred in the majority of women during their first leukemia admission and was associated with significantly more blood and platelet transfusions. Further research in effective management of VB in these patients is indicated. Comparison of leukemia patients admitted for chemotherapy with and without VB (mean ± SD). Bleeding (n=69) No bleeding (n=45) P value Age 33.3 ± 7.8 34.3 ± 8.1 0.435 Admission hematocrit 28.8 ± 4.9 29.7 ± 5.2 0.222 Admission platelets 135.6 ± 105.7 160.5 ± 202.0 0.947 Length of stay (days) 32.0 ± 11.8 28.0 ± 15.3 0.107 No. of PRBC transfused 11.3 ± 7.5 6.8 ± 5.7 <0.0005 No. of bags platelets transfused 8.4 ± 8.2 7.6 ± 11.7 0.007