PB0367 - Heavy menstrual bleeding in paediatric patient due to resistant chronic immune thrombocytopenia successfully treated with eltrombopag and tranexemic acid - a case report form Bosnia and Herzegovina

Background: Immune thrombocytopenia (ITP) is a disorder that can lead to easy or excessive bruising and bleeding. Patients with platelet's lower than 10-30 × 109/L, are at increased bleeding risk. Usual clinical features include petechiae, bruises, epistaxis, and gum bleeds. ITP can cause menstrual problems. Heavy menstrual bleeding (HMB) may occur at the onset of menarche. HMB is defined as menstrual periods with abnormally heavy bleeding and/or prolonged bleeding (more than 7 days).

Aims: To present the successful management of HMB at the onset of menarche in paediatric female patient due to chronic refractory ITP, with the introduction of eltrombopag in combination with tranexemic acid (during first 5 days of the cycle)

Methods: retrospective review of patient's data

Results: 11-year-old girl with chronic ITP, resistant to steroids, immunoglobulins and rituximab was admitted to our department due to prolonged heavy menstrual bleeding and extremely low platelets. ITP was diagnosed at the age of 2 years and 7 months. She was treated with 1st, 2nd and 3rd line therapy for ITP, without success. Before the introduction of eltrombopag, platelet values ranged from 10-20 x10*9, with clinical manifestations of petechiae, frequent epistaxis. Upon admission platelet values were 2x10*9, and the menstrual bleeding lasted for 10 days. After the introduction of eltrombopag, platelet values increased to 20 (after 7 days), then above 50 (after 14 days of therapy). The next menstrual cycle, along with eltrombopag, tranexmic acid was prescribed for the first 5 days of the cycle, and it lasted 6 days. During the follow-up of 2 years, menstrual cycles last aproximately 5-6 days, without excessive bleeding. During the cycle platelets maintained in the interval of 40-90x10*9.

Conclusion(s): The management of HMB in our paediatric patient with chronic ITP treated in combination with eltrombopag and tranexemic acid confirmed to be successful during a follow-up of 2 years.