**5.1 Menorrhagia (Case 6)**

A 12-year-old female was referred to pediatric hematology clinic for a possible bleeding disorder. She had had heavy menstrual periods since menarche 6 months previously. She had been admitted to a local community hospital 4 months earlier at which time she was found to be profoundly anemic with a hemoglobin of 5.9 g/dL, MCV 68.2 fL with symptoms of anemia requiring several blood transfusions. She was started on oral birth control pills with resolution of her menorrhagia. She was also started on daily iron sulfate tablets.

Apart from dysfunctional uterine bleeding, the patient did not have a past medical history of bleeding problems, nosebleeds, easy bruising, petechiae or mucosal bleeding. She denied any loose, bloody, tarry stools or abdominal pain. She had no food allergies. She was healthy before the onset of menarche except for daily headaches which had been evaluated by CT. Her father said he experienced similar headaches as an adolescent. Her father denied a family history of bleeding disorders or menorrhagia. She was doing well in 7th grade and enjoyed cheerleading.

In clinic the patient was alert and in no apparent distress. She was afebrile, with normal vital signs. Skin was unremarkable with no petechiae or bruising. Her conjunctivae were pink without pallor. Abdomen was soft, nontender, nondistended without hepatosplenomegaly. A comprehensive coagulation workup showed no evidence of a systemic bleeding disorder. At the time of her visit to pediatric hematology clinic her hemoglobin was 12.5 g/dL, MCV 82.4, fL, both normal. A ferritin level was normal.
