Klinički značaj dijagnostičkog algoritma u detekciji blažih poremećaja hemostaze kod pacijentkinja sa menoragijom
Sažetak
Uvod/Cilj. Poremećaji koagulacije mogu da budu uzrok menoragije kod žena u reproduktivnom periodu. Cilj istraživanja bio je utvrđivanje učestalosti poremećaja koagulacije kod žena sa menoragijom i kreiranje odgovarajućeg algoritma za detektovanje poremećaja koagulacije. Metode. Ispitivani su parametri koagulacije kod 115 žena (36,1 ± 9,6 godina) sa anamnestičkim podatkom o postojanju menoragije koja je verifikovana primenom semi-kvantitativne metode ˗ Pictorial Bleeding Assessment Chart (PBAC) sa skorom ≥ 100. Rezultati. Menoragija je bila objektivno verifikovana kod 55,7% ispitanica. Pacijentkinje sa menoragijom imale su viši PBAC skor [medijana (Md) = 150,0 vs. Md = 50,0; p < 0,001], ali ne i dužinu menstrualnog ciklusa (7,2 ± 2,1 dana vs. 7,3 ± 1,9 dana; p > 0,05). Poremećaji koagulacije bili su detektovani kod 12 (10,4%) ispitanica – snižene vrednosti faktora (F) IX: Ac kod 4 (3,5%), F VII: Ac kod 1 (0,9%), F X: Ac kod 1 (0,9%), F XI: Ac kod 1 (0,9%), a 5 (4,3%) pacijentkinja ispunjavalo je kriterijume blage forme von Willebrandove bolesti (VWB) tip 1. Ispitanice sa poremećajima koagulacije su imale produženo protrombinsko vreme (PT) [Md = 13,1 s (12,2–14,8 s) vs. Md = 12,5 s (10,6–18,3) s; p = 0,032]. Anemija je dijagnostikovana kod 61 (53,0%) pacijentkinje. Najjači prediktor poremećaja hemostaze bilo je postojanje objektivno verifikovane menoragije (količnik verovatnoće 0.018), a zatim prisustvo anemije (12.43), PT (2.35), dužina menstrualnog ciklusa (1.16) i vrednost PBAC skora (0.98). Zaključak. Rezultati istraživanja ukazuju na potrebu formiranja dijagnostičkog algoritma poremećaja hemostaze. Sofisticirane i skupe laboratorijske analize za dijagnozu poremećaja hemostaze bilo bi racionalno sprovesti kod pacijentkinja koje imaju menoraguju verifikovanu objektivnim metodama, PBAC skor > 100, produžen menstrualni ciklus, anemiju i produženo PT.
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