Management of uterine bleeding during hematopoietic stem cell transplantation.
Management of uterine bleeding during hematopoietic stem cell transplantation.
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DOI：
10.1097/aog.0b013e318270ecd3
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发表时间：
2013-02
影响因子：
7.2
通讯作者：
Stratton P
中科院分区：
文献类型：
--
作者：
Purisch SE;Shanis D;Zerbe C;Merideth M;Cuellar-Rodriguez J;Stratton P
造血干细胞移植是治疗多种血液病的有效策略，但患者存在凝血功能障碍和异常出血的风险。在移植前经常咨询妇科医生以管理异常子宫出血，这在这种情况下可能特别具有挑战性。一名患有MonoMAC（一种罕见的成人发病性免疫缺陷综合征，特征为GATA 2（早期造血的关键基因）突变导致的单核细胞减少症和鸟分枝杆菌复合体感染）的绝经前女性出现全血细胞减少症、进展性白血病和近期卒中，需要抗凝治疗。在准备造血干细胞移植期间，她经历了需要输血的长期月经过多。手术治疗是禁忌的，只有在与球囊填塞相结合时，药物治疗才能成功。球囊填塞可能是造血干细胞移植前控制子宫出血的药物治疗的一种潜在的挽救生命的辅助手段。
Hematopoietic stem cell transplant is an effective treatment strategy for a variety of hematologic disorders, but patients are at risk for dysfunctional coagulation and abnormal bleeding. Gynecologists are often consulted before transplant for management of abnormal uterine bleeding, which may be particularly challenging in this context. A premenopausal woman with MonoMAC (a rare adult-onset immunodeficiency syndrome characterized by monocytopenia and Mycobacterium avium complex infections resulting from mutations in GATA2, a crucial gene in early hematopoiesis) presented with pancytopenia, evolving leukemia, and recent strokes, necessitating anticoagulation. During preparation for hematopoietic stem cell transplant, she experienced prolonged menorrhagia requiring transfusions. Surgical therapy was contraindicated, and medical management was successful only when combined with balloon tamponade. Balloon tamponade may be a potentially life-saving adjunct to medical therapy for control of uterine hemorrhage before hematopoietic stem cell transplant.
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