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Forum Name: Hematology Topics

Question: Long bleeding time & low iron but without a diagnostic


 esullivan - Sun Aug 26, 2007 12:22 am

My daughter is 15 years old, with general good health. She had her first period 3.5 years ago, and from the very beginning, I noticed that something was wrong: the amount of blood was enormous!! Until then, I didn't notice any abnormal bleeding. My husband and I have good health, without bleeding problems

Our family doctor run some tests and the only abnormal result was her bleeding time (12 minutes).
She was referred to a children hematology service. The hematoligist ran dozens of blood tests (Proteins, Von Wildebrand, factors, etc). All the results seem normal, however, her bleeding time remains between 10-12 minutes
Since last year the amount of blood of her periods seems more "controlled", however, each injury bleeds a lot. But other than this, my daughter has a normal life.
But suddenly, last year, even without injuries or excessive bleeding, she started to feel tired. Her ferritin level was checked annd was 35. She took an iron supplement, the ferritin went to 52. After 6 month she was told to stop with the supplement and now the ferritin level is again in 35

Therefore, we don't have a diagnostic or a solution. We were told that the tiredness may be or may be not related with the ferritin level. The only answer we have from the doctors is "she has a medical condition and she should live with this".

Are there other diagnostic resources? Can this problem be a consequence of other disorder (meaning liver, or kidneys or...) Should we look for more answers with other medical specialties?
Thank you in advance
 Dr. Chan Lowe - Fri Sep 14, 2007 11:08 pm

User avatar Hi Esullivan,

It sounds as if your daughter has seen a hematologist already. Follow up with them is important.

The most common reason for a prolonged bleeding time is an improperly done test now that it is not commonly done anymore. In the setting of a truly prolonged bleeding time, Von Willebrand's disease is the most common cause and often presents with prolonged or heavy menstrual bleeding in girls.

It is important to assess not only for proper Von Willebrand's factor levels but also for proper functioning. Von Willebrand's type II is a qualitative function problem with the Von Willebrand's factor and the levels are normal but the protein doesn't work.

Assuming this has been tested for there are some other very rare coagulation disorders that are still being characterized. These disorders can cause a prolonged bleeding time also. One of these disorders I found while researching this is a condition where the platelet microvesicle generation is impaired. I can't tell you much beyond this about this condition, though.

Regarding the iron, heavy menstrual bleeding is a very common cause of iron deficiency anemia. Ferritin is an indirect marker of iron levels. Given that she responded to the iron supplementation it is likely that this is the cause. She should probably continue to take a good iron supplement to keep her levels up.

Best wishes.

Best wishes.
 esullivan - Tue Sep 18, 2007 11:10 am

Dr. Lowe,

Thank you for your answer.
The report we received from the Hematology Clinic states that my daughter "had and extensive work-up for a bleeding disorder which revealed all were within normal limits. Her INR, PTT, von Willebrand screening and platelet aggregation studies were all normal as were her platelet electron microscopy results. Rare fibrinolytic defects were also investigated which were within normal limits"

They also stated "We will therefore not need to see her again in clinic"

Regarding the continued iron intake, they stated "should not over-use iron as to avoid iron toxicity"

The above reasons show why I am lost.
As I understand my daughter bleeds but has not a bleeding disorder? her ferritin is low but if she takes too much iron can be toxic?

Thank you again

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