Abnormal Uterine Bleeding and External Genital Endometriosis in a 14-Year-Old Patient with Idiopathic Thrombocytopenic Purpura: Case Report

Background. Idiopathic Thrombocytopenic Purpura is one of the most common acquired blood-clotting disorders in adolescents. This disease is characterized by an increased risk of developing concomitant gynecological pathologies, such as abnormal uterine bleeding, ovarian tumors and tumor-like masses, external genital endometriosis, which requires careful medical supervision and, if necessary, surgical intervention. 
Case report. A clinical event of a 14-year-old patient with idiopathic thrombocytopenic purpura complicated by external genital endometriosis and abnormal uterine bleeding is being considered. The patient underwent surgery in the amount of laparoscopic oophorectomy, which prevented the development of severe complications. 
Conclusion. This case gives accent to the importance of a comprehensive and interdisciplinary approach to the treatment of patients with idiopathic thrombocytopenic purpura and concomitant gynecological pathologies, which helps minimize the risk of life-threatening complications.

1. Yelak A, From A, Gilad O, et al. Symptomatic corpus luteum hemorrhage in adolescent females with ITP. Eur J Pediatr. 2024;183(7):2893–2897. doi: https://doi.org/10.1007/s00431-024-05560-0

2. Shaw J, Kilpatrick K, Eisen M, Tarantino M. The incidence and clinical burden of immune thrombocytopenia in pediatric patients in the United States. Platelets. 2020;31(3):307–314. doi: https://doi.org/10.1080/09537104.2019.1635687

3. Despotovic JM, Grimes AB. Pediatric ITP: is it different from adult ITP?Hematology Am Soc Hematol Educ Program. 2018;2018(1):405–411. doi: https://doi.org/10.1182/asheducation-2018.1.405

4. Schifferli A, Holbro A, Chitlur M, et al. A comparative prospective observational study of children and adults with immune thrombocytopenia: 2-year follow-up. Am J Hematol. 2018;93(6):751-759. doi: https://doi.org/10.1002/ajh.25086

5. Tungjitviboonkun S, Bumrungratanayos N. Immune thrombocytopenia (ITP): historical perspectives, pathophysiology, and treatment advances. Discov Med. 2024;1(7). doi: https://doi.org/10.1007/s44337-024-00008-8

6. Bolton-Maggs PHB, George JN. Immune Thrombocytopenia Treatment. N Engl J Med. 2021;385(10):948–950. doi: https://doi.org/10.1056/NEJMe2110953

7. Elliott RH. Diagnostic and Therapeutic Considerations in the Management of Idiopathic Thrombocytopenic Purpura. Bull N Y Acad Med. 1939;15(3):197–210.

8. Ahn YS, Harrington WJ. Treatment of idiopathic thrombocytopenic purpura (ITP). Annu Rev Med. 1977;28:299–309ENG. doi: https://doi.org/10.1146/annurev.me.28.020177.001503

9. George JN, Woolf SH, Raskob GE, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996;88(1):3–40.

10. Harama D, Goi K, Saito K, et al. Decreased incidence of acute immune thrombocytopenia in children during the COVID-19 pandemic. Int J Hematol. 2023;117:(2)307–308. doi: https://doi.org/10.1007/s12185-022-03521-7

11. Kurmanaleeva AY, Sibirskaya EV, Korotkova SA, Osipova GT. COVID-19 kak prediktor razvitiya anomnal’nykh matochnykh krovotecheniy. Effektivnaya farmakoterapiya. 2023;19(23):28–32. (In Russ). doi: https://doi.org/10.33978/2307-3586-2023-19-23-28-32]

12. Sakamoto K, Ono R, Doi T, et al. Reduced incidence of hemophagocytic lymphohistiocytosis in Japan during the COVID-19 pandemic. Int J Hematol. 2022;115(4):446–448. doi: https://doi.org/10.1007/s12185-022-03302-2

13. Sibirskaya EV, Kurmangaleeva AY, Korotkova SA, Osipova GT. Abnormal uterine bleeding and COVID-19 (literature review). Russian Journal of Human Reproduction. 2023;29(3):74–80. (In Russ). doi: https://doi.org/10.17116/repro20232903174]

14. Adamyan LV, Sibirskaya EV, Koltunova IE, et al. Anomalous uterine bleeding during puberty: diagnosis and treatment tactics (literature review). Russian Journal of Human Reproduction. 2016;22(6):89–97. (In Russ). doi: https://doi.org/10.17116/repro201622689-97]

15. Adamyan LV, Koltunov IE, Sibirskaya EV, et al. Features of the differential diagnosis of ovarian tumors in girls (observation from the practice). Detskaya Khirurgya (Pediatric Surgery, Russian journal). 2018;22(4):205–208. (In Russ). doi: https://doi.org/10.18821/1560-9510-2018-22-4-205-208]

16. Singh N, Tripathi R, Mala Y, et al. Massive Spontaneous Intraperitoneal Hemorrhage in a Young Female with Chronic Immune Thrombocytopenic Purpura Masquerading as Ruptured Ovarian Cyst: Successful Nonsurgical Management of This Rare Catastrophic Event. Pediatr Emerg Care. 2015;31(3):284–285. doi: https://doi.org/10.1097/PEC.0000000000000402

17. Shaw TB, Ma B, Barazza M, Sawaya D. Surgical Control of Bleeding From Ovarian Torsion in the Setting of Immune Thrombocytopenic Purpura Without Splenectomy. Am Surg. 2023;89(11):4884–4887. doi: https://doi.org/10.1177/00031348211011128

18. Kaplan J, Bannon CC, Hulse M, Freiberg A. Peritoneal hemorrhage due to a ruptured ovarian cyst in ITP. J Pediatr Hematol Oncol. 2007;29(2):117–120. doi: https://doi.org/10.1097/MPH.0b013e3180314206

19. Ramadan MK, Kharroubi M, Khaza’al J. Successful Conservative Treatment of Ovulation-Related Hemoperitoneum in a Patient With Congenital Hypofibrinogenemia: A Case Report and Review of Literature. J Clin Gynecol Obstet. 2020;9(4):112–118. doi: https://doi.org/10.14740/jcgo628

20. Radakovic B, Grgic O. Von Willebrand disease and recurrent hematoperitoneum due to the rupture of haemorrhagic ovarian cysts. Haemophilia. 2009;15(2):607–609. doi: https://doi.org/10.1111/j.1365-2516.2008.01930.x