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Painful bruising: Gynecology, hematology, or just pill bias? A case report

A 23-year-old woman, G0, presented to the emergency department with painful bruising of the legs shortly after starting an oral contraceptive pill. The presumed diagnosis was pill-induced ecchymosis, and she was instructed to discontinue the medication. Her bruising resolved. However, the working di...

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Detalles Bibliográficos
Autores principales: Villamor, Gabriela, Winograd, Deborah, Baum, Jonathan D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502329/
https://www.ncbi.nlm.nih.gov/pubmed/37719129
http://dx.doi.org/10.1016/j.crwh.2023.e00538
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author Villamor, Gabriela
Winograd, Deborah
Baum, Jonathan D.
author_facet Villamor, Gabriela
Winograd, Deborah
Baum, Jonathan D.
author_sort Villamor, Gabriela
collection PubMed
description A 23-year-old woman, G0, presented to the emergency department with painful bruising of the legs shortly after starting an oral contraceptive pill. The presumed diagnosis was pill-induced ecchymosis, and she was instructed to discontinue the medication. Her bruising resolved. However, the working diagnosis was later questioned as the patient had used other oral contraceptive pills in the past without any adverse reaction. In addition, there is robust literature associating these medications with thrombosis, not bruising. The patient later disclosed that she had concomitantly started an oral hair supplement along with her oral contraceptive pill. Analysis of the supplement contents revealed that it contained extract of Aesculus hippocastanum, a herbal anticoagulant, making this a much more plausible explanation for the ecchymosis. She then resumed the original oral contraceptive pill alone without any reaction. The case highlights how cognitive bias resulted in a misdiagnosis. Specifically, this case introduces the concept of pill bias, as the patient's unexplained bruising was presumed to be a result of her use of an oral contraceptive despite the lack of evidence to support this claim. This bias has the potential to impact clinical decision-making and lead to clinical errors.
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spelling pubmed-105023292023-09-16 Painful bruising: Gynecology, hematology, or just pill bias? A case report Villamor, Gabriela Winograd, Deborah Baum, Jonathan D. Case Rep Womens Health Article A 23-year-old woman, G0, presented to the emergency department with painful bruising of the legs shortly after starting an oral contraceptive pill. The presumed diagnosis was pill-induced ecchymosis, and she was instructed to discontinue the medication. Her bruising resolved. However, the working diagnosis was later questioned as the patient had used other oral contraceptive pills in the past without any adverse reaction. In addition, there is robust literature associating these medications with thrombosis, not bruising. The patient later disclosed that she had concomitantly started an oral hair supplement along with her oral contraceptive pill. Analysis of the supplement contents revealed that it contained extract of Aesculus hippocastanum, a herbal anticoagulant, making this a much more plausible explanation for the ecchymosis. She then resumed the original oral contraceptive pill alone without any reaction. The case highlights how cognitive bias resulted in a misdiagnosis. Specifically, this case introduces the concept of pill bias, as the patient's unexplained bruising was presumed to be a result of her use of an oral contraceptive despite the lack of evidence to support this claim. This bias has the potential to impact clinical decision-making and lead to clinical errors. Elsevier 2023-08-31 /pmc/articles/PMC10502329/ /pubmed/37719129 http://dx.doi.org/10.1016/j.crwh.2023.e00538 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Villamor, Gabriela
Winograd, Deborah
Baum, Jonathan D.
Painful bruising: Gynecology, hematology, or just pill bias? A case report
title Painful bruising: Gynecology, hematology, or just pill bias? A case report
title_full Painful bruising: Gynecology, hematology, or just pill bias? A case report
title_fullStr Painful bruising: Gynecology, hematology, or just pill bias? A case report
title_full_unstemmed Painful bruising: Gynecology, hematology, or just pill bias? A case report
title_short Painful bruising: Gynecology, hematology, or just pill bias? A case report
title_sort painful bruising: gynecology, hematology, or just pill bias? a case report
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502329/
https://www.ncbi.nlm.nih.gov/pubmed/37719129
http://dx.doi.org/10.1016/j.crwh.2023.e00538
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