Treatment of menorrhagia due to aplastic anemia by hysteroscopic resection of endometrial functional layer and levonorgestrel-releasing intra-uterine system: Three case reports

RATIONALE: In women, menorrhagia associated with aplastic anemia (AA) is secondary to thrombocytopenia and can be acute and severe. Endometrial ablation or hysterectomy has been reported to achieve beneficial results. However, serious limitations and long-term complications exist. We report this clinical case series with the aim of sharing our experiences and exploring a safe and effective way to treat abnormal uterine bleeding (AUB) AA women with future fertility desire. PATIENT CONCERNS: The 3 young patients aged 25 to 29 years old suffered from AUB secondary to AA. DIAGNOSIS: They were diagnosed with AA by bone marrow biopsy and presented with symptoms and signs of AUB without other identified causations. INTERVENTIONS: When the platelet count was between 30∗10(9) /L∼50∗10(9) /L after a blood transfusion, each patient received a hysteroscopic resection of endometrial functional layer and was fitted a levonorgestrel-releasing intra-uterine system (LNG-IUS) in uterine cavity following the surgery. OUTCOMES: All the patients recovered without incident and were discharged in clinically stable conditions. LESSONS: In conclusion, AUB secondary to AA can be acute and severe. Hemostasis is more difficult due to progressive pancytopenia. For young women with future fertility desire, LNG-IUS following hysteroscopic resection of endometrial functional layer is a safe and effective way against endometrial ablation or hysterectomy.