Dysfunctional Uterine Bleeding in Pediatrics Workup
- Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Andrea L Zuckerman, MD more...
Focus routine laboratory studies on discovering common complications and ruling out serious medical conditions that can mimic dysfunctional uterine bleeding (DUB), as follows:
Complete blood count (CBC), including platelet count - Useful for revealing anemia, thrombocytopenia, oncologic concerns, and infections
Prothrombin time (PT), activated partial thromboplastin time (aPTT), and bleeding time - For possible blood dyscrasias and clotting disorders
Pregnancy test - Must be performed, even in patients who deny sexual activity
Cervical cultures or urine DNA probe - To determine the existence of chlamydial infection and gonorrhea, especially if sexual activity is suspected - The prevalence of chlamydial infection has historically been underestimated; in the United States, it is the most commonly reported sexually transmitted infection 
Reserve the following secondary laboratory studies for patients with abnormal bleeding; for patients who are unresponsive to therapy; and for patients with findings on history, physical examination, or laboratory studies suggestive of a systemic disorder:
Thyroid-stimulating hormone (TSH) test and free thyroxine concentration (fT4) -To screen for thyroid disease
Fasting glucose - To rule out occult diabetes
Prolactin - To rule out hyperprolactinemia 
Dehydroepiandrosterone sulfate (DHEAS), free testosterone, and 17-hydroxyprogesterone (17 OHP) - To evaluate for polycystic ovarian syndrome (PCOS)
vWF:Ag (von Willebrand factor: antigen), vWF:RCo (von Willebrand factor: ristocetin cofactor) and factor VIII - If von Willebrand disease is suspected 
Reserve pelvic imaging studies for women who do not respond to routine management.
Ultrasonography, either transabdominal or transvaginal (the latter to be considered only in patients with a history of sexual intercourse/tampon use), is the method of choice for evaluation of the female pelvis. It is useful for detecting structural abnormalities of the uterus, PCOS, and ovarian neoplasms. An experienced ultrasound technician or practitioner is necessary to properly perform and interpret this imaging study.
Magnetic resonance imaging (MRI) has adequate resolution, but it is only rarely superior to ultrasonography and is significantly more expensive.
Computed tomography (CT) can be useful in the workup of adolescent females with a confirmed neoplasm. It is important to ascertain a benefit for using this study as to avoid unnecessary radiation exposure to the pelvic region.
Uterine curettage is rarely indicated in the adolescent with DUB. This procedure is usually reserved for women with significant and prolonged hemorrhage unresponsive to medical therapy.
Diagnostic hysteroscopy can be used to look for structural abnormalities as a cause of persistent DUB.
Sonohysterography is a less invasive but less accurate method of evaluating the uterine cavity. The procedure consists of injecting fluid into the uterus under ultrasonographic visualization.
Endometrial biopsy is rarely required and should be reserved for adolescents with unresponsive uterine bleeding to standard medical intervention. Endometrial curetting often demonstrates a disordered proliferative pattern without secretory activity (absence of progesterone effect). Findings of endometrial biopsies in patients who are currently receiving hormonal therapy demonstrate the hormonal effects and sometimes interfere with biopsy interpretation.
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