High Prevalence and Clinical Burden of Bleeding Disorder of Unknown Cause in Adolescents With Heavy Menstrual Bleeding: Application of New Definition by the International Society on Thrombosis and Haemostasis.

Authors

Ruchika Sharma, Lindsey Hartland, Kendra Malone, Urooj Wahid, Ravi Sarode, Sean G Yates, Jessica Garcia, Ayesha Zia

Published in

Haemophilia : the official journal of the World Federation of Hemophilia. Oct 10, 2026. Epub Oct 10, 2026.

Abstract

Bleeding disorder of unknown cause (BDUC) is increasingly recognized in patients with clinically significant bleeding despite normal haemostatic testing. The International Society on Thrombosis and Haemostasis (ISTH) recently proposed a standardized definition incorporating bleeding phenotype and validated assessment tools.
To determine the prevalence and clinical impact of BDUC in adolescents with heavy menstrual bleeding (HMB) using the ISTH definition for BDUC.
Among 205 adolescents, 57.6% met criteria for BDUC, including 86.8% of those without an established bleeding disorder using the ISTH paediatric bleeding assessment tool threshold ≥3, most with clinically significant HMB (PBAC >100). Adolescents with BDUC demonstrated similar bleeding severity, with comparable ISTH-BAT and PBAC scores (p = 0.95 and p = 0.62, respectively) as those with diagnosed bleeding disorders. However, BDUC was associated with higher rates of anaemia (50% vs. 31%, p = 0.016) and increased emergency department utilization (47% vs. 30%, p = 0.03), while iron deficiency, hospitalizations, and transfusion requirements were similar between groups. Health-related quality of life was similarly impaired in both groups (PedsQL fatigue scores of 61.1 vs. 59.6, p = 0.65).
BDUC is highly prevalent among adolescents with HMB and is associated with a clinical burden comparable to, and in some domains exceeding, that of established bleeding disorders. These findings support BDUC as a clinically meaningful phenotype and highlight the need for improved diagnostic precision and targeted management strategies.

PMID:
42855996
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.

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