The objective of this study was to determine the number of women presenting with abnormal uterine bleeding as the chief complaint leading to a diagnosis of hematologic cancer.
This is a retrospective chart review of 205 adult women with hematopoietic cancer and concurrent abnormal uterine bleeding during a 10-year period from January 1, 2002, to January 1, 2011.
A total of 2,095 premenopausal women with hematopoietic cancer were seen; of these, 205 of 2,095 (9.8%) experienced concurrent abnormal uterine bleeding. Nineteen (9.3%) of these 205 women described abnormal uterine bleeding as the presenting symptom leading to their cancer diagnosis. The women were all young (mean age 39 years), premenopausal, and otherwise healthy. Their abnormal uterine bleeding was described as new onset and severe with bleeding significantly heavier than previous cycles, causing them to seek immediate gynecologic or emergency care. Accompanying symptoms included fatigue (63.2%), bruising and petechiae (42.1%), dyspnea on exertion (36.8%), and fever (16%). They were thrombocytopenic with a mean platelet count of 52.9 (range 5–175 K/UL), had abnormal white blood cell counts (mean 25.8, range 1.4–127 K/UL), and 89.5% were anemic with mean mercury 9.0 (range 5.1–13.7 g/dL). Half of the women were diagnosed with acute myelogenous leukemia, and 42% (8/19) of this cohort died.
Although hematologic cancer presenting as abnormal uterine bleeding is rare (1% [19/2,095]), it has potentially devastating consequences. Young healthy women with a history of normal menstrual cycles who present with acute onset of heavy abnormal uterine bleeding warrant further scrutiny with a complete blood cell count. Findings of profound thrombocytopenia or pancytopenia can facilitate the prompt diagnosis of a hematologic malignancy.