Уважаемая доктор Татьяна!
Соглашусь с Вами, что гинекологическая патология занимает лидирующее положение в генезе менометроррагии, я же имел в виду первичные (без наличия явной гинекологической причины).
Аргументирую ответ:
Blood Coagul Fibrinolysis. 2002 Mar;13(2):89-93.
von Willebrand's disease: an important cause of dysfunctional uterine bleeding.
Woo YL, White B, Corbally R, Byrne M, O'Connell N, O'Shea E, Sheppard BL, Bonnar J, Smith OP.
...VWD was diagnosed in five of 38 (13%) patients with menorrhagia and one of 38 (2.6%) patients with normal menstrual blood loss. The mean VWF:Ac value was significantly reduced in patients with menorrhagia (mean +/- standard deviation, 84.5 +/- 26.7 IU/dl versus 103.9 +/- 34.5 IU/dl; P < 0.01) and this effect persisted after exclusion of patients diagnosed with VWD...
J Thromb Haemost. 2003 Mar;1(3):477-84.
Platelet functional defects in women with unexplained menorrhagia.
Philipp CS, Dilley A, Miller CH, Evatt B, Baranwal A, Schwartz R, Bachmann G, Saidi P.
Menorrhagia is a common clinical problem and is unexplained in more than 50% of women... Seventy-four women were studied. Bleeding time was prolonged in 23 women (31.5%). Maximal percent platelet aggregation was decreased with one or more agonists in 35 (47.3%) women. The most commonly found platelet function defects were reduced aggregation responses to ristocetin in 22 (29.7%) women and to epinephrine in 16 women. Sixteen of 22 women with reduced ristocetin aggregation had von Willebrand ristocetin cofactor (VWF:RCo) and von Willebrand factor antigen (VWF:Ag) > 60%... Ten women (13.5%) had VWF:RCo and/or VWF:Ag < 60%.
Т.е. у каждой третьей женщины с необьяснимой менометроррагией можно найти снижение фактора фон Виллебранда, у каждой 7-8 определить заболевание (снижение менее 60%). Хотя опять-таки априори соглашусь, что среди всех менометроррагий данный процент значительно ниже.
Beck EA, Limoni C.
Subnormal plasma von Willebrand factor (ristocetin cofactor) and iron deficiency anaemia in menstruating women.
Thromb Haemost. 1996 Apr;75(4):693.
Интересное наблюдение наводит на мысль, что вероятно, сам по себе железодефицит может быть причиной снижения синтеза/секреции ффВ и это в свою очередь может усиливать менструальные потери.
Сравнивая 2 референтных диапазона значений ТТГ (0,23 - 4,0 и 0,27 - 4,2 мкU/мл) можно заключить, что значение 4,5 если и не является повышенным, то граничит с верхней границей нормы при использовании любых тест-наборов, но меня это не слишком смущает, тк есть наблюдения, что существуют небольшие изменения гормонов ЩЖ (похожие на их субклинический дефицит) при дефиците железа и это может нормализоваться при коррекции анемии/дефицита железа.
Exp Clin Endocrinol Diabetes. 1999;107(6):356-60.
Incidence of sideropenia and effects of iron repletion treatment in women with subclinical hypothyroidism.
Duntas LH, Papanastasiou L, Mantzou E, Koutras DA.
Endocrine Unit, Evgenidion Hospital, Athens University Medical School, Greece.
Sideropenia affects ca. 20% of the world population, and iron dependent anemia is the most frequent type of anemia worldwide. The aim of the study was to investigate the incidence of sideropenia and dependent anemia in patients with subtle changes of the thyroid function, such as subclinical hypothyroidism (SH). 57 women with SH and 61 euthyroid controls (CG) were studied. Serum concentrations of T4, T3, TSH, anti-TPO, anti-Tg, ferrum (Fe), ferritin (Frt) total iron binding capacity (TIBC) and blood count were determined. In SH 17 patients (29.8%) presented low Fe levels (<50 microg/dl). 9 (15.7%) also had decreased Frt, confirming iron deficiency, whereas 8 patients presented additionally diminished hematocrit and hemoglobin levels, suggesting manifested sideropenic anemia. In CG, 10 persons (16%) had sideropenia, 6 (9.8%) had low Fe and Frt and only 3 (4.9%) had blood count alterations suggesting manifested sideropenic anemia. In SH, anti-TPO were positive in 39 patients (68%), whereas, in CG only 2 (3.2%) were positive. 8 patients with SH and manifested sideropenic anemia were treated with ironproteinsuccinylate (I-PSL), (80 mg Fe /day, for three months), a new iron compound. The repletion treatment safely led to the clinical and laboratory correction of sideropenia and showed a good tolerability. Furthermore, iron treatment provoked a minor increase of T4 and a mild decline of TSH, but the levels were not significant. These results suggest that sideropenia is a common finding in patients with slightly decreased thyroid activity, and that determination of Frt should be routinely advised. Finally, in the assessment of sideropenia and dependent anemia, evaluation of the thyroid function must be taken into account.
