Acquired von Willebrand D...

An 18-year-old unmarried female presented to the Gynecology outpatient department with chief complaints of irregular and prolonged menstrual cycles. Since menarche at 12 years old, she experiences 8-10 days of heavy bleeding every 25 to 30 days, leading to severe anemia. Initial treatment with Tranexamic acid temporarily reduces bleeding but prolongs its duration. Only high doses of estrogen followed by Progesterone effectively stop bleeding, albeit with side effects. On examination, severe pallor, facial puffiness, and generalized edema are observed, with no signs of hypothyroidism, lymphadenopathy, or splenomegaly. No family history of bleeding disorder. Investigations revealed the following results: Hemoglobin level at 5 g/dL, CBC and Platelets within normal range, and a peripheral blood smear showing microcytic hypochromic cells. Bleeding time was recorded at 2.11 minutes and clotting time at 5.15 minutes. The patient's blood group was determined as 'B' Rh Positive. The von Willebrand Factor antigen level was 31.11%, below the reference range for both 'O' and non-'O' blood groups. Prothrombin time was 16 seconds with a control of 12 seconds, resulting in an INR of 1.16. APTT was measured at 38 seconds with a control of 31 seconds. Thyroid-stimulating hormone level was elevated at 20.08 uIU/ml, and thyroid peroxidase antibody was positive at 76.14 U/mL.