Adolescence Endometriosis...

A 13-year-old adolescent had complained of dysmenorrhea and heavy menstrual bleeding one year before admission. These complaints began two months after her menarche and occurred with each menstrual cycle every month. She reported using about 7-10 pads daily for ten consecutive days. Previously, she was a healthy woman with no significant medical history, especially regarding blood coagulation diseases. A blood sample was taken, revealing severe microcytic hypochromic anemia, with a hemoglobin level of 5.8 g/dL, prolonged prothrombin time (PT) at 4.7 times the control, and prolonged activated partial thromboplastin time (aPTT) at 4.7 times the control, raising suspicion of a blood coagulation disease such as Von Willebrand disease. Unfortunately, further investigation indicated normal VIII and IX factor levels at 122.9% (normal range 40-170%) and 112.6% (normal range 51-137%), respectively, along with normal antigen VWF at 94% (normal range 54-148% for O blood group). A blood smear revealed a normal count and morphology of platelets but severe microcytic hypochromic anemia with anisopoikilocytosis, including the presence of oval, pencil, and target cells.  The ultrasound examination revealed a 7 cm diameter multilocular cystic ovarian mass with heterogeneous echogenicity and irregular borders, suggestive of a cystic ovarian neoplasm with potential hemorrhage. Subsequently, a CT scan was conducted for further evaluation.