Intrauterine balloon tamponade as a treatment for immune thrombocytopenic purpura-induced severe uterine bleeding

Objective: To report our experience of applying balloon tamponade in the treatment of intrauterine bleeding in two patients with immune thrombocytopenic purpura (ITP). Immune thrombocytopenic purpura is a well-known hematologic autoimmune disease. The uterus may be a major site of bleeding in patients with ITP. Halting bleeding is imperative to reduce blood loss and platelet consumption and to allow medical treatment to increase platelet count. Balloon tamponade has been described as an effective method to control bleeding in a variety of clinical situations; it is an effective and accessible modality, requiring no analgesia or anesthesia, and helps facilitate continuous monitoring of uterine bleeding. Design: Report of two cases. Setting: Obstetrics and gynecology department in a tertiary care center in Jerusalem, Israel. Patient(s): Two patients with ITP with severe uterine bleeding refractory to treatment with estrogen and IV IgG. Intervention(s): Intrauterine balloon tamponade. Main Outcome Measure(s): Cessation of uterine bleeding, appearance of complications. Result(s): Insertion of balloon tamponade successfully controlled bleeding in both cases. The patient in case 1 subsequently had persistent hypomenorrhea. The patient in case 2 had abdominal pain and suspected pelvic inflammation. Conclusion(s): Our presented cases demonstrate that uterine bleeding can be controlled successfully in patients with ITP with an intrauterine balloon. This novel application raises many technical issues, such as the appropriate filling pressures and duration of treatment. Possible risks, such as endometrial injury, still remain to be resolved and mandate future clinical research.