Design: Case Series

Setting: Academic, tertiary-care medical center.

Patients or Participants: Patient A was a 44-year-old G3P3003 who presented with dyspnea and acute uterine bleeding. Patient was diagnosed with B-cell lymphoma and associated pancytopenia with a platlet nadir of 8 * 10³/uL. Patient B was a 44-year-old who presented for acute uterine bleeding in setting of severe aplastic anemia. Patient B had platelet nadir of 10 * 10³/uL. Decision was made to proceed with hysteroscopy and endometrial ablation.

Interventions: Patient A received 20 units of platelets with rise to 42 * 10³/uL on day of surgery. She was receiving trimethoprim/sulfamethoxazole, fluconazole, and levofloxacin for neutropenia prophylaxis. No additional preoperative antibiotics given. MAC anesthesia was utilized without a paracervical block. A stitch was placed in the anterior cervix in replacement of a tenaculum. This was tied at the end to avoid leaving open puncture wounds. The cervix was hydrodilated and soft tissue morcellator was used to sample the endometrium. Bipolar radiofrequency endometrial ablation was completed. Total operative time was 28 seconds. Patient B received IVIG, methylprednisolone, and 4 units platelets with no response. Platelets on day of surgery were 11 * 10³/uL. Neutropenic prophylaxis regiment consisted of acyclovir, levofloxacin, and voriconazole. Additional pre operative regimen was given with cefazolin and metronidazole. Anesthesia and the procedure were performed in the same fashion with an additional sharp curettage. Total operative time was 19 minutes. Post operative doxycycline was prescribed.

Measurements and Main Results: Uterine bleeding stopped in both patients without the need for further interventions for over two years.

Conclusion: Endometrial ablation can be a safe and feasible approach to surgical management of abnormal uterine bleeding in the setting of severe thrombocytopenia, even in patients refractory to platelet transfusions. These cases demonstrate measures our team took to perform the procedures safely.