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Collaborative clinic focuses on bleeding disorders

Sep. 8, 2016, 9:45 AM

Vanderbilt University Medical Center (VUMC) is home to a specialized clinic for teens, adolescents and young adults focusing on bleeding disorders.

Celeste Hemingway, M.D.
Celeste Hemingway, M.D.

The Women’s Bleeding Disorder Clinic (WBDC), a collaborative effort between pediatric and adolescent Gynecology and Pediatric Hematology, is run by Celeste Hemingway, M.D., assistant professor of Obstetrics and Gynecology, and Allison Wheeler, M.D., assistant professor of Pediatrics and Pathology, Microbiology and Immunology.

The two see about 50 patients a year seeking treatment and care for a variety of bleeding issues. As awareness of menstrual bleeding as a presenting symptom of bleeding disorders increases, they hope they can expand to help more of these young women.

Allison Wheeler, M.D.
Allison Wheeler, M.D.

A common scenario involves patients coming to the clinic with one or more of the following complaints: prolonged menstrual bleeding (greater than seven days), saturating a pad or tampon every one to two hours and passing quarter-sized clots. Often the symptoms are coupled with a family history of mothers, siblings or aunts having similar issues.

“People discount a lot of symptoms as being normal,” Hemingway said. “A lot of times girls will assume that heavy menstrual bleeding is OK, especially when they first start having their periods. Regardless of the symptoms it is definitely worth an evaluation and, more importantly, there are treatment options.

“It is also important to find out what the bleeding source is because it could be a hematologic issue. The sooner we are able to recognize and treat the problem the sooner we can potentially reduce the risk of complications down the line.”

The monthly clinic is held at Vanderbilt Health One Hundred Oaks. Most patients have multiple visits that include labs, exams and follow-up appointments to ensure the selected treatment is the most appropriate.

The clinic is experiencing success in its collaborative approach.

“Women’s bleeding is a recognized focus of medicine that thinks about women and their menstrual bleeding and evaluates it from both a gynecological and hematologic perspective,” Wheeler said. “Our clinic has been able to narrow the gap of care and provide combined evaluation and diagnostic management that has proven very beneficial for our patients.”

Madelyn Fitzsimmons from Evansville, Indiana, was diagnosed with a bleeding disorder in 2011. It wasn’t until 2013 that she came to Vanderbilt for help.

Now a freshman in college, the 18-year-old says her quality of life is much improved.

“Coming to Vanderbilt and being treated in the clinic has changed my life,” said Fitzsimmons. “For so long I had all these symptoms that made my life so very hard. To get to this point — to go an entire year with no symptoms — is absolutely phenomenal.”

Fitzsimmons was diagnosed with von Willebrand disease, a bleeding disorder that affects the blood’s ability to clot.

Symptoms of the disease cause prolonged and heavy periods, anemia, and bruising.

“It had gotten to the point that my dad was threatening to prevent me from shaving,” Fitzsimmons said. “I was scared to participate in gym class because of the injury issues.

“I was taking more than 40 pills a day over a 10-14 day period. The side effects were awful. I missed a lot of school and I couldn’t concentrate.”

Now all of that has changed. The premed student is looking forward to her next phase in life, one that is leaning toward her becoming a hematologist, like Wheeler.

“The collaboration between both doctors and the focus they placed on what was going on with me really impacted me,” Fitzsimmons said. “It has stuck with me and I want to help other girls in need of similar medical attention.”

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