An adolescent female reports heavy, irregular menses. The complete blood count shows hemoglobin 8.9 g/dL. What test should be ordered next?

An adolescent female reports heavy, irregular menses. The complete blood count shows hemoglobin 8.9 g/dL. What test should be ordered next?

• A. C-reactive protein
• B. Coagulation studies
• C. Thyroid function
• D. Ultrasound of pelvis

Answer: (B)

Heavy, irregular menses with a significant anemia in a teen often points to a bleeding tendency rather than a purely hormonal or structural issue. The most informative next step is to assess hemostasis with coagulation studies. These tests help determine if a coagulopathy (for example, a von Willebrand-type disorder or other clotting factor issues) is contributing to the heavy bleeding. Identifying a bleeding disorder early guides both acute management (how to control menses and prevent further blood loss) and longer-term planning (need for routine treatment, family counseling, and targeted therapies). The other options don’t address the likely root cause as directly. C-reactive protein would check for inflammation, which isn’t the driver of heavy menses. Thyroid function can influence menstrual patterns but is less urgent when there’s marked anemia that needs immediate evaluation and treatment. An ultrasound of the pelvis would help look for structural causes, which are less common in adolescents but can be considered after initial hematologic assessment if bleeding persists.

Heavy, irregular menses with a significant anemia in a teen often points to a bleeding tendency rather than a purely hormonal or structural issue. The most informative next step is to assess hemostasis with coagulation studies. These tests help determine if a coagulopathy (for example, a von Willebrand-type disorder or other clotting factor issues) is contributing to the heavy bleeding. Identifying a bleeding disorder early guides both acute management (how to control menses and prevent further blood loss) and longer-term planning (need for routine treatment, family counseling, and targeted therapies).

The other options don’t address the likely root cause as directly. C-reactive protein would check for inflammation, which isn’t the driver of heavy menses. Thyroid function can influence menstrual patterns but is less urgent when there’s marked anemia that needs immediate evaluation and treatment. An ultrasound of the pelvis would help look for structural causes, which are less common in adolescents but can be considered after initial hematologic assessment if bleeding persists.