Why a 15-year-old with heavy bleeding since her first period is screened for a bleeding disorder before any imaging, argued step by step through PALM-COEIN, is the core of the NU576 abnormal bleeding workup here. Searches like "nu 576 unit 7 assignment example", "nu576 unit 7 sample" and "nu576 unit 7 example" land here.
Heavy From the First Period: An Abnormal Bleeding Workup at 15 That Looks for a Bleeding Disorder Before Anything Else
[Student Name]
Purdue University Global
NU576: NP II - Primary Care of Women's Health
Unit 7 Abnormal Bleeding Workup
[Instructor Name]
[Date]
The patient is a composite; values and results are bracketed.
The Patient
[Emma], 15, has had heavy periods since menarche at 12. They last seven to eight days, on her worst days she soaks through a pad roughly hourly, passes clots larger than a quarter, and has missed school because of flooding. Cycles are regular, every [26 to 30] days. She bruises easily and had prolonged bleeding after a tooth extraction last year. Her mother needed a transfusion after giving birth to her. She is not sexually active, by her report in confidential history. Hemoglobin [10.1] g/dL, ferritin [5] ng/mL.
The Frame
The FIGO system sorts the causes of uterine bleeding problems before menopause into structural causes, PALM, and nonstructural causes, COEIN (Munro et al., 2018). Each is tested against her history.
1. Polyp: rare at 15. Excluded clinically; ultrasound only if bleeding persists after evaluation.
2. Adenomyosis: very rare at 15. Not pursued.
3. Leiomyoma: rare at 15. Not pursued.
4. Malignancy or hyperplasia: very rare at 15 without prolonged unopposed estrogen. Not pursued.
5. Coagulopathy: plausible. Heavy bleeding since menarche, easy bruising, bleeding after dental extraction, and a mother with postpartum hemorrhage. Confirm or exclude with hemostasis testing.
6. Ovulatory dysfunction: common in adolescents in the first years after menarche. Against: regular cycles. Still considered.
7. Endometrial: a local disorder of hemostasis; a diagnosis of exclusion.
8. Iatrogenic: no hormonal or anticoagulant medications.
9. Not otherwise classified: no evidence.
Why a Bleeding Disorder Heads the List
In an adolescent, heavy menstrual bleeding since the first period is the pattern most suggestive of an inherited bleeding disorder. ACOG advises that adolescents with heavy menstrual bleeding, particularly since menarche, be screened for bleeding disorders, using a structured history of bleeding symptoms and family history (American College of Obstetricians and Gynecologists [ACOG], 2019). Von Willebrand disease is the most common inherited bleeding disorder, and heavy menstrual bleeding is often its first sign in young women. Her bruising, her bleeding after a dental extraction and her mother's postpartum hemorrhage each add to the concern. A validated bleeding assessment tool quantifies it; her score was [8], above the threshold that suggests a bleeding disorder.
Test Order
1. Pregnancy test: always first, even when sexual activity is denied, because pregnancy-related bleeding changes everything that follows. Result: [negative].
2. Complete blood count with platelets, and ferritin: to measure anemia and iron stores and exclude thrombocytopenia. Result: hemoglobin 10.1, platelets [248], ferritin 5.
3. Prothrombin time and partial thromboplastin time: a general screen. Result: [normal]. A normal result does not exclude von Willebrand disease.
4. Von Willebrand panel: von Willebrand factor antigen, von Willebrand factor activity and factor VIII. The 2021 international guideline recommends these initial tests when von Willebrand disease is suspected (James et al., 2021). Drawn not during heavy bleeding or while taking estrogen, both of which can raise levels and mask the disorder; timing is noted.
5. TSH: thyroid disease can disturb cycles. Result: [normal].
6. Pelvic ultrasound: not ordered now, because structural causes are unlikely at her age and history; reserved for bleeding that persists after evaluation and treatment.
Why Not Start Hormones First
Starting a combined pill today would likely reduce her bleeding, and it is tempting when a teenager is missing school. But estrogen raises von Willebrand factor levels and can make a mild case look normal, so starting it before the panel is drawn could hide the diagnosis for years. The panel is drawn today, and hormonal treatment can start as soon as the sample is taken. If her bleeding were acute and severe, with a falling hemoglobin, treatment would come first and testing would be interpreted with that in mind. She is not in that situation, so the order favors the diagnosis.
Treating the Iron Deficiency
A ferritin of 5 with a hemoglobin of 10.1 means her iron stores are empty and she is anemic. Oral iron starts today, taken with a source of vitamin C and away from dairy, and she and her mother were told that it will take weeks to rebuild her hemoglobin and months to refill her stores. Fatigue, poor concentration at school and breathlessness during sports may all improve. If she cannot tolerate oral iron, or if her bleeding continues to outpace it, intravenous iron is an option.
Confidential Time
Part of the history was taken with her mother out of the room. Her report that she is not sexually active was obtained then, along with questions about mood, school and safety. The pregnancy test was done as routine for every patient with abnormal bleeding, and she was told this beforehand so that it would not feel like an accusation.
If the Results Show
1. Low von Willebrand factor levels: hematology referral for diagnosis and typing; treatment options include tranexamic acid during periods, hormonal therapy, and desmopressin for some types. Her mother and siblings may be offered testing.
2. Normal von Willebrand panel with a high bleeding score: hematology referral for platelet function testing and other factor deficiencies.
3. Normal hemostasis: ovulatory or endometrial cause; hormonal treatment.
In every case, iron replacement starts now, and a hormonal option, such as a [combined oral contraceptive] or a [52 mg levonorgestrel] IUD, is discussed to reduce bleeding, after the von Willebrand panel is drawn so that estrogen does not affect the result.
What She and Her Mother Were Told
The heavy bleeding has a cause that can probably be found and treated. The blood tests look for a clotting problem that can run in families. Her mother was told that the same testing might explain her own bleeding after delivery, and that it matters for [Emma]'s future surgeries, dental work and pregnancies.
What the Workup Protects Against
Heavy menstrual bleeding in adolescents is often treated for years as a nuisance, with hormonal therapy started and the reason never found. That approach can work for the bleeding and still miss a bleeding disorder, which then surfaces as a hemorrhage after a tonsillectomy, a wisdom tooth extraction or childbirth. Finding von Willebrand disease at 15 lets her surgeons, dentists and future obstetric team plan for it, and it may also explain her mother's hemorrhage and lead to testing of her siblings. The workup is longer than a prescription, but it is the only route that answers the question her history raises.
References
American College of Obstetricians and Gynecologists. (2019). Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding: ACOG Committee Opinion No. 785. Obstetrics & Gynecology, 134(3), e71-e83. https://doi.org/10.1097/AOG.0000000000003411
James, P. D., Connell, N. T., Ameer, B., Di Paola, J., Eikenboom, J., Giraud, N., Haberichter, S., Jacobs-Pratt, V., Konkle, B., McLintock, C., McRae, S., Montgomery, R. R., O'Donnell, J. S., Scappe, N., Sidonio, R., Flood, V. H., Husainat, N., Kalot, M. A., & Mustafa, R. A. (2021). ASH ISTH NHF WFH 2021 guidelines on the diagnosis of von Willebrand disease. Blood Advances, 5(1), 280-300. https://doi.org/10.1182/bloodadvances.2020003265
Munro, M. G., Critchley, H. O. D., & Fraser, I. S. (2018). The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. International Journal of Gynecology & Obstetrics, 143(3), 393-408. https://doi.org/10.1002/ijgo.12666
How this NU576 Unit 7 example is structured
The FIGO classification from 2011, revised in 2018, provides the frame, and the paper introduces it in two sentences before applying it. Each of the nine categories receives a row stating whether it is plausible for this patient and what would confirm or exclude it. The age discussion follows: in adolescents, structural causes are rare and anovulation is common, but heavy bleeding since menarche is the pattern that should prompt screening for a bleeding disorder, as ACOG's committee opinion on adolescents advises. The paper applies that guidance explicitly, with a validated bleeding assessment and a family history. Test order is then justified step by step, pregnancy first and specialized hemostasis tests after the basics, so the sequence reads as reasoning, never as a checklist. A short conditional section closes the workup, pairing each possible result with a next step, including a hormonal option once the evaluation is under way.
Get an NU576 Unit 7 example written to your instructions
Bleeding cases differ by age and history, and the workup turns on both, so the full NU576 case is needed word for word, plus its rubric. The model applies PALM-COEIN category by category, justifies each test in sequence, and brackets any agent it names. A first workup is free, landing within 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU576 Unit 7 questions, answered
Is PALM-COEIN required, or can another framework be used?
Many sections expect it by name because it is the FIGO standard, and graders look for it. If your prompt allows another approach, the paper can use it, but the structural and nonstructural distinction should still be visible. Citing the 2018 revision alongside the original 2011 system shows current knowledge.
When does a younger patient need endometrial sampling?
Current guidance extends sampling below forty-five when there is unopposed estrogen exposure, as with obesity or polycystic ovary syndrome, when medical management has failed, or when bleeding persists. A workup should apply each criterion to the case explicitly; stating that sampling is indicated without saying why earns little.
Should treatment appear in a workup paper?
Only conditionally, unless your prompt asks for a full plan. A workup is about reaching the diagnosis, so treatment written before the results can suggest the conclusion was assumed. Pairing each possible result with a next step shows planning without skipping the evaluation, and any medication named should be bracketed and sourced.