{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:48:59Z","timestamp":1791618539258,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Haemophilia"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bleeding disorder of unknown cause (BDUC) is increasingly recognized in patients with clinically significant bleeding despite normal haemostatic testing. The International Society on Thrombosis and Haemostasis (ISTH) recently proposed a standardized definition incorporating bleeding phenotype and validated assessment tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the prevalence and clinical impact of BDUC in adolescents with heavy menstrual bleeding (HMB) using the ISTH definition for BDUC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 205 adolescents, 57.6% met criteria for BDUC, including 86.8% of those without an established bleeding disorder using the ISTH paediatric bleeding assessment tool threshold \u22653, most with clinically significant HMB (PBAC &gt;100). Adolescents with BDUC demonstrated similar bleeding severity, with comparable ISTH\u2010BAT and PBAC scores (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.95 and\n                      <jats:italic>p<\/jats:italic>\n                      = 0.62, respectively) as those with diagnosed bleeding disorders. However, BDUC was associated with higher rates of anaemia (50%\u00a0vs. 31%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.016) and increased emergency department utilization (47%\u00a0vs. 30%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.03), while iron deficiency, hospitalizations, and transfusion requirements were similar between groups. Health\u2010related quality of life was similarly impaired in both groups (PedsQL fatigue scores of 61.1\u00a0vs. 59.6,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.65).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BDUC is highly prevalent among adolescents with HMB and is associated with a clinical burden comparable to, and in some domains exceeding, that of established bleeding disorders. These findings support BDUC as a clinically meaningful phenotype and highlight the need for improved diagnostic precision and targeted management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hae.70422","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:03:56Z","timestamp":1791615836000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High Prevalence and Clinical Burden of Bleeding Disorder of Unknown Cause in Adolescents With Heavy Menstrual Bleeding: Application of New Definition by the International Society on Thrombosis and Haemostasis"],"prefix":"10.1111","author":[{"given":"Ruchika","family":"Sharma","sequence":"first","affiliation":[{"name":"Division of Hematology\/Oncology\/BMT, Department of Pediatrics University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Children's Health  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Hartland","sequence":"additional","affiliation":[{"name":"Children's Health  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendra","family":"Malone","sequence":"additional","affiliation":[{"name":"Children's Health  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urooj","family":"Wahid","sequence":"additional","affiliation":[{"name":"Peter O'Donnell Jr. School of Public Health University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Sarode","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Transfusion Medicine and Hemostasis University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Department of Pathology and Internal Medicine (Hematology\/Oncology) University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean G.","family":"Yates","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Transfusion Medicine and Hemostasis University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Garcia","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology\/BMT, Department of Pediatrics University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Children's Health  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Zia","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology\/BMT, Department of Pediatrics University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Children's Health  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"issue":"3","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"357","DOI":"10.3324\/haematol.10816","article-title":"High Prevalence of Bleeders of Unknown Cause Among Patients With Inherited Mucocutaneous Bleeding. 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