{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:20:02Z","timestamp":1787653202134,"version":"build-2736575974"},"reference-count":7,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Refractory peri\u2010procedural bleeding may be the first manifestation of an occult systemic bleeding disorder. A 46\u2010year\u2010old woman with heavy menstrual bleeding developed severe uterine hemorrhage after endometrial sampling and intrauterine device removal, refractory to conservative treatment and requiring balloon tamponade and uterine artery embolization. Her history revealed spontaneous ecchymoses, hematemesis, and a previous nontraumatic subcapsular liver hematoma. Further evaluation showed nephrotic\u2010range proteinuria, monoclonal IgG\u2010lambda in serum and urine, an abnormal serum free light chain ratio, and gastrointestinal amyloid deposition. Bone marrow examination demonstrated 11% lambda\u2010restricted clonal plasma cells, confirming AL amyloidosis. Factor X activity was mildly reduced to 63% (reference range: 70%\u2013120%). This case highlights that near\u2010normal routine coagulation studies do not exclude clinically significant bleeding risk. Careful bleeding history and recognition of systemic disorders are essential when peri\u2010procedural hemorrhage is disproportionate to the intervention.<\/jats:p>","DOI":"10.1111\/jog.70469","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T11:42:54Z","timestamp":1787226174000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: When Routine Gynecologic Procedures Unmask a Systemic Bleeding Disorder: Refractory Uterine Hemorrhage Leading to the Diagnosis of\n                    <scp>AL<\/scp>\n                    Amyloidosis"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0260-8568","authenticated-orcid":false,"given":"Nur \u0130layda","family":"Gen\u00e7","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet G\u00f6khan","family":"G\u00f6nenli","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3300-9434","authenticated-orcid":false,"given":"Sogol","family":"Sadri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1836-5038","authenticated-orcid":false,"given":"Toygun","family":"\u00c7akmak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Medical Park Tem Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130brahim \u00d6ner","family":"Do\u011fan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pathology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga Meltem","family":"Akay","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.27177"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2000.02183.x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/03009734.2012.690457"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.1398"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.21603"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.946334"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.70084"}],"container-title":["Journal of Obstetrics and Gynaecology Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jog.70469","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jog.70469","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jog.70469","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:34:23Z","timestamp":1787650463000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/jog.70469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":7,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/jog.70469"],"URL":"https:\/\/doi.org\/10.1111\/jog.70469","archive":["Portico"],"relation":{},"ISSN":["1341-8076","1447-0756"],"issn-type":[{"value":"1341-8076","type":"print"},{"value":"1447-0756","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-07-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70469"}}