Reviewer ’s report  
Title: Levonorgestrel -releasing intrauterine system for treatment  of heavy menstrual bleeding in 
adolescents with Glanzmann's Thrombasthenia: Illustrated case series  
 
Version: 0 Date: 02 Aug 2017  
 
Reviewer: Megan Billow  
 
Reviewer's report:  
Levonorgestrel -releasing intrauterine system for treatment of heavy menstrual bleeding in 
adolescents with Glanzmann's Thrombasthenia: Illustrated case series.  
 
The authors present a case series of two patients with Glanzmann's Thrombast henia with AUB -C 
who failed hormonal and anti -fibrinolytic therapy. The patients underwent insertion of LNG -IUS 
which subsequently reduced their menstrual blood loss.  
 
Abstract:  
Lines 41 - 44: The authors may a conclusive statement that can not be ascerta ined through a case 
series. They should consider revision of this statement.  
 
1. Background - The authors define GT however, do not emphasize how this can impact an 
adolescent female's quality of life. There are several articles that convey how women with 
inherited bleeding disorders are often diagnosed after menarche. The authors should better define 
why this is an important issue to women with an underlying bleeding disorder.  
* The authors should be consistent with the terms heavy menstrual bleeding (HMB ) and 
menorrhagia. Menorrhagia should not be used.  
 
2. Case Presentations -  
a. Case 1 - The patient's history should be better presented. The authors state she was diagnosed 
with GT - how was this diagnosis made? Was she evaluated for other bleeding dis orders such as 
von Willebrand's disease? Was she sexually active? How many total blood transfusions did she 
receive? How long did the patient receive oral contraceptive therapy? What dose did she receive? 
Where was her hemoglobin level? At what level did h er hemoglobin decrease prior to insertion 
of the LNG -IUS? The authors state her menstrual blood loss volume decreased with shorter 
menses and relief…how was this quantified? What was her hemoglobin after insertion? 
Furthermore, the authors should consider providing more details regarding her long term results 
ie. what was her hemoglobin 2 years after insertion?  
 
b. Line 38: edit Hemoglobin value to 4.5 g/L  
 
c. Case 2 - Similarly, the authors should provide more details regarding the patient's history, 
clinical presentation and diagnosis of GT.  
 
3. Discussion -  
a. Lines 48 -51 - Statement may be improved by discussing AUB and PALM -COEIN or 
clarifying HMB as it relates to the pediatric/adolescent patient population.  
 
b. The authors state that "anti -fibrinolytics are the first line therapy for menorrhagia" - what is 
the source. ACOG suggests that hormonal management is the first line treatment for acute 
AUB. (Committee Opinion Number 557, Management of Acute AUB in Nonp regnant 
Reproductive -Aged Women)  
c. The authors present clear data regarding the use of LNG -IUS for HMB.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Unable to assess  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Unable to assess  
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
Unable to assess  
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
Declaration of competing interests  
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3. Do you hold or are you currently apply ing for any patents  relating to the content of the 
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4. Have you received reimbursements, fees, funding, or salary from an organization that 
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