Vaginoscopy approach with Mechanical Tissue Removal System for AUB inPediatric Aplastic Anemia: a case report

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BACKGROUND: Aplastic anemia (AA) is a rare childhood blood disease characterized by anemia, infection, and a tendency for hemorrhage. AA may present as abnormal uterine bleeding (AUB) and intrauterine infection in female patients with menstrual cycles. The management of AA-associated AUB in pediatric patients remains a significant challenge due to the absence of established, comprehensive guidelines. We report a rare case of a patient who successfully underwent bone marrow transplantation (BMT) after treatment with vaginoscopy combined with a mechanical hysteroscopic tissue removal system (mHTRs). CASE PRESENTATION: A 10-year-old female patient, diagnosed with AA for four years, presented with heavy menstrual bleeding (HMB) and lower abdominal pain accompanied by fever for ten days. To ensure she could proceed with her scheduled BMT, she required management for AUB and suspected intrauterine infection. We removed the lesion via innovative vaginoscopy combined with mHTRs. Through multidisciplinary cooperation and a precise blood transfusion strategy, the procedure achieved the objects of endometrium protection, hymen preservation, and hematological safety. CONCLUSION: For pediatric patients with AA-associated AUB, the combination of vaginoscopy and mHTRs represents a promising surgical alternative. Compared to traditional approaches, this technique allows minimally invasive lesion resection while preserving endometrium and hymen integrity, addressing the main concern for pediatric patients. Furthermore, integrating multidisciplinary expertise and precise transfusion management ensures the safety of surgery and hemodynamics. This approach provides a clinically feasible, patient-tailored solution for a complex population with limited treatment options.

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