A 17-year-old white female who is a student at a local high school presents to your department with her mother with complaints of easy bleeding and heavy menstrual bleeding. She reports that she has noticed bleeding of her gums when she flosses her teeth in the morning or after meals. Her menstrual periods are regular, but she has about 100 ml of blood loss every cycle, menses usually last about eight days with a heavy blood flow. She usually does not have vaginal bleeding between her periods.
Her menarche was at the age of 14; she thinks that the heavy menstrual flow has increased this year. She had presented to a physician with a similar complaint last year at the age of 16, and she was advised to take oral contraceptive pills. They seemed to help a little, but she says that the problem has largely remained. She denies abdominal or pelvic pain. She has no hospitalization or surgery history. When her mother steps outside she admits to having sexual relations with her boyfriend for the past six months. They use barrier contraception consistently, and she uses oral contraceptive pills sometimes. She does not smoke, doesn’t drink alcohol and denies recreational drugs abuse. She denies aspirin, NSAIDs, or any other medications use. She is the only child in the family, her parents are divorced, she lives with her mother. Her mother is healthy and has never complained of similar symptoms. She says that though she rarely sees her father who lives in another city, he might have had some sort of bleeding disorder - this report is corroborated by her mother.
Physical examination reveals a young woman Tanner stage IV with pale skin, her temperature 37.1°C, BP 100/55 mm Hg, HR 100 bpm, and her respirations are 18 bpm with a BMI of 21 m/kg². Examination of systems doesn’t show any abnormalities. You order laboratory tests which reveal:
Hb: 100g/L
Hematocrit: 34%
Platelet: 400 x 10^9/L
WBC count: 9 x 10^9/L
Segmented neutrophils: 65%
Bands: 1%
Eosinophils: 1%
Lymphocytes: 28%
Monocytes: 5%
Bleeding time: 5 min
aPTT: 65 seconds
PT: 14 seconds
The primary medication used in the treatment of this disease most likely acts on which of the following receptors?
a) Estrogen receptors
b) V1 receptors
c) V2 receptors
d) Prostaglandin I2 receptor
e) Glycoprotein IIb/IIIa receptor