Polite Dissent

Y: The Last Man #47 “The Tin Man”
Brian K. Vaughan, writer
Goran Sudzuka, penciler

By request, a look at Y: The Last Man #47:

Dr. Allison Mann is experiencing an incredible amount of what appears to be vaginal bleeding. In fact, she’s bleeding so much that she’s going into shock from the blood loss.

What conditions could lead to this amount of bleeding?

1. Trauma
   Like anywhere else in the body, trauma (such as lacerations or abrasions) to the female genital tract can lead to bleeding. The pelvic region has a good blood supply, so heavy bleeding is possible.
2. Uterine Fibroids
   An abnormal (but non-cancerous) growth of muscle cells within the uterus.
3. Hormonal Imbalance
   Especially elevated or unopposed estrogen. A thyroid or adrenal gland problem can cause some abnormal bleeding as well, but generally not this amount.
4. Pregnancy-related bleeding
   This can include a miscarriage or threatened miscarriage. In pregnant women, placenta previa (where the placenta is lying over the cervix) or placental abruption (where the placenta is pulling away from the uterus. This can be fatal to mother and child.) are concerns. Heavy bleeding could also be from retained tissue after birth or miscarriage, such as a retained placenta. A final pregnancy-related cause would also be postpartum hemorrhage, when the uterus does not contract down after birth and continues to bleed. Postpartum hemorrhage can be fatal — but given Dr. Mann’s recnet history, that is unlikely to be the cause here.
5. Genital Tract Inflammation
   Inflammation, most commonly caused by infections, can cause bleeding, but not at the level Dr. Mann is experiencing.
6. Bleeding Disorders
   Hemophilia (though extremely unlikely in a woman), Von Willebrand’s Disease or other blood disorders can lead to heavy bleeding. Use of anticoagulant medications such as warfarin or heparin could also cause heavy bleeding.
7. Cancer
   Cancer, particularly endometrial or uterine cancer, can cause heavy bleeding.
8. Arteriovenous Malformation
   A uterus with an abnormal blood supply could result in heavy bleeding.

Dr. Mann believes the cause of the bleeding is related to miscarriage she suffered earlier, before the series began. Without knowing more about the timing involved or the miscarriage itself, it’s difficult to know for sure. But if I had to speculate: Given that she was not receiving professional prenatal care, she may not have sought professional assistance at the time of her miscarriage. Thus uterine trauma or damage could have occurred during, or due to, the miscarriage. I suppose there could also be retained tissue left over from the miscarriage, but that seems unlikely given the time that seems to have passed since the miscarriage. I think we’ll just have to wait and see what Vaughan has in mind.

Other medical evaluations of Y: The Last Man:Y: The Last Man #29 (plague or botulism?) Y: The Last Man #30 (active and passive Immunity) Y: The Last Man #45 and #46 (homeopathic surgeons?)