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Utility of International Society on Thrombosis and Hemostasis Bleeding Assessment Tool (ISTH-BAT) in Patients with Inherited Bleeding Disorders: A Cross-Sectional Study from Southern India

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Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

The International Society on Thrombosis and Hemostasis bleeding assessment tool (ISTH-BAT) was developed to record bleeding symptoms and aid in patient diagnosis. This study was done to investigate the utility of ISTH-BAT in patients suspected to have inherited bleeding disorders. This cross-sectional study was conducted in a tertiary care hospital in Southern India over 3 and 1/2 years. A trained investigator administered the ISTH-BAT questionnaire to 432 patients undergoing evaluation for inherited bleeding disorder prior to routine coagulation screening and confirmatory tests and to 131 healthy volunteers as controls. Among patients, 42(9.7%) had primary hemostatic defect, 150(34.7%) had secondary hemostatic defects and 229(53%) had normal screening coagulogram with mean bleeding scores (BS) being 5.9, 6.9, and 4.2 respectively and the proportion of patients with abnormal BS being 69%, 88.7% and 59.4% respectively; the latter qualifying as unknown hemostatic defect. 11(2.5%) with acquired hemostatic defect on workup were excluded. The mean BS was 1.52 among healthy volunteers. Common bleeding patterns were epistaxis (73.8%), cutaneous bleeding (52.4%), hematuria (54.8%), menorrhagia (50%) in primary hemostatic defect; cutaneous bleeding (72%), muscle hematoma (58.7%), hemarthrosis (46.7%), menorrhagia (58.7%) in secondary hemostatic defects and epistaxis (45.9%), cutaneous bleeding (62.4%), menorrhagia (30.7%) in normal screening coagulogram group. Grade of bleeding was mostly 2 and sometimes 4 in primary, 2–4 in secondary and 1–2 in normal screening coagulogram group. ISTH-BAT is a valuable tool to record lifelong bleeding history. The pattern and score give clues regarding the nature and severity of the bleeding disorder.

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Acknowledgements

The authors acknowledge Mr. Sankar Perumal, Technical Officer, Department of Pathology, JIPMER for coagulation laboratory services, Mr. V. Balachandar, Research Assistant and Dr. Sitanshu Sekhar Kar, Additional Professor, Department of PSM, JIPMER for help in data analysis

Funding

This study was funded by JIPMER Intramural Grant for Ph.D. project.

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Authors and Affiliations

  1. Department of Pathology, Institute Block-2nd Floor, Jawaharlal Institute of Post-Graduate Medical Education and Research, Dhanvantari Nagar, Puducherry, 605006, India

    Pagadalu Lokababu Ambika, Debdatta Basu & Rakhee Kar

  2. Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, India

    Sukesh Chandran Nair

Authors
  1. Pagadalu Lokababu Ambika
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  2. Debdatta Basu
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  3. Sukesh Chandran Nair
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  4. Rakhee Kar
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Contributions

PLA administered the questionnaire, performed the bench work and prepared the manuscript; DB co-guided the study and reviewed the manuscript; SCN reviewed the study periodically, provided critical inputs and reviewed the manuscript; RK conceptualized and guided the study, analyzed the results and edited the manuscript.

Corresponding author

Correspondence to Rakhee Kar.

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Conflict of interest

Authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Institute Ethics Committee (JIP/IEC/2015/13/540 dated 23.04.15).

Ethical Standards

This study was conducted on patients who were enrolled in routine diagnostic care who were administered a questionnaire prior to their routine sampling. Healthy volunteers were administered the questionnaire. All were in accordance with the ethical standards of the Institute ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed written consent was obtained from the adult patients and from the parent or legal guardian for pediatric patients enrolled in the study according to Institute ethical guidelines.

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Preliminary data from the study were presented as posters in the ISTH SSC Meeting in Montpelier, France, 2016 and in Platelet Society meeting in Jesus College, Cambridge, 2019.

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Ambika, P.L., Basu, D., Nair, S.C. et al. Utility of International Society on Thrombosis and Hemostasis Bleeding Assessment Tool (ISTH-BAT) in Patients with Inherited Bleeding Disorders: A Cross-Sectional Study from Southern India. Indian J Hematol Blood Transfus 38, 122–131 (2022). https://doi.org/10.1007/s12288-021-01435-8

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  • DOI: https://doi.org/10.1007/s12288-021-01435-8

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