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Diagnostic work up of patients with increased bleeding tendency
Suzanne A M Zegers1, Yolba Smit1, Joline L Saes1,2
1Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands.
Haemophilia : the Official Journal of the World Federation of Hemophilia
|December 31, 2019
Summary
Patients with high bleeding scores, especially after surgery or postpartum, are less likely to receive a diagnosis. Further research into better screening and diagnostic assays for bleeding disorders is needed.
Area of Science:
- Hematology
- Diagnostic Medicine
Background:
- Diagnosing bleeding disorders is complex, costly, and time-consuming.
- Approximately 50% of patients with a bleeding tendency remain undiagnosed.
Purpose of the Study:
- To gain deeper insight into the diagnostic process for patients with suspected bleeding disorders.
- To compare diagnostic parameters between patients with and without a final diagnosis.
Main Methods:
- 117 adult patients with suspected bleeding tendency were evaluated.
- Patients were categorized into: final diagnosis, bleeding of unknown cause (BUC) with high Tosetto bleeding assessment tool (BAT) score, and control with low BAT score.
- Parameters compared included BAT scores and laboratory screening results.
Main Results:
- Patients classified as BUC had significantly higher BAT scores (8.1) than those with a final diagnosis (4.9).
- Surgery and postpartum hemorrhage were common factors in the BUC group.
- Abnormal laboratory screening, particularly PFA and von Willebrand factor activity, was more frequent in patients receiving a final diagnosis.
Conclusions:
- A high bleeding score, especially related to surgical or postpartum bleeding, is associated with a lower likelihood of diagnosis.
- Consideration should be given to withholding extensive hemostatic testing in certain cases.
- Improved screening and confirmatory hemostatic assays are required for accurate diagnosis.
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