Do you have a bleeding disorder

KARA CORDINER

Kara Cordiner is Haemophilia Clinical Nurse Consultant at the Ronald Sawers Haemophilia Centre, Alfred Health, Melbourne

What makes bleeding episodes caused by a bleeding disorder different to other bleeding? How do clinicians check bleeding symptoms to see if they suggest a bleeding disorder? Kara Cordiner explains the role of a common and internationally recognised Bleeding Assessment Tool (BAT), the ISTH-BAT score tool.

When you first visit the Haemophilia Treatment Centre, clinical staff will often ask questions regarding your history of bleeding and may use the ISTH-BAT score tool to aid in assessing your bleeding history.

The ISTH International Bleeding Assessment Tool (ISTH-BAT) is a standardized scoring system developed by the International Society on Thrombosis and Haemostasis (ISTH).

It is used worldwide to assess bleeding symptoms and evaluate if individuals may have a bleeding disorder, such as haemophilia or von Willebrand disease (VWD). It may also be used prior to a clinical trial.

ISTH INTERNATIONAL BLEEDING SCORE

The ISTH-BAT includes a detailed questionnaire and scoring system that evaluates bleeding in multiple areas of the body, such as:

1. Skin: frequency and severity of bruising or petechiae (small blood spots on the skin, like a rash).
2. Mucosal Bleeding: including nosebleeds (epistaxis) and gum bleeding (gingival bleeding).
3. Menstrual bleeding: for females, assessing heavy menstrual bleeding (menorrhagia/abnormal uterine bleeding).
4. Surgical or procedural bleeding: assessing excessive bleeding during or after surgeries, dental extractions, or childbirth.
5. Joint and muscle bleeding: common in individuals with some bleeding disorders like haemophilia or type 3 VWD.
6. Gastrointestinal bleeding: episodes of blood loss in stools (faeces/poo) or vomiting.
7. Central nervous system bleeding: rare but severe, including intracranial haemorrhages (bleeding inside the skull).

Each symptom is scored based on its frequency, severity, and impact on the patient’s life, helping clinicians determine the likelihood of a bleeding disorder.

IMPORTANCE OF ISTH-BAT

The ISTH-BAT provides a systematic way to document and evaluate bleeding symptoms, reducing subjective bias and improving diagnostic consistency.

The score helps in identifying individuals with mild or moderate bleeding disorders that might otherwise go unnoticed, especially in cases of:

• mild haemophilia
• von Willebrand disease (VWD)
• platelet function disorders.

The tool is particularly helpful in:

• determining whether bleeding symptoms warrant further laboratory evaluation with a blood test, such as clotting factor assays/tests or genetic testing.
• differentiating between normal bleeding variations and medical conditions.

The ISTH-BAT is an invaluable tool in clinical practice for evaluating bleeding symptoms and guiding the diagnosis and management of bleeding disorders. It is standardised worldwide and enhances the quality of care, reduces diagnostic delays, and ensures that patients with bleeding tendencies receive appropriate and timely treatment.