Practical-Haemostasis.com



A Practical Guide to Haemostasis


Bleeding Assessment:
The ISTH-SSC Bleeding Assessment Tool [BAT]

Introduction

The ISTH BAT comprises 14 categories for assessing bleeding symptoms retrospectively and it has been shown that a high bleeding score is associated with the presence of an inherited bleeding disorder. Each of the 14 variables is scored from 0-4 [except for CNS Bleeding when the scores are 0, 3 or 4 and on the basis of this a final score is derived. 

The ISTH-BAT is relatively insensitive to children with a possible inherited bleeding disorder and this may lead to an underestimation of bleeding symptoms.   In addition the ISTH-BAT is inflexible with respect to changes in the bleeding phenotype of the developing child.  In addition the ISTH-BAT is relatively insensitive to acquired bleeding disorders.

The ISTH-BAT:


Select Criteria:

Epistaxis
None/trivial 0 Points
>5/ Year or >10 minutes 1 Point
Consultation only 2 Points
Packing/Cauterisation/Antifibrinolytic agents 3 Points
Blood Transfusion or replacement agents [- haemostatic components/rVIIa] or Desmopressin 4 Points
Cutaneous Bruising
No/trivial 0 Points
5 or more [>1cm] in exposed areas 1 Point
Consultation only 2 Points
Extensive 3 Points
Spontaneous requiring Blood Transfusion 4 Points
Bleeding from minor wounds
No/trivial 0 Points
>5/ Year or >10 minutes 1 Point
Consultation only 2 Points
Surgical haemostasis 3 Points
Blood Transfusion or replacement agents or Desmopressin 4 Points
Oral Cavity Bleeding
No/trivial 0 Points
>5/ Year or >10 minutes 1 Point
Consultation only 2 Points
Surgical haemostasis or Antifibrinolytic agent 3 Points
Blood Transfusion or replacement agents or Desmopressin 4 Points
GI Bleeding
No/trivial 0 Points
Present - not associated with portal hypertension, ulcer, haemorrhoids, angiodysplasia 1 Point
Consultation only 2 Points
Surgical haemostasis or Antifibrinolytic agent 3 Points
Blood Transfusion or replacement agents or Desmopressin 4 Points
Haematuria
No/trivial 0 Points
Present - macroscopic 1 Point
Consultation only 2 Points
Surgical haemostasis, iron therapy 3 Points
Blood Transfusion or replacement agents or Desmopressin 4 Points
Dental Extractions
No/trivial or none done 0 Points
Reported in ≤ 25% of procedures, no interventions 1 Point
Reported in > 25% of procedures, no interventions 2 Points
Surgical haemostasis or Antifibrinolytic agent 3 Points
Blood Transfusion or replacement agents or Desmopressin 4 Points
Surgery
No/trivial or none done 0 Points
Reported in ≤ 25% of procedures, no interventions 1 Point
Reported in > 25% of procedures, no interventions 2 Points
Surgical haemostasis or Antifibrinolytic agent 3 Points
Blood Transfusion or replacement agents or Desmopressin 4 Points
Menorrhagia
No/trivial

0 Points
Consultation only
or
Changing pads more frequently than every 2 hrs
or
Clot sand flooding
or
PBAC Score >100

1 Point
Time of work/school >2X year 
or
Requiring Antifibrinolytic agents 
or
Hormonal therapy or iron therapy

2 Points
Requiring combined treatment with Antifibrinolytic agents and hormonal therapy
or
Present since menarche and >12 months

3 Points
Acute menorrhagia requiring hospital admission and emergency treatment
or
Blood Transfusion or replacement agents or Desmopressin
or
Requiring D & C or endometrial ablation or hysterectomy
4 Points
Post-partum Haemorrhage
No/trivial or no deliveries

0 Points
Consultation only
or
Use of syntocin
or
Lochia > 6 weeks

1 Point
Iron therapy
or
Antifibrinolytic

2 Points
Requiring Blood Transfusion, Replacement agents, Desmopressin
or
Requiring examination under anaesthesia and/or the use of uterine balloon package to tamponade the uterus

3 Points
Any surgical procedure requiring critical care or surgical intervention e.g. hysterectomy, iliac artery ligation, uterine artery embolisation, uterine artery bracing. 4 Points
Muscle Haematomas
Never 0 Points
Post-trauma, no therapy 1 Point
Spontaneous no therapy 2 Points
Spontaneous or traumatic requiring Desmopressin or replacement therapy 3 Points
Spontaneous or traumatic requiring surgical intervention or blood transfusion 4 Points
Haemarthrosis
Never 0 Points
Post-trauma, no therapy 1 Point
Spontaneous no therapy 2 Points
Spontaneous or traumatic requiring Desmopressin or replacement therapy 3 Points
Spontaneous or traumatic requiring surgical intervention or blood transfusion 4 Points
CNS Bleeding
Never 0 points
Subdural, any intervention 3 Points
Intracerebral, any intervention 4 Points
Other Bleeding Problems
No/trivial 0 Points
Present 1 Point
Consultation only 2 Points
Surgical haemostasis or Antifibrinolytic agent 3 Points
Blood Transfusion or replacement agents or Desmopressin 4 Points


Score

[Max Score 56 points]

Interpretation:
Normal Range: Males1 0-3

A score >4 is considered abnormal
Normal Range: Females1 0-5

A score >6 is considered abnormal
Child <3

1
See Reference 2 - Elbatarny et al.


Click HERE to re-set the ISTH-BAT algorithm.