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
14 variables are listed below:
| Epistaxis |
| Cutaneous Bruising |
| Bleeding from minor wounds |
| Oral Cavity Bleeding |
| GI Bleeding |
| Haematuria |
| Dental Extractions |
| Surgery |
| Menorrhagia |
| Post-partum Haemorrhage |
| Muscle Haematomas |
| Haemarthrosis |
| CNS Bleeding |
| Other Bleeding Problems |
There are limitations to the ISTH-BAT:
i. It
is relatively insensitive to children with a possible inherited bleeding disorder and this may lead to an underestimation of bleeding symptoms.
ii.
The ISTH-BAT is inflexible with respect to changes in the bleeding phenotype of the developing child.
iii.
The ISTH-BAT is relatively insensitive to acquired bleeding disorders.
The ISTH-BAT has been assessed as a screening tool for individuals with a possible inherited platelet function defect - see Gresele et al. The ISTH-BAT can separate individuals with an inherited platelet function defect from controls but it is less efficient in separating an inherited platelet function defect from Type 1 VWD. Therefore, the ISTH-BAT appears useful for identifying subjects requiring laboratory evaluation for a suspected inherited platelet function defect once VWD has been excluded.