VPB1191 - Bleeding of unknown cause or Unclassified Bleeding Disorder : single center experience in west Algeria.

Background: Patients with unclassified bleeding disorder or Bleeding of unknown cause, sometimes present with significant bleeding symptoms despite the presence of normal haemostatic tests. The management of this bleeding episode is not standardized.

Aims: To assess the frequency and impact of bleeding measured by ISTH-BAT.

Methods: Retrospective cohort analysis of patients with unclassified bleeding disorder betwene 2007 and 2020 at haemobiology departement of university Hospital of Oran in west Algeria. The inclusion criterion is the presence of a significant bleeding symptom ISTH-BAT greater than 3 and the presence of normal haemostatic exploratory tests.

Results: Out of 3,321 patients referred for exploration of a hemorrhagic syndrome over a period of 13 years, 61 patients with unclassified bleeding disorder were identified, therefore an incidence of 1.83%.
42 (69%) were female and 19 (31%) male. Mean age at diagnosis was 27 years (range 13 -71 years). There was 13 case of consanguinity.
Leading presenting symptoms in women were heavy menstrual bleeding (69%) and epistaxis (26%). Most frequent symptoms leading to diagnosis in men were epistaxis (93%) and bleeding after tooth-extraction (10%). Incidence of anaemia was 48% (range 8.5-11.5 g/dL).
Mean ISTH-BAT score was 3.56 (range 3-7) and in women mean score was 5.2.
11 patients underwent 16 majors and minors surgeries. Haemostatic cover was administered in 9 cases; Blood and platelet transfusion in 02 patients.

Conclusion(s): Patients with an Unclassified Bleeding Disorder suffer from various bleeding symptoms and are at risk of bleeding when undergoing surgical procedures. Women are more exposed to hemostatic challenge, especially due to monstrual bleeding. There is a need for standardization of diagnosis and management guidelines for these patients.