PB1076 - Clinical utility of ISTH BAT and Thromboelastography in assessment of patients referred for evaluation of bleeding disorders

Background: Diagnosis of bleeding disorders still remains a challenge as bleeding is a symptom experienced by the healthy and diseased alike. A properly taken history is still considered the most important tool. Different bleeding assessment tools with standardized, guided questions have been devised, ISTH BAT is one such tool. The standard tests of coagulation are performed on platelet poor plasma which negates the contribution of red blood cells, platelets to hemostasis. A need for a test that simulates the steps of hemostasis invitro was long felt and the advent of Thromboelastography has addressed some of the issues mentioned. In our study we have seen the utility of these two tools in assessments of patients with bleeding disorders.

Aims: To determine the clinical utility of ISTH BAT and Thromboelastography in assessment of patients referred for evaluation of bleeding disorders.

Methods: A total of 223 patients who were referred for evaluation of bleeding disorders were enrolled into the study. ISTH BAT was administered in each patient and the final score was calculated. Thromboelastography(TEG) and other tests of coagulation was performed in each sample per protocol and the results were analyzed. Sensitivity, Specificity, Negative and Positive predictive value (NPV, PPV) were calculated for ISTH BAT bleeding score, TEG separately and taken together.

Results: Sensitivity, specificity, PPV, NPV for ISTH BAT were 92%, 63.3%, 75.9% and 86.4% respectively while for TEG it was 86%, 85.7%, 89.7% and 80.9% respectively. When both these modalities were taken together sensitivity, specificity, PPV, NPV was 97.5%, 56.6%, 76.3% and 94.4%.

Conclusion(s): Diagnosis of bleeding disorders is challenging and there are no tests that are considered as gold standards. As a result the tests performed are expensive and time consuming. ISTH BAT and TEG may serve as an effective screening tool in resource constrained setting owing to their high sensitivity and negative predictive value.