PB0445 - Enhancing the utility of Skin Bleeding time (SBT) by using it along with ISTH-BAT to identify a bleeding diathesis in patients with menorrhagia.

Background: Heavy menstrual bleeding (HMB) is defined as heavy bleeding that lasts more than 7 days, causing >80ml blood loss per menstrual cycle or a subjective complaint of increased menstrual blood flow that negatively affects well-being and quality of life.

Aims: To investigate if the SBT is useful in identifying a bleeding disorder (BD) when used in conjunction with International Society of Thrombosis and Hemostasis Bleeding Assessment Tool (ISTH-BAT) in patients suspected to have menorrhagia.

Methods: 61 cases with menorrhagia who had come for complete coagulation work up between December 2022 and December 2023 were included after administering ISTH-BAT questionnaire and PBAC (Pictorial Bleeding Assessment Chart). SBT was performed by one of the two experienced personnel using a lancet device (MiniCollect Safety Lancet with blade, Greiner Bio-one, Vienna, Austria) with a modified Ivy technique. Citrated blood (3.2% sodium citrate in a 9: 1 blood: anticoagulant ratio) was used for complete coagulation work up which included specific tests like platelet aggregometry (CS 2400, Sysmex, Kobe Japan), VWF assays (CS 2400, Sysmex), Factor assays (CS 2400 Sysmex) and Flow cytometry (DxFlex, Beckman Coulter, Miami, US).

Results: The participants who were diagnosed with a Bleeding Diathesis also had the following bleeding symptoms: epistaxis (18%), oral cavity bleeding (11%) and ecchymoses (8%). ISTH-BAT score, PBAC score and SBT are given in Table 1. ISTH-BAT as a screening tool to identify BD demonstrated a moderate discriminative ability with an area under the curve (AUC) of 0.624 (95% CI: 0.484, 0.764). All BDs in this study except borderline levels of VWF and acquired haemophilia had a prolonged SBT.

Conclusion(s): At an ISTH-BAT score of >4, a prolonged Skin Bleeding Time is a strong predictor of a bleeding disorder in the setting of menorrhagia.