PB1305 - Enhancing the utility of Skin Bleeding time by using it along with ISTH-BAT score to identify primary hemostatic bleeding disorders

Background: The International Society on Thrombosis and Hemostasis bleeding assessment tool (ISTH-BAT) was developed to aid in patient diagnosis. The skin bleeding time (SBT) test has also been widely utilized as a means of assessing primary hemostasis. But SBT is relatively insensitive and nonspecific in identifying disorders of primary hemostasis.

Aims: This study was done to investigate if the SBT becomes more beneficial in the diagnosis of primary hemostatic disorders after ISTH-BAT score is found to be significant.

Methods: 167 patients suspected cases of primary hemostatic disorder referred for complete coagulation work up were included after administering ISTH-BAT questionnaire. Cases of thrombocytopenia and secondary hemostatic disorders were excluded. 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 obtained for a 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: Common bleeding symptoms were epistaxis: 31%, easy bruisability: 26%, skin bleeds (petechiae, ecchymoses): 31 %, prolonged bleeding from minor wounds: 32%, oral cavity bleed: 31%, menorrhagia: 15%, post surgery bleed: 4%, GI bleed: 18%, other bleeds (CNS bleed, hematuria, umbilical stump bleeding): 8%. The SBT and ISTH-BAT scores are shown in Table 1. followed by the statistical analysis in Table 2.

Conclusion(s): ISTH-BAT is a valuable tool to record lifelong bleeding history. Use of SBT after administering ISTH-BAT gives an indication regarding the nature and also severity of the bleeding disorder. Hence Skin Bleeding Time can be use in resource-limited settings to identify primary haemostatic disorders.