PB0121 - Clinical value of laboratory diagnostics for bleeding disorders in general practice

Background: The national guidelines on laboratory diagnostics in primary care advise activated partial thromboplastin time (aPTT), prothrombin time (PT) and thrombocyte count as screening laboratory tests in case of analysis of an increased bleeding tendency in primary care. Since 2018, the Central Diagnostic Laboratory (CDL) in MUMC+ uses a more extensive assortment of tests, including hemoglobin (Hb), leukocyte differentiation and platelet function analyzer (PFA, ADP and EPI).

Aims: To evaluate bleeding tendency diagnostics in primary care.

Methods: Data from primary care patients who were screened for an increased bleeding tendency from 2018-2022 were analyzed. Test results, referral to secondary care services and diagnostic outcomes were analyzed.

Results: A total of 304 patients were screened for a bleeding tendency in primary care. In 25% of these patients, a laboratory abnormality was found. In 78% of these patients (n=63/80), only the PFA was prolonged (one or both agonists). 32 patients with abnormal test results were referred to a hematologist for further analysis. In 17/32 patients, a diagnosis was found (platelet function disorder (n=10), von Willebrands disease (n=4), bleeding disorder of unknown cause (n=2) and thrombopenia (n=2)). In the majority of these patients (16/17), only the PFA was prolonged.

Conclusion(s): Adding PFA to the diagnostic screening tests for bleeding disorders in primary care leads to more referrals to secondary care. In referred patients with test abnormalities, the chance of having a bleeding disorder is rather high. A part of the patients with abnormalities in the screening laboratory tests are not referred to the hematologist, which is a remarkable observation. The complexity of the bleeding history and interpretation of hemostasis laboratory tests in primary care might (partly) explain this. This could be solved by a customized (phone) consult from the laboratory specialist, instead of a generic consult. This service will be offered by the CDL from the MUMC+.