Advertisement

The value of bleeding scores in the assessment of patients presenting with bleeding of unknown cause: Bleeding assessment tools have still a place

  • Alberto Tosetto
    Correspondence
    To whom correspondence should be addressed
    Affiliations
    Institution: Hemophilia and Thrombosis Center, Hematology Department, San Bortolo Hospital, AULSS 8 "Berica", viale Rodolfi 37, 36100 Vicenza, Italy
    Search for articles by this author
      In this issue of the Journal, Genhart and coworkers present data about the discriminatory power of bleeding assessment tools (BATs) in adults with a mild to moderate bleeding tendency [
      • Gebhart J.
      • Hofer S.
      • Kaider A.
      • Rejtö J.
      • Ay C.
      • Pabinger I.
      The discriminatory power of bleeding assessment tools in adult patients with a mild to moderate bleeding tendency.
      ]. They compared 97 patients with a definite diagnosis of hemostatic disorder with 228 patients in whom no laboratory abnormality was observed (Bleeders of unknown cause, BUCs). Not very surprisingly, they found that both the Vicenza or ISTH bleeding scores were not able to discriminate between the two subgroups of bleeding patients. These findings led Drs Malec and Crowther to conclude, in an accompanying commentary, that the use of these BATs should be confined to specialized centers that they should not be used to guide which patients receive laboratory testing, or undergo more aggressive monitoring or treatment [
      • Malec L.
      • Crowther M.
      The value of bleeding scores in the assessment of patients presenting with bleeding of unknown cause: complex algorithms with little predictive value.
      ].

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gebhart J.
        • Hofer S.
        • Kaider A.
        • Rejtö J.
        • Ay C.
        • Pabinger I.
        The discriminatory power of bleeding assessment tools in adult patients with a mild to moderate bleeding tendency.
        Eur J Internal Med. 2020; (https://doi.org/)https://doi.org/10.1016/j.ejim.2020.04.023
        • Malec L.
        • Crowther M.
        The value of bleeding scores in the assessment of patients presenting with bleeding of unknown cause: complex algorithms with little predictive value.
        Eur J Internal Med. 2020; https://doi.org/10.1016/j.ejim.2020.05.025
        • Penaloza A.
        • Verschuren F.
        • Meyer G.
        • Quentin-Georget S.
        • Soulie C.
        • Thys F.
        • Roy P.M.
        Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism.
        Ann Emerg Med. 2013; 62e112https://doi.org/10.1016/j.annemergmed.2012.11.002
        • Rodeghiero F.
        • Castaman G.
        • Tosetto A.
        • Batlle J.
        • Baudo F.
        • Cappelletti A.
        • Casana P.
        • De Bosch N.
        • Eikenboom J.C.
        • Federici A.B.
        • Lethagen S.
        • Linari S.
        • Srivastava A.
        The discriminant power of bleeding history for the diagnosis of type 1 von Willebrand disease: an international, multicenter study.
        J Thromb Haemost. 2005; 3: 2619-2626https://doi.org/10.1111/j.1538-7836.2005.01663.x
        • Rodeghiero F.
        • Tosetto A.
        • Abshire T.
        • Arnold D.M.
        • Coller B.
        • James P.
        • Neunert C.
        • Lillicrap D.
        • Isj V.W.F.
        • Perinatal/Pediatric Hemostasis Subcommittees Working G
        ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders.
        J Thromb Haemost. 2010; 8: 2063-2065https://doi.org/10.1111/j.1538-7836.2010.03975.x
        • Tosetto A.
        • Castaman G.
        • Plug I.
        • Rodeghiero F.
        • Eikenboom J.
        Prospective evaluation of the clinical utility of quantitative bleeding severity assessment in patients referred for hemostatic evaluation.
        J Thromb Haemost. 2011; 9: 1143-1148https://doi.org/10.1111/j.1538-7836.2011.04265.x
        • Federici A.B.
        • Bucciarelli P.
        • Castaman G.
        • Mazzucconi M.G.
        • Morfini M.
        • Rocino A.
        • Schiavoni M.
        • Peyvandi F.
        • Rodeghiero F.
        • Mannucci P.M.
        The bleeding score predicts clinical outcomes and replacement therapy in adults with von Willebrand disease.
        Blood. 2014; 123: 4037-4044https://doi.org/10.1182/blood-2014-02-557264
      1. Tosetto A., Badiee Z., Baghaipour M.-R., Baronciani L., Battle J., Berntorp E., Bodó I., Budde U., Castaman G., Eikenboom J.C.J., Eshghi P., Ettorre C., Goodeve A., Goudemand J., Charles Richard Morris H., Hoorfar H., Karimi M., Keikhaei B., Lassila R., Leebeek F.W.G., Lopez Fernandez M.F., Mannucci P.M., Mazzucconi M.G., Morfini M., Oldenburg J., Peake I., Parra Lòpez R., Peyvandi F., Schneppenheim R., Tiede A., Toogeh G., Trossaert M., Zekavat O., Zetterberg E.M.K., Federici AB Bleeding symptoms in patients diagnosed as type 3 Von Willebrand Disease: results from 3WINTERS-IPS, an international and collaborative cross-sectional study. J Thromb Haemostasisn/a (n/a). doi:10.1111/jth.14886.