The evolution and value of bleeding assessment tools

Abstract

Summary. A personal history of excessive mucocutaneous bleeding is a key component in the diagnosis of a number of mild bleeding disorders, including von Willebrand disease (VWD), platelet function disorders (PFD), and coagulation factor deficiencies. However, the evaluation of hemorrhagic symptoms is a well‐recognized challenge for both patients and physicians, because the reporting and interpretation of bleeding symptoms is subjective. As a result, bleeding assessment tools (BATs) have been developed and studied in a variety of clinical settings. This work has been pioneered by a group of Italian researchers, and the resultant ‘Vicenza Bleeding Questionnaire’ stands as the original BAT. In this review, we will discuss the modifications of the Vicenza Bleeding Questionnaire that have taken place over the years, as well as the validation studies that have been published. Other BATs that have been developed and published will be reviewed, as will the special situations of assessing pediatric bleeding as well as menorrhagia. Lastly, the clinical utility of BATs will be discussed including remaining challenges and future directions for the field.

How I treat type 2 variant forms of von Willebrand disease

“…Bleeding assessment tools have been proposed and validated in type 1 VWD patients to help with the collection and interpretation of such data. [22][23][24][25] These tools usually comprise a bleeding questionnaire and a severity scale; each bleeding symptom is scored from 0 (absence or trivial symptom) to 3 or 4 for the most severe symptoms (eg, bleeding requiring transfusion of blood products). The overall patient bleeding score (BS) is determined by summing up the scores for all of the bleeding symptoms.…”

Clinical and laboratory variability in a cohort of patients diagnosed with type 1 VWD in the United States

“…4,5 Bleeding symptoms are difficult to quantify, but much recent work has been performed adapting bleeding assessment tools (BATs) and assessing their reliability in VWD diagnosis. 6 Lack of reliable screening tests for VWD also complicates diagnosis, in that no single screening test can confirm the presence or absence of VWD, and an array of tests is required to diagnose and classify the type of VWD present. VWF antigen (VWF:Ag) is used to measure total The online version of this article contains a data supplement.…”

Preoperative screening for bleeding disorders: A comprehensive laboratory assessment of clinical practice

“…First, like all bleeding questionnaires, the BAT is susceptible to the subjective interpretation of the severity of bleeding symptoms by both the patient and the professional administering the BAT 32. Second, healthy subjects are known to report bleeding symptoms 33, 34.…”