Variability in International Society on Thrombosis and Haemostasis-Scientific and Standardization Committee endorsed Bleeding Assessment Tool (ISTH-BAT) score with normal aging in healthy females: contributory factors and clinical significance
Background: Bleeding assessment tools are key screening tests used in the evaluation of patients with suspected inherited bleeding disorders. The International Society on Thrombosis and Haemostasis-Scientific and Standardization Committee endorsed Bleeding Assessment Tool (ISTH-BAT) has differing reference ranges for adult males (0-3), adult females (0-5), and children (0-2), reflecting differing bleeding symptoms and exposure to hemostatic challenges in these healthy population subgroups. Age is known to markedly impact bleeding score in individuals with von Willebrand disease. However, the influence of age on bleeding score in healthy adult controls is poorly understood.
Objectives: We aimed to assess variability in ISTH-BAT score with age among healthy control females.
Methods: We used the legacy "Merging Project" dataset of normal healthy controls upon which current ISTH-BAT normal ranges are based. We included women, totaling 646 individuals. The normal range (middle 95th percentile) of total ISTH-BAT and grouped subdomain scores between age quartiles was assessed.
Results: The normal range of ISTH-BAT scores increased with age, ranging from 0 to 4 in the youngest quartile (age range, 18-30) to 0 to 6 in the oldest (age range, 52-88). This increased variability with aging was related both to high menorrhagia domain scores in older women and an increase in postprocedural bleeding with accumulated exposure to hemostatic challenges.
Conclusions: Cumulatively, our data highlight that normal aging leads to increased variability in bleeding scores in healthy adult females. Further refinement of the ISTH-BAT with age-adjusted reference ranges may improve the sensitivity and specificity of the tool among females.
Health Research Board (Grant Number 203930/B/16/Z)
Health Service Executive, National Doctors Training and Planning
NIH for the Zimmerman Program (HL081588)
National Center For Advancing Translational Science (UL1 TR001866) Clinical and Translational Science Award Program
Science Foundation Ireland Principal Frontiers for the Future (FFP) award (20/FFP-A/8952)
Health and Social Care Research and Development Division, Northern Ireland
CommentsThe original article is available at https://www.jthjournal.org/
Published CitationDoherty D. et al. Variability in International Society on Thrombosis and Haemostasis-Scientific and Standardization Committee endorsed Bleeding Assessment Tool (ISTH-BAT) score with normal aging in healthy females: contributory factors and clinical significance. J Thromb Haemost. 2023;21(4):880-886
Publication Date27 December 2022
- Irish Centre for Vascular Biology
- School of Pharmacy and Biomolecular Sciences
- Published Version (Version of Record)