Papel de los trastornos de la hemostasia en el sangrado uterino anormal / Role of haemostatic disorders in abnormal uterine bleeding

El sangrado uterino anormal es una manifestación hemorrágica que afecta la calidad de vida de las mujeres al limitar sus actividades laborales y sociales. Con frecuencia, es la primera manifestación de un trastorno hemorrágico subyacente, por lo que su identificación temprana es fundamental para evitar retrasos en el tratamiento. Los trastornos hemorrágicos congénitos incluyen una amplia variedad de defectos de la hemostasia. Entre ellos, la enfermedad de von Willebrand es el más prevalente. Con una frecuencia menor encontramos los trastornos plaquetarios congénitos y las deficiencias de otros factores de la coagulación que también pueden manifestarse con sangrado uterino anormal. Existe una amplia variación en la gravedad de las manifestaciones hemorrágicas entre los distintos trastornos de la hemostasia, así como entre distintos pacientes afectos del mismo trastorno. Estas manifestaciones pueden ser de carácter leve o moderado o bien presentar una diátesis hemorrágica grave. Por ello, cada paciente debe ser valorado de manera individual. El manejo de las mujeres con sangrado uterino anormal y trastornos de la hemostasia es multidisciplinar, con participación conjunta de ginecólogos y hematólogos. Para el diagnóstico de un trastorno hemorrágico asociado a sangrado uterino anormal es fundamental la sospecha clínica, la elaboración de una historia personal y familiar dirigida, el empleo de herramientas estandarizadas que evalúen la magnitud del sangrado y la realización de una serie de estudios de laboratorio que permitan confirmar el diagnóstico. El tratamiento será individualizado en función de la gravedad de las manifestaciones clínicas y del tipo de alteración de la hemostasia subyacente.(AU)

Abnormal uterine bleeding is a haemorrhagic manifestation that affects women's quality of life by limiting their work and social activities. It is often the first manifestation of an underlying bleeding disorder, so its early identification is essential to avoid delays in treatment. Congenital bleeding disorders include a wide variety of haemostatic defects. Among them, von Willebrand disease is the most prevalent. Less frequently we find congenital platelet disorders and deficiencies of other coagulation factors that can also manifest with abnormal uterine bleeding. There is wide variation in the severity of bleeding manifestations among different disorders of haemostasis, as well as among different patients with the same disorder. These manifestations can be mild, moderate, or present severe bleeding diathesis. Therefore, each patient must be assessed individually. The management of women with abnormal uterine bleeding and haemostasis disorders is multidisciplinary with the joint participation of gynaecologists and haematologists. For the diagnosis of a bleeding disorder associated with abnormal uterine bleeding, clinical suspicion is essential, as well as taking a targeted personal and family history, using standardized tools that assess the magnitude of the bleeding, and performing a series of laboratory studies to confirm the diagnosis. Treatment will be individualized based on the severity of the clinical manifestations and the type of underlying haemostasis alteration.(AU)

Reliability and Feasibility of the Self-Administered ISTH-Bleeding Assessment Tool.

Introduction Standardized bleeding assessment tools (BATs), such as the International Society for Thrombosis and Hemostasis (ISTH)-BAT, are screening instruments used during the diagnostic workup of suspected bleeding disorders. A self-administered ISTH-BAT (self-BAT) would enhance screening and save time during an outpatient clinic visit. Aim This study was aimed to investigate the reliability and feasibility of the self-BAT. Methods The electronic self-BAT was created from the ISTH-BAT and paper-version of self-BAT and optimized by patients and physicians. Patients with a (suspected) congenital platelet defect (CPD), who had previously undergone physician-administered ISTH-BAT assessment, were invited to complete the self-BAT. Optimal self-BAT cut-off values to detect a bleeding tendency, as defined by the ISTH-BAT, were evaluated by receiver operator characteristic (ROC) curve analysis to reach a sensitivity ≥95%. Reliability was tested by assessing sensitivity, specificity, and intraclass correlation (ICC). Feasibility was evaluated on comprehension and length of self-BAT. Results Both versions of the BAT were completed by 156 patients. Optimal cut-off values for self-BAT to define a bleeding tendency were found to be identical to those of the ISTH-BAT. Normal/abnormal scores of the ISTH-BAT and self-BAT were agreed in 88.5% (138/156, 95% confidence interval [CI]: 0.83-0.93) of patients. The sensitivity and specificity of the self-BAT to detect a bleeding tendency were 96.9 and 48.1%, respectively. The ICC was 0.73. Self-BAT questions were graded by 96.8% (151/156) as "very easy," "easy," and "satisfactory" and questionnaire length as "exactly right" by 91% (142/156) of patients. Conclusion In patients with a (suspected) CPD, the self-BAT is sufficiently reliable and feasible to detect a bleeding tendency, which supports its use as a screening tool.