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James, P. D.; Mahlangu, J.; Bidlingmaier, C.; Mingot-Castellano, M. E.; Chitlur, M.; Fogarty, P. F.; Cuker, A.; Mancuso, M. E.; Holme, P. A.; Grabell, J.; Satkunam, N.; Hopman, W. M. und Mathew, P. (2016): Evaluation of the utility of the ISTH-BAT in haemophilia carriers: a multinational study. In: Haemophilia, Bd. 22, Nr. 6: S. 912-918

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Abstract

IntroductionThere has been increasing recognition in recent years that female carriers of haemophilia manifest abnormal bleeding;however, data on the use of bleeding assessment tools in this population are lacking. AimOur objective was to validate the ISTH-BAT in haemophilia carriers to describe bleeding symptoms and allow for comparisons with factor levels and other patient groups. MethodsThis was a prospective, observational, cross-sectional study performed by members of Global Emerging HEmostasis Panel(GEHEP). Unselected consecutive haemophilia carriers were recruited and a CRF and the ISTH-BAT were completed by study personnel. ResultsA total of 168 haemophilia carriers were enrolled: 155 haemophilia A and 13 haemophilia B. The mean age was 40years (range: 20-82). Carriers had higher mean bleeding scores (BS) compared with age-matched controls (n=46;5.7 vs. 1.43;P<0.0001) and Type 3 VWD OC (n=32;3.0;P=0.009), but lower BS compared with women with Type 1 VWD (n=83;8.7;P<0.0001). Fifteen carriers reported haemarthrosis, and of those six had normal FVIII/FIX levels. There was a significant but weak negative correlation between BS and factor level (Spearman's r(2)=-0.36, P<0.001). ConclusionOur results show that haemophilia carriers experience abnormal bleeding, including haemarthrosis. Overall, BS in women with Type 1 VWD>haemophilia carriers>Type 3 VWD OC>controls. Understanding the performance of the ISTH-BAT in this population is a critical step in future research aimed at investigating the underlying pathophysiology of abnormal bleeding, with the ultimate goal of optimizing treatment.

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