Evaluation of Normal Range of Bleeding Scores in Healthy Iranian Adults using the International Society on Thrombosis and Hemostasis Bleeding Assessment Tool

Background: Bleeding assessment tools are key components in the evaluation of patients suspicious for bleeding disorders. The exact determination of the normal ranges of ISTH-BAT (International Society on Thrombosis and Hemostasis –Bleeding Assessment Tool) in the healthy population is a crucial step for determining who needs to be referred for further coagulation laboratory examinations. We aimed to determine the normal range of ISTH-BAT and simultaneously evaluate the Von Willebrand disease (VWD) diagnostic panel tests in a healthy Iranian group. Methods: ISTH-BAT as well as prothrombin time, activated partial thromboplastin time, factor VIII clotting assay, von Willebrand factor (VWF) antigen, VWF ristocetin cofactor assay, ristocetin induced platelet agglutination, and blood group typing were assessed for 25 normal adults without any bleeding symptoms or a known coagulation disorder. Results: In the 25 studied subjects (13 men, 12 women), the range of bleeding score was 0-6 in women and 0-5 in men; however, since the scores were lower than 2 in most (68%) cases, the interquartile range (IQR) was used for normalizing the data. The ISTH-BAT normal range was found to be 1-4 in women and 0–2 in men. Conclusion: According to this result, the ISTH-BAT cut-off for abnormal bleeding score was ≥5 in adult women and ≥3 in adult men. These data may be valuable in the routine practice of clinicians and adult hematologists in our country for the assessment of individuals with suspected bleeding disorders.