ALATI ZA PROCENU KRVARENJA
Sažetak
Alati za procenu krvarenja (engl. blood assessment tool − BATs) predstavljaju sisteme bodovanja za krvarenja koji se koriste za skrining i kvantitativnu procenu blagih poremećaja krvarenja. Sastoje se od standardizovanog upitnika i sistema bodovanja koji se upotrebljava za računanje konačnog zbira bodova. U ovom preglednom članku predstavljeni su alati za procenu krvarenja koji se koriste u oblasti hematologije.
Prvi alati bili su dizajnirani radi razlikovanja bolesnika sa Fon Vilebrandovom bolešću od zdravih osoba. Kasnije modifikacije originalnog Vičenza alata razvijene su kako bi se poboljšale njegova specifičnost, preciznost i fleksibilnost i kako bi se skratilo vreme potrebno za popunjavanje upitnika. Najznačajnija od ovih modifikacija jeste alat Internacionalnog društva za trombozu i hemostazu (ISTH-BAT), takođe validiran za upotrebu kod hemofilije i urođenih bolesti trombocita. ISTH-BAT zbir > 6 kod odraslih žena, > 4 kod odraslih muškaraca i > 3 kod dece smatra se abnomalnim nalazom.
Prvi alat za imunološku trombocitopeniju (engl. immune thrombocytopenia− ITP) razvila je Svetska zdravstvena organizacija (SZO). Međutim, nedavno je Internacionalna radna grupa (engl. International Working Group−IWG) za ITP razvila ITP-BAT. Radna grupa definiše teško / klinički relevantno krvarenje kao ITP-BAT SMOG index: S > 2 i/ili M > 1 i/ili O > 1. Modifikovanjem ITP-BAT tokom 2016. godine grupa kineskih eksperata razvila je ITP-2016. Vrednosti ITP-2016 zbira > 5 odgovaraju teškoj imunološkoj trombocitopeniji.
Na nivou primarne zdravstvene zaštite alati za procenu krvarenja predstavljaju korisne skrining alate za otkrivanje bolesnika sa patološkim krvarenjima, koji zahtevaju sprovođenje dopunskih hematoloških pretraga.
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