How do you know if you bleed normally? Scientists at The Rockefeller University Hospital's Center for Clinical and Translational Science (CCTS) aim to answer that question more definitively with the launch of an assessment tool designed to help physicians and researchers more accurately determine what is inside and outside the normal range of bleeding symptoms.
The Phenotype Recording and Analysis Tool (PRAT), a Web-based questionnaire designed by Physician in Chief Barry S. Coller, Clinical Scholar Andreas C. Mauer and their colleagues, is the subject of a new pilot study that may change the way we diagnose and deal with bleeding disorders.
Mauer, principal investigator on the study and instructor in clinical investigation in Coller's Allen and Frances Adler Laboratory of Blood and Vascular Biology, is currently recruiting 500 participants with no known bleeding-related disease and no recent use of medication with anti-coagulant or anti-platelet properties. Participants will answer an hour-long questionnaire detailing their history of everyday bleeding symptoms - e.g., shaving nicks, nosebleeds and menstruation - and uncommon ones - unexplained bruises, coughing blood or bleeding in joints or muscles.
The primary aim of the study is to extrapolate characteristics and ranges of bleeding symptoms for normal individuals, parameters that could eventually be used as a tool in diagnosing bleeding disorders and improving screening standards for assessing preoperative risk. "Many subtle bleeding diatheses manifest only after an individual is exposed to a hemostatic challenge such as surgery, when a problem occurs," says Mauer. The study carries implications for research as well, as the results may allow investigators to draw correlations between lab results or genetic analyses and bleeding symptoms, which will in turn allow them to identify patients who may have genetic or environmental factors that influence their bleeding symptoms.
Mauer and his colleagues, including Ed Barbour, Nickolay Khazanov, Natasha Levenkova and Shamim Mollah of the CCTS's informatics department, will also break down the range of what's normal for subgroups classified by age, sex, medication use, race, ethnicity and history of trauma or surgeries - factors that may affect the bleeding score. Further delineation of "normal" bleeding will assist the team with its secondary aim of validating and refining the questionnaire.