Philipp Tool Demonstrates Low Utility in Assessing Heavy Menstrual Bleeding for a Hemostatic Defect
Although anovulation is the most common cause of heavy menstrual bleeding, an underlying hemostatic defect may also contribute to this menstrual problem.
The Philipp tool, developed to screen for hemostatic defects (HDs) in women with heavy menstrual bleeding (HMB), was not found to be diagnostically accurate in adolescents with HMB within a secondary care setting, according to a study published in Haemophilia.
The Philipp tool comprises 8 questions in 4 categories regarding the severity of the patient's HMB and any personal or family history of HDs, with a positive result indicating that the patient may have an HD. The tool was developed for and validated in adult women, but its diagnostic accuracy for adolescents and in a secondary care setting is unknown.
In this multicenter[kt3] study, researchers tested 248 adolescent patients for anemia, iron deficiency, and HDs including low von Willebrand factor (VWF) levels, von Willebrand disease (VWD), qualitative platelet dysfunction, isolated thrombocytopenia, and clotting factor deficiencies. The patients had either self-reported or been referred for HMB and did not have diagnosed HDs or prior use of anticoagulants. In addition to undergoing laboratory testing, the patients completed a modified version of the Philipp tool to which the researchers had assigned a scoring system of 1 to 4 in an effort to attain better specificity. Additionally, patients at the University of Texas Southwestern Medical Center (UTSW) in Dallas (n=140) completed a pictorial blood assessment chart (PBAC), the scores for which were assigned based on visual assessment of menstrual blood loss.
The researchers reported that 52.3% of the patients were found to be anemic, and a further 26% were iron deficient but not anemic. Furthermore, 29% of the patients were diagnosed with an HD. The Philipp tool demonstrated 95% sensitivity (68/72 true positive screenings) and 14% specificity (25/176 true negative screenings). When the Philipp tool was assessed in conjunction with a PBAC score >185, sensitivity decreased to 72% while specificity increased to 60%.
The study authors concluded the Philipp tool, both on its own and with modifications, has low utility in diagnosing HDs. They further emphasized “the need for future research on adolescent-specific HMB tools for a secondary care setting” in order to find “one bleeding assessment tool [that] can both be highly sensitive and specific.”
- Zia A, Stanek J, Christian-Rancy M, Ahuja SP, Savelli S, O'Brien SH. Utility of a screening tool for haemostatic defects in a multicenter cohort of adolescents with heavy menstrual bleeding [published online September 12, 2018]. Haemophilia. doi:10.1111/hae.13609