Biologie des anomalies de l’hémostase. - Brief INAHTA - Biology of haemostasis disorders: bleeding time

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Description

Mis en ligne le 20 juil. 2011 Ce travail a eu pour but d’évaluer dix actes de biologie mesurant les anomalies de l’hémostase, qui avaient été signalés par le demandeur de cette évaluation soit comme obsolètes mais figurant encore à la Nomenclature des actes de biologie médicale (NABM), soit comme pertinents mais ne figurant pourtant pas dans cette nomenclature.Cette évaluation pourra donc permettre l’actualisation du sous chapitre 5-02 « Hémostase et coagulation » de la NABM. Cette évaluation a donné lieu à la rédaction de sept documents :Tome I : Evaluation du Temps de saignement (Epreuve de DUKE et tests d’IVY) ;Tome II : Temps de Thrombine et correction du Temps de Thrombine ;Tome III : Test photométrique d’agrégation plaquettaire ;Tome IV : Recherche d’anticorps antifacteur 4 plaquettaire dans le cadre d’une thrombopénie induite par l’héparine ;Tome V : Recherche et titrage d’inhibiteur contre les facteurs antihémophiliques ;Tome VI : Détection d’un anticoagulant de type lupique ;Tome VII : Recherche de la mutation G1691A du gène du facteur V (FV de Leiden) et de la mutation G20210A du gène du facteur II. Le texte court de cette évaluation reprend la totalité des 7 tomes (10 actes évalués). Mis en ligne le 20 juil. 2011

Sujets

• Biologie
• Médecine

Informations

• Publié par: haute-autorite-sante-techniques-et-procedures-de-diagnostic
• Publié le: 01 juillet 2011
• Nombre de lectures: 26
• Licence : En savoir +
  Paternité, pas d'utilisation commerciale, partage des conditions initiales à l'identique
• Langue: Français

Extrait

 

INAHTA brief   Title of haemostasis disorders: bleeding time Biology   Agency French National Authority for Health (Haute Autorité de Santé) HAS,    2 avenue du Stade de France – F 93218 La Plaine Cedex, France  Tel: + 33 (0) 1 55 93 71 13 – Fax: + 33 (0) 1 55 93 74 35,    fré[e-mail],haw.wwrftn.e-sas    Referencer//f8299ieogolbiona-sed-d-seilam-san.hasr/pote.f/lcjtria1_00smc/e/-wwwtp:/ht lhemostase     Aim The National Salaried Workers’ Health Insurance Fund (CNAMTS) asked HAS to assess the value of the different laboratory tests for haemostasis abnormalities with a view to updating the section in the Nomenclature of Procedures in Laboratory Medicine (NABM) containing the procedures in laboratory medicine for measuring haemostasis disorders (subsection 5- 02). One of these tests is the bleeding time (Duke’s test, Ivy’s incision test or Ivy’s 3-point test). The bleeding time (BT), an NABM procedure, is a global test to investigate primary haemostasis in vivotime needed for bleeding to stop after a. BT consists in measuring the superficial incision is made in the patient’s skin. Historically, the BT was used for preoperative assessment of haemostasis or to investigate haemorrhagic syndrome.     Conclusions and results According to the different documents analysed, the BT has little or no reproducibility, poor sensitivity and specificity, and lacks predictive value. The BT is an invasive procedure which may leave scars. The BT is not considered suitable for the investigation of primary haemostasis   . There are alternative techniques: - “preoperative investigation of haemostasis” for the preoperative assessment of the risk of  haemorrhage, which is already an NABM procedure; - “measurement of von Willebrand’s factor”, “determination of ristocetin activity” and “measurement of factor VIII” for the diagnosis of von Willebrand’s disease, which are already NABM procedures; - photometric platelet aggregation test” for the assessment of platelet function disorders,  “ which is not at present an NABM procedure but is the subject of a HAS assessment report. In conclusion, on the basis of the literature identified and analysed, BT is not recommended either for preoperative assessment of the risk of haemorrhage or for the diagnosis of von Willebrand’s disease, nor does it have any place in the diagnostic strategy. There are alternatives which are already NABM procedures.     Recommendations    On the basis of the literature identified and analysed, the BT   has been shown to be an obsolete procedure which should no longer be used in current practice.   Methods This assessment is based on a critical analysis of the literature carried out by the Haute Autorité de Santé, and reviewed by experts in haemostasis. It takes into account the arguments of a group of experts assembled by CNAMTS on which CNAMTS based its request. The assessment of this procedure is based on a critical analysis of the literature

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