Type of bleeding | Score | ||||
0 | 1 | 2 | 3 | 4 | |
Epistaxis | None or trivial | >5 episodes per year or episode(s) lasting >10 minutes | Consultation only* | Required packing, cauterization, or antifibrinolytic therapy | Required blood transfusion, replacement therapy¶, or desmopressin |
Cutaneous (eg, bruising, ecchymoses, purpura) | None or trivial | ≥5 (>1 cm) in exposed areas | Consultation only* | Extensive | Spontaneous hematoma requiring blood transfusion |
Bleeding from minor wounds | None or trivial | >5 episodes per year or episode(s) lasting >10 minutes | Consultation only* | Required surgical hemostasis | Required blood transfusion, replacement therapy¶, or desmopressin |
Oral cavity | None or trivial | Present | Consultation only* | Required surgical hemostasis or antifibrinolytic therapy | Required blood transfusion, replacement therapy¶, or desmopressin |
Gastrointestinal bleeding | None or trivial | Present (not associated with ulcer, portal hypertension, hemorrhoids, angiodysplasia) | Consultation only* | Required surgical hemostasis or antifibrinolytic therapy | Required blood transfusion, replacement therapy¶, or desmopressin |
Hematuria | None or trivial | Present (macroscopic) | Consultation only* | Required surgical hemostasis or iron therapy | Required blood transfusion, replacement therapy¶, or desmopressin |
Bleeding after tooth extraction | None, trivial, or no prior extractions | Reported in ≤25% of all procedures, did not require interventionΔ | Reported in >25% of all procedures, did not require interventionΔ | Required resuturing or packing | Required blood transfusion, replacement therapy¶, or desmopressin |
Surgical bleeding | None, trivial, or no prior surgeries | Reported in ≤25% of all procedures, did not require interventionΔ | Reported in >25% of all procedures, did not require interventionΔ | Required surgical hemostasis or antifibrinolytic | Required blood transfusion, replacement therapy¶, or desmopressin |
Menorrhagia | None or trivial | Any of the following:
| Required any of the following:
| Either of the following:
| Required any of the following:
|
Postpartum hemorrhage | No/trivial or no deliveries | Any of the following:
| Required iron or antifibrinolytic therapy | Either of the following:
| Required surgical intervention or a procedure requiring critical care (eg, hysterectomy, internal iliac artery legation, uterine artery embolization, uterine brace sutures) |
Muscle hematomas | Never | Post-traumatic, not requiring treatment | Spontaneous, not requiring treatment | Spontaneous or traumatic, requiring desmopressin or replacement therapy¶ | Spontaneous or traumatic, requiring surgical intervention or blood transfusion |
Hemarthrosis | Never | Post-traumatic, not requiring treatment | Spontaneous, not requiring treatment | Spontaneous or traumatic, requiring desmopressin or replacement therapy¶ | Spontaneous or traumatic, requiring surgical intervention or blood transfusion |
Intracranial hemorrhage | Never | N/A | N/A | Subdural | Intracerebral |
Other:
| None or trivial | More than trivial but did not require medical evaluation | Consultation only* | Required surgical hemostasis or antifibrinolytic therapy | Required blood transfusion, replacement therapy¶, or desmopressin |
ISTH BAT: International Society on Thrombosis and Haemostasis bleeding assessment tool; D&C: dilatation & curettage; VWD: von Willebrand disease.
* Consultation only means that the patient sought medical evaluation and was either referred to a specialist or offered laboratory investigation but did not require hemostatic therapy or transfusion.
¶ Replacement therapy includes use of hemostatic blood components and/or recombinant factor VIIa.
Δ For example, if the patient had ≥4 prior extractions/surgeries and experienced more than trivial bleeding only once without need for intervention, a score of 1 should be assigned. If the patient had ≤3 prior extractions/surgeries and experienced more than trivial bleeding in any of them (not requiring intervention), a score of 2 should be assigned. If the patient experienced bleeding that required intervention, the score to be assigned is a 3 or 4 depending on the type of intervention (as detailed in the table above).
◊ For these categories, the presence of more than trial bleeding in infancy requires detailed investigation independently from the overall score.Do you want to add Medilib to your home screen?