Table 1.
A Questionnaire for Bleeding Score (ISTH/SSC Bleeding Assessment Tool).
| Symptoms | Score | ||||
|---|---|---|---|---|---|
| 0a | 1a | 2 | 3 | 4 | |
| Epistaxis | No/trivial | >Five/year or more than 10 minutes | Consultation onlyb | Packing or cauterization or antifibrinolytic | Blood transfusion or replacement therapy (use of hemostatic blood components and rFVIIa) or desmopressin |
| Cutaneous | No/trivial | For bruises 5 or more (>1 cm) in exposed areas | Consultation onlyb | Extensive | Spontaneous hematoma requiring blood transfusion |
| Bleeding from minor wounds | No/trivial | >Five/year or more than 10 minutes | Consultation onlyb | Surgical hemostasis | Blood transfusion, replacement therapy, or desmopressin |
| Oral cavity | No/trivial | Present | Consultation onlyb | Surgical hemostasis or antifibrinolytic | Blood transfusion, replacement therapy or desmopressin |
| GI bleeding | No/trivial | Present (not associated with ulcer, portal hypertension, hemorrhoids, angiodysplasia) | Consultation onlyb | Surgical hemostasis, antifibrinolytic | Blood transfusion, replacement therapy, or desmopressin |
| Hematuria | No/trivial | Present (macroscopic) | Consultation onlyb | Surgical hemostasis, iron therapy | Blood transfusion, replacement therapy, or desmopressin |
| Tooth extraction | No/trivial or none done | Reported in ≤25% of all procedures, no interventionc | Reported in >25% of all procedures, no interventionc | Resuturing or packing | Blood transfusion, replacement therapy, or desmopressin |
| Surgery | No/trivial or none done | Reported in ≤25% of all procedures, no interventionc | Reported in >25% of all procedures, no interventionc | Surgical hemostasis or antifibrinolytic | Blood transfusion, replacement therapy or desmopressin |
| Menorrhagia | No/trivial | Consultation onlyb or changing pads more frequently than every 2 hours or clot and flooding or PBAC score>100d | Time off work/school >2/year or requiring antifibrinolytics or hormonal or iron therapy | Requiring combined treatment with antifibrinolytics and hormonal therapy or present since menarche and >12 months | Acute menorrhagia requiring hospital admission and emergency treatment or requiring blood transfusion, replacement therapy, desmopressin, or requiring dilatation and curettage or endometrial ablation or hysterectomy |
| Postpartum hemorrhage | No/trivial or no deliveries | Consultation onlyb or use of syntocin or lochia > 6 weeks | Iron therapy or antifibrinolytics | Requiring blood transfusion, replacement therapy, desmopressin, or requiring examination under anesthesia and/or the use of uterin balloon/package to tamponade the uterus | Any procedure requiring critical care or surgical intervention (eg, hysterectomy, internal iliac artery legation, uterine artery embolization, uterine brace sutures) |
| Muscle hematomas | Never | Post trauma, no therapy | Spontaneous, no therapy | Spontaneous or traumatic, requiring desmopressin or replacement therapy | Spontaneous or traumatic, requiring surgical intervention or blood transfusion |
| Hemarthrosis | Never | Post trauma, no therapy | Spontaneous, no therapy | Spontaneous or traumatic, requiring desmopressin or replacement therapy | Spontaneous or traumatic, requiring surgical intervention or blood transfusion |
| CNS bleeding | Never | - | - | Subdural, any intervention | Intracerebral, any intervention |
| Other bleedingse | No/trivial | Present | Consultation onlyb | Surgical hemostasis, antifibrinolytics | Blood transfusion or replacement therapy or desmopressin |
Abbreviations: CNS, central nervous system; GI, gastrointestinal; PBAC, pictorial blood loss assessment chart; rFVIIa, recombinant factor VIIa.
aDistinction between 0 and 1 is of critical importance. Score 1 means that the symptom is judged as present in the patient’s history by the interviewer but does not qualify for a score 2 or more.
bConsultation only: the patient sought medical evaluation and was either referred to a specialist or offered detailed laboratory investigation.
cExample: 1 extraction/surgery resulting in bleeding (100%): the score to be assigned is 2; 2 extractions/surgeries, 1 resulting in bleeding (50%): the score to be assigned is 2; 3 extractions/surgeries, 1 resulting in bleeding (33%): the score to be assigned is 2; 4 extractions/surgeries, 1 resulting in bleeding (25%): the score to be assigned is 1.
dIf already available at the time of collection.
eInclude: umbilical stump bleeding, cephalohematoma, cheek hematoma caused by sucking during breast/bottle feeding, conjunctival hemorrhage, or excessive bleeding following circumcision or venipuncture. Their presence in infancy requires detailed investigation independently from the overall score.