ISTH-SSC Bleeding Assessment Tool

SCORE

In addition to the guidance offered by the table, it is mandatory to refer to the text for more detailed instructions.

^§ Distinction 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

* Consultation only: the patient sought medical evaluation and was either referred to a specialist or offered detailed laboratory investigation

** Example: 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

# If already available at the time of collection

^ Include: 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

Normal range is <4 in adult males, <6 in adult females and <3 in children (3).

ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders.
Rodeghiero F, Tosetto A, Abshire T, Arnold DM, Coller B, James P, Neunert C, Lillicrap D; ISTH/SSC joint VWF and Perinatal/Pediatric Hemostasis Subcommittees Working Group.
J Thromb Haemost. 2010 Sep;8(9):2063-5
SUPPLEMENTARY MATERIAL TO THE OFFICIAL COMMUNICATION OF THE SSC (LAST REVISION: 19 JULY 2011)
isth-ssc_bleeding_assessment.pdf
Normal range of bleeding scores for the ISTH-BAT: adult and pediatric data from the merging project.
Elbatarny M, Mollah S, Grabell J, Bae S, Deforest M, Tuttle A, Hopman W, Clark DS, Mauer AC, Bowman M, Riddel J, Christopherson PA, Montgomery RR; Zimmerman Program Investigators, Rand ML, Coller B, James PD. Haemophilia. 2014 Nov;20(6):831-5. doi: 10.1111/hae.12503. Epub 2014 Sep 6.

	SCORE
SYMPTOMS (up to the time of diagnosis)	0^§	1^§	2	3	4
Epistaxis	No/trivial	- > 5/year or - more than 10 minutes	Consultation only*	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 (> 1cm) in exposed areas	Consultation only*	Extensive	Spontaneous hematoma requiring blood transfusion
Bleeding from minor wounds	No/trivial	- > 5/year or - more than 10 minutes	Consultation only*	Surgical hemostasis	Blood transfusion, replacement therapy, or desmopressin
Oral cavity	No/trivial	Present	Consultation only*	Surgical hemostasis or antifibrinolytic	Blood transfusion, replacement therapy or desmopressin
GI bleeding	No/trivial	Present (not associated with ulcer, portal hypertension, hemorrhoids, angiodysplasia)	Consultation only*	Surgical hemostasis, antifibrinolytic	Blood transfusion, replacement therapy or desmopressin
Hematuria	No/trivial	Present (macroscopic)	Consultation only*	Surgical hemostasis, iron therapy	Blood transfusion, replacement therapy or desmopressin
Tooth extraction	No/trivial or none done	Reported in ≤25% of all procedures, no intervention**	Reported in ≥25% of all procedures, no intervention**	Resuturing or packing	Blood transfusion, replacement therapy or desmopressin
Surgery	No/trivial or none done	Reported in ≤25% of all procedures, no intervention**	Reported in ≥25% of all procedures, no intervention**	Surgical hemostasis or antifibrinolytic	Blood transfusion, replacement therapy or desmopressin
Menorrhagia	No/trivial	Consultation only* or - Changing pads more frequently than every 2 hours or - Clot and flooding or - PBAC score>100#	- 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 & curretage or endometrial ablation or hysterectomy)
Post-partum hemorrhage	No/trivial or no deliveries	Consultation only* or - Use of syntocin or - Lochia > 6 weeks	- Iron therapy or - Antifibrinolytics	- Requiring blood transfusion, replacement therapy, desmopressin or - Requiring examination under anaesthesia and/or the use of uterin balloon/package to tamponade the uterus	- Any procedure requiring critical care or surgical intervention (e.g. 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 bleedings^	No/trivial	Present	Consultation only*	Surgical hemostasis, antifibrinolytics	Blood transfusion or replacement therapy or desmopressin