ISTH Bleeding Assessment Tool

1. See Also
   1. Bleeding Disorder
2. Indications
   1. Screening for congenital Bleeding Disorders
3. Precautions
   1. Test Sensitivity and Test Specificity are poor for inherited platelet function disorders
      1. Lowe (2013) J Thromb Haemost 11(9): 1663-8 [PubMed]
4. Criteria
   1. Epistaxis
      1. Score 0: None or Trivial
      2. Score 1: More than 5 per year, or lasting >10 minutes
      3. Score 2: Consultation Only
      4. Score 3: Treated with packing, cauterization or antifibrinolytics
      5. Score 4: Blood Transfusion, replacement (e.g. Factor VIIa, PCC4), Desmopressin
   2. Cutaneous symptoms
      1. Score 0: None or Trivial
      2. Score 1: Five or more Bruises, each >1 cm, in exposed areas
      3. Score 2: Consultation Only
      4. Score 3: Extensive
      5. Score 4: Spontaneous hematoma requiring Blood Transfusion
   3. Bleeding from minor wounds
      1. Score 0: None or Trivial
      2. Score 1: More than 5 per year, or lasting >10 minutes
      3. Score 2: Consultation Only
      4. Score 3: Surgical hemostasis
      5. Score 4: Blood Transfusion, replacement (e.g. Factor VIIa, PCC4), Desmopressin
   4. Oral cavity symptoms
      1. Score 0: None or Trivial
      2. Score 1: Present
      3. Score 2: Consultation Only
      4. Score 3: Surgical hemostasis or antifibrinolytics
      5. Score 4: Blood Transfusion, replacement (e.g. Factor VIIa, PCC4), Desmopressin
   5. Gastrointestinal Bleeding
      1. Score 0: None or Trivial
      2. Score 1: Present (but not associated with ulcer, Portal Hypertension, Hemorrhoids or angiodysplasia)
      3. Score 2: Consultation Only
      4. Score 3: Surgical hemostasis or antifibrinolytics
      5. Score 4: Blood Transfusion, replacement (e.g. Factor VIIa, PCC4), Desmopressin
   6. Hematuria
      1. Score 0: None or Trivial
      2. Score 1: Present
      3. Score 2: Consultation Only
      4. Score 3: Surgical hemostasis or iron therapy
      5. Score 4: Blood Transfusion, replacement (e.g. Factor VIIa, PCC4), Desmopressin
   7. Tooth Extraction
      1. Score 0: None or Trivial
      2. Score 1: Bleeding reported in <25% of patient's procedures (but no intervention needed)
      3. Score 2: Bleeding reported in >25% of patient's procedures (but no intervention needed)
      4. Score 3: Resuturing or packing required
      5. Score 4: Blood Transfusion, replacement (e.g. Factor VIIa, PCC4), Desmopressin
   8. Surgery
      1. Score 0: None or Trivial
      2. Score 1: Bleeding reported in <25% of patient's procedures (but no intervention needed)
      3. Score 2: Bleeding reported in >25% of patient's procedures (but no intervention needed)
      4. Score 3: Surgical hemostasis or antifibrinolytics
      5. Score 4: Blood Transfusion, replacement (e.g. Factor VIIa, PCC4), Desmopressin
   9. Menorrhagia
      1. Score 0: None or Trivial
      2. Score 1: Consultation only (changed pads more than q2h, clotting or flooding, or score >100 on pictorial blood loss)
      3. Score 2: Work or school missed more than twice yearly due to bleeding. Treated with antifibrinolytic or iron therapy
      4. Score 3: Treated with both antifibrinolytic and hormon therapy OR Menorrhagia since Menarche and duration >12 months
      5. Score 4: Acute with hospitalization, Blood Transfusion, replacement, Desmopressin, and D&C, ablation or Hysterectomy
   10. Postpartum Hemorrhage
       1. Score 0: None or Trivial
       2. Score 1: Consultation only, treated with Pitocin, lochia persisted >6 weeks
       3. Score 2: Treated with antifibrinolytic or iron therapy
       4. Score 3: Treated with Blood Transfusion or other replacement, Desmopressin, exam under anesthesia, uterine balloon
       5. Score 4: Required Critical Care or surgery (Hysterectomy, iliac artery ligation, uterine artery embolization, uterine brace)
   11. Muscle Hematomas
       1. Score 0: Never
       2. Score 1: Post-Trauma and no treatment required
       3. Score 2: Spontaneous onset and no treatment required
       4. Score 3: Spontaneous or Traumatic, but required Desmopressin or replacement therapy
       5. Score 4: Spontaneous or Traumatic, but required Blood Transfusion or surgical intervention
   12. Hemarthrosis
       1. Score 0: Never
       2. Score 1: Post-Trauma and no treatment required
       3. Score 2: Spontaneous onset and no treatment required
       4. Score 3: Spontaneous or Traumatic, but required Desmopressin or replacement therapy
       5. Score 4: Spontaneous or Traumatic, but required Blood Transfusion or surgical intervention
   13. Central Nervous System Bleeding
       1. Score 0: Never
       2. Score 3: Subdural Hematoma, any intervention
       3. Score 4: Intracerebral, any intervention
   14. Other Bleeding (e.g. umbilical stump bleeding, Cephalohematoma, Conjunctival Hemorrhage, excessive bleeding after venipuncture)
       1. Score 0: None or Trivial
       2. Score 1: Present
       3. Score 2: Consultation only
       4. Score 3: Surgical hemostasis or antifibrinolytics
       5. Score 4: Blood Transfusion, replacement (e.g. Factor VIIa, PCC4), Desmopressin
5. Interpretation
   1. Abnormal cut-offs
      1. Men >3
      2. Women >5
      3. Children >2
   2. References
      1. Elbatarny (2014) Haemophilia 20(6): 831-5 +PMID:25196510 [PubMed]
6. Resources
   1. ISTH-BAT PDF full documentation
      1. https://c.ymcdn.com/sites/www.isth.org/resource/resmgr/ssc/isth-ssc_bleeding_assessment.pdf
7. References
   1. Neutze (2016) Am Fam Physician 93(4): 279-86 [PubMed]
   2. Rodeghhiero (2010) J Thromb Haemost 8(9): 2063-5 [PubMed]