Tosetto et al developed a clinical bleeding score to describe the severity of bleeding for a patient with von Willebrand disease. The authors are from S. Bortolo Hospital in Vicenza, Italy.
Parameters:
(1) epistaxis
(2) cutaneous bleeding
(3) bleeding from minor wounds
(4) bleeding from the oral cavity
(5) bleeding associated with tooth extraction
(6) gastrointestinal tract bleeding
(7) surgical bleeding
(8) muscle hematomas
(9) hemarthrosis
(10) central nervous system (CNS) bleeding
(11) for a woman, menorrhagia
(12) for a woman, post-partum bleeding
|
Parameter |
Finding |
Points |
|---|---|---|
|
epistaxis |
none or trivial |
0 |
|
|
present but controlled |
1 |
|
|
requires packing or cautery |
2 |
|
|
requires blood transfusion or vWF replacement |
3 |
|
cutaneous bleeding |
none or trivial |
0 |
|
|
petechiae, bruises |
1 |
|
|
hematoma |
2 |
|
|
required consultation, blood transfusion, surgery |
3 |
|
bleeding from minor wounds |
none or trivial |
0 |
|
|
several for > 5 minutes |
1 |
|
|
required consultation |
2 |
|
|
surgical hemostasis, blood transfusion, vWD replacement |
3 |
|
bleeding from the oral cavity |
none or trivial |
0 |
|
|
present but controlled |
1 |
|
|
required consultation |
2 |
|
|
surgical hemostasis, blood transfusion, vWD replacement |
3 |
|
bleeding with dental extractions |
none or trivial |
0 |
|
|
present but controlled |
1 |
|
|
suturing or packing required |
2 |
|
|
blood transfusion required |
3 |
|
gastrointestinal tract bleeding |
none or trivial |
0 |
|
|
associated with ulcer or other GI pathology |
1 |
|
|
spontaneous or consultation required |
2 |
|
|
surgical hemostasis, blood transfusion, vWD replacement |
3 |
|
surgical bleeding |
none or trivial |
0 |
|
|
present but controlled |
1 |
|
|
suturing or resurgery |
2 |
|
|
surgical hemostasis, blood transfusion, vWD replacement |
3 |
|
muscle hematoma |
none or trivial |
0 |
|
|
after trauma |
1 |
|
|
spontaneous or consultation required |
2 |
|
|
surgical hemostasis, blood transfusion, vWD replacement |
3 |
|
hemarthrosis |
none or trivial |
0 |
|
|
after trauma |
1 |
|
|
spontaneous or consultation required |
2 |
|
|
surgical hemostasis, blood transfusion, vWD replacement |
3 |
|
CNS bleeding |
never |
0 |
|
|
subdural |
2 |
|
|
intracerebral |
3 |
|
menorrhagia |
none |
0 |
|
|
present but controlled |
1 |
|
|
consult required, iron, pill use |
2 |
|
|
blood transfusion, dilation and curettage, hysterectomy |
3 |
|
post-partum bleeding |
none or trivial |
0 |
|
|
present but controlled, may need iron |
1 |
|
|
blood transfusion, dilation and curettage, suturing |
2 |
|
|
hysterectomy |
3 |
where:
• There are 2 sets of responses for several items (epistaxis, bleeding from minor wounds, gastrointestinal bleeding, tooth extraction bleeding, surgical bleeding, menorrhagia, post-partum bleeding, muscle hematoma and hemarthrosis).
• The authors developed 2 different scores, one with points assigned from 0 to 3 and the second from -1 to 4. The version above is for the 0 to 3 score. The -1 to 4 score has more choices.
bleeding score =
= SUM(points for all of the applicable parameters)
Interpretatation:
• minimum score: 0
• maximum score: 36
• The higher the score the greater the bleeding severity.
• Normal male will have a bleeding score < 3 and a normal female will have a score < 5.
• A bleeding score > 3 in males and > 5 in females indicates a bleeding tendency that needs to be evaluated and which may represent von Willebrand's disease.
Specialty: Hematology Oncology, Clinical Laboratory
ICD-10: ,
