Fardet et al developed the HScore to help identify a patient with the reactive hemophagocytic syndrome. The authors are from multiple hospitals in France.
Parameters:
(1) known underlying immunosuppression
(2) temperature in °C
(3) organomegaly
(4) number of cytopenias
(5) serum ferritin in ng/mL
(6) serum triglycerides in mmol/L
(7) plasma fibrinogen in g/L
(8) serum glutamic oxaloacetic transaminase in IU/L (aspartate aminotransferase, AST)
(9) hemophagocytosis features seen in bone marrow aspirate
|
Parameter |
Finding |
Points |
|
known underlying immunosuppression |
no |
0 |
|
|
yes |
18 |
|
temperature in °C |
< 38.4 °C |
0 |
|
|
38.4 to 39.4°C |
33 |
|
|
> 39.4°C |
49 |
|
organomegaly |
none |
0 |
|
|
hepatomegaly or splenomegaly |
23 |
|
|
hepatomegaly and splenomegaly |
38 |
|
number of cytopenias |
0 or 1 |
0 |
|
|
2 |
24 |
|
|
3 |
34 |
|
serum ferritin |
< 2,000 ng/mL |
0 |
|
|
2,000 to 6,000 ng/mL |
35 |
|
|
> 6,000 ng/mL |
50 |
|
serum triglycerides |
< 1.5 mmol/L |
0 |
|
|
1.5 to 4.0 mmol/L |
44 |
|
|
> 4 mmol/L |
64 |
|
plasma fibrinogen |
> 2.5 g/L |
0 |
|
|
<= 2.5 g/L |
30 |
|
serum glutamic oxaloacetic transaminase |
< 30 IU/L |
0 |
|
|
>= 30 IU/L |
19 |
|
hemophagocytic features on bone marrow aspirate |
no |
0 |
|
|
yes |
35 |
Cytopenias:
(1) hemoglobin <= 9.2 g/dL
(2) WBC count <= 5,000 per µL
(3) platelet count <= 110,000 per µL
HScore =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 337
• The higher the score the greater the probability of the reactive hemophagocytic syndrome.
• A score >= 169 had a sensitivity of 93% and specificity of 86%.
|
Score |
Probability |
|
< 100 |
< 1% |
|
100 to 150 |
(0.01262 * ((score)^2)) - (2.667 * (score)) + 142.5 |
|
150 to 190 |
(-0.005714 * ((score)^2)) + (3.343 * (score)) - 348.2 |
|
190 to 240 |
(-0.009405 * ((score)^2)) + (4.418 * (score)) - 420.1 |
|
> 240 |
> 99% |
Specialty: Hematology Oncology
