The International Study Group of Liver Surgery (ISGLS) reported criteria for post-hepatectomy hemorrhage. This can help standardize reporting of cases. The authors are from multiple institutions from around the world.
Patient selection: status post hepatectomy
Exclusion: absence of active hemorrhage AND transfused immediately after surgery for intra-operative blood loss AND <= 2 units packed RBCs transfused
Criteria for diagnosis - one or more of the following:
(1) drop in hemoglobin > 3 g/dL after surgery from baseline
(2) any postoperative blood transfusion for a falling hemoglobin
(3) need for invasive re-intervention to stop bleeding (embolization, re-operation, etc)
Confirmation of active hemorrhage - one or more of the following:
(1) frank blood loss from abdominal drain (if present)
(2) intra-abdominal hematoma
(3) active bleeding on abdominal imaging studies
Parameters for grading:
(1) number of units of packed RBCs transfused
(2) invasive re-intervention (embolization, re-laparatomy, etc)
|
Units of Packed RBCs
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Invasive Re-Intervention
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Grade
|
|
<= 2
|
no
|
A
|
|
> 2
|
no
|
B
|
|
NA
|
yes
|
C
|
