II. Indications

  1. Screening for congenital Bleeding Disorders

III. 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]

IV. 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

V. 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]

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