ISTH mucocutaneous bleeding criteria

International Society for Thrombosis and Hemostasis criteria for significant mucocutaneous bleeding

A significant mucocutaneous bleeding history requires that at least one of the following criteria are met:

  • TWO OR MORE of the following symptoms in the absence of a blood transfusion history, OR
  • ONE symptom requiring treatment with blood tranfusion, OR
  • ONE symptom recurring on at least three distinct occasions

Symptom list

Nose bleeding, ≥ 2 episodes without a history of trauma not stopped by short compression of < 10min or ≥ 1 episode requiring blood transfusion
Cutaneous hemorrhage and bruisability with minimal or no apparent trauma, as a presenting symptom or requiring medical treatment
Prolonged bleeding from trivial wounds, lasting ≥ 15min or recurring spontaneously during the 7 days after wounding
Oral cavity bleeding that requires medical attention, such as gingival bleeding, or bleeding with tooth eruption, or bites to lips or tongue
Spontaneous GI bleeding requiring medical attention, or resulting in acute or chronic anaemia, unexplained by ulceration or portal hypertension
Heavy, prolonged or recurrent bleeding after tooth extraction or other oral surgery such as tonsillectomy and adenoidectomy, requiring medical attention
Menorrhagia resulting in acute or chronic anaemia, or requiring medical treatment, not associated with structural lesions of the uterus
Bleeding from other skin or mucous membrane surfaces requiring medical treatment (e.g. eye, ear, respiratory tract, genitourinary tract other than uterus)

These criteria for a significant mucocutaneous bleeding history were developed as part of provisional consensus criteria for type 1 von Willebrand disease by a working party of the International Society on Thrombosis and Haemostasis (ISTH) in 1995-6. They were published in 2005,1 and are more stringent than HSC criteria.

In 2010, the ISTH published a detailed bleeding assessment tool,2, which is available at the following link: