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
|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: http://c.ymcdn.com/sites/www.isth.org/resource/resmgr/ssc/isth-ssc_bleeding_assessment.pdf
- Sadler JE, Rodeghiero F; ISTH SSC Subcommittee on von Willebrand Factor. Provisional criteria for the diagnosis of VWD type 1. Journal of Thrombosis and Haemostasis 2005; 3: 775–7.
- Rodeghiero F, Tosetto A, Abshire T, Arnold DM, Coller B, James P et al. ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. Journal of Thrombosis and Haemostasis 2010; 8: 2063-5.