Rebulla et al developed a scale for describing bleeding following therapy for acute leukemia. The authors are from the Gruppo Italiano Malattie Ematologiche Maligne dell'Adults.
|
Bleeding |
Grade |
|
none |
0 |
|
petechiae; mucosal bleeding not requiring blood transfusion; retinal bleeding without impairment of vision |
1 |
|
melena, hematuria, hemoptysis or hematemesis not requiring blood transfusion |
2 |
|
any bleeding requiring blood transfusion |
3 |
|
retinal bleeding accompanied by impairment of vision |
4 |
|
nonfatal cerebral bleeding |
5 |
|
fatal cerebral bleeding |
6 |
|
fatal noncerebral bleeding |
7 |
Rearranged:
|
Site |
Feature |
Grade |
|
no bleeding |
|
0 |
|
petechiae |
|
1 |
|
retinal |
no loss of vision |
1 |
|
|
loss of vision |
4 |
|
mucosal bleeding |
not requiring blood transfusion |
1 |
|
|
requiring blood transfusion |
3 |
|
cerebral bleeding |
nonfatal |
5 |
|
|
fatal |
6 |
|
other bleeding (melena, hematuria, hemoptysis, hematemesis, etc.) |
not requiring blood transfusion |
2 |
|
|
requiring blood transfusion |
3 |
|
|
fatal |
7 |
where:
• Petechial hemorrhage can range from minor to severe. A single grade may not be able to describe this.
• Nonfatal cerebral hemorrhage may range from minor to one causing serious neurologic signs.
A Grade 1 bleed is considered a minor bleed.
A Grade 2-7 bleed is considered major.
Limitations (Koreth et al, page 606):
• A higher grade does not necessarily imply a worse outcome (at least in range 3 to 5).
• Grades cannot be combined.
• Frequency and duration of bleeding are not included in the grade.
Purpose: To describe bleeding following therapy for acute leukemia using the scale of Rebulla et al.
Specialty: Hematology Oncology
Objective: severity, prognosis, stage, response to therapy, adverse effects
ICD-10: C91, C92, C93, C94, C95,
