Khellaf et al developed a bleeding score for evaluating a patient with autoimmune thrombocytopenic purpura. This was based on the score of Godeau et al (see previous section). The authors are from Assistance Publique Hopitaux de Paris and Hopital Henri Mondor in France.
Parameters:
(1) age in years
(2) cutaneous bleeding
(3) mucosal bleeding
(4) gastrointestinal bleeding
(5) urinary bleeding
(6) endometrial bleeding in a female
(7) central nervous system bleeding
|
Parameter |
Finding |
Points |
|
age in years |
<= 65 years of age |
0 |
|
|
> 65 and <= 75 years |
2 |
|
|
> 75 years |
5 |
|
cutaneous bleeding |
none |
0 |
|
|
localized petechial bleeding |
1 |
|
|
localized ecchymotic purpura |
2 |
|
|
petechial purpura at 2 sites |
2 |
|
|
generalized petechiae |
3 |
|
|
generalized ecchymotic purpura |
4 |
|
mucosal bleeding |
none |
0 |
|
|
unilateral epistaxis |
2 |
|
|
bilateral epistaxis |
3 |
|
|
hemorrhagic oral bullae and/or spontaneous gingival bleeding |
5 |
|
gastrointestinal bleeding |
none |
0 |
|
|
without anemia |
4 |
|
|
with anemia and/or shock |
15 |
|
urinary bleeding |
none |
0 |
|
|
macroscopic without anemia |
4 |
|
|
macroscopic with anemia |
10 |
|
endometrial bleeding |
none |
0 |
|
|
menorrhagia and/or metrorrhagia without anemia |
4 |
|
|
menorrhagia and/or metrorrhagia with anemia |
10 |
|
central nervous system bleeding |
absent |
0 |
|
|
present (bleeding or life-threatening hemorrhage) |
15 |
where:
• Anemia after GI bleeding: > 2 gram drop in hemoglobin within 24 hours.
total score =
= (points for mucosal bleeding) + (points for CNS bleeding) + MAX(points for age, cutaneous bleeding, GI bleeding, urinary bleeding, endometrial bleeding)
Interpretation:
• minimum score: 0
• maximum score: 35
• The higher the score the more severe the bleeding.
• If the platelet count is <= 20,000 per µL and bleeding score is <=8, then the patient is treated with steroids only.
• If the platelet count is <= 20,000 per µL and bleeding score is > 8, then the patient is treated with oral steroids and intravenous immune globulin (IVIG, 1 to 2 grams per kilogram).
Specialty: Hematology Oncology, Clinical Laboratory, Immunology/Rheumatology
ICD-10: ,
