The International Society on Thrombosis and Haemostasis (ISTH) has developed criteria for significant mucocutaneous bleeding in a patient with von Willebrand's Disease (VWD).


Criteria for significant mucocutaneous bleeding:

(1) one symptom recurring on >= 3 distinct occasions

(2) one symptom requiring treatment with blood transfusion

(3) >= 2 types of symptoms in the absence of a blood transfusion history



(1) nose bleeding without a history of trauma not stopped by short compression < 10 minutes (require >= 2 episodes in the absence of blood transfusion)

(2) cutaneous hemorrhage and bruisability after no or minimal trauma, as a presenting symptom or requiring medical treatment

(3) prolonged bleeding from trivial wounds lasting >= 15 minutes or recurring spontaneously during the next 7 days

(4) oral cavity bleeding (associated with gingivitis, tooth eruption, bite to lip, bite to tongue, etc.) requiring medical attention

(5) spontaneous gastrointestinal bleeding not due to ulceration or portal hypertension (a) resulting in acute or chronic anemia or (b) requiring medical attention

(6) heavy, prolonged, or recurrent bleeding after tooth extraction or other oral surgery (tonsillectomy and adenoidectomy) requiring medical attention

(7) menorrhagia not associated with a structural lesion of the uterus (a) resulting in acute or chronic anemia OR (b) requiring medical treatment

(8) bleeding from sites other than skin or mucous membrane surfaces (eye, ear, respiratory tract, genitourinary tract other than uterus) requiring medical treatment



• Counting nose bleeds may be open to interpretation. To be counted as an episode it has to have occurred at least 2 times without transfusion. However, to meet the first criteria for significant mucocutaneous bleeding, does it need to occur 3 or 6 times?


Exclusions: other causes for hypocoagulability (anticoagulation therapy, thrombocytopenia, DIC, other).


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