Buchanan and Adix graded hemorrhage in children with acute idiopathic thrombocytopenic purpura (ITP). This can be used at presentation and during the course of care. The authors are from the University of Texas Southwestern Medical Center and the Children's Medical Center in Dallas.
Measures:
(1) overall bleeding severity
(2) epistaxis
(3) oral bleeding
(4) skin bleeding
|
Parameter |
Finding |
Points |
|
overall bleeding |
none |
0 |
|
|
minor (possibly a few new petechiae and/or <= 5 small bruises; no mucosal bleeding) |
1 |
|
|
mild (> 100 petechiae and/or > 5 large bruises; no mucosal bleeding) |
2 |
|
|
moderate (overt mucosal bleeding that does not require immediate medical attention or intervention) |
3 |
|
|
severe (overt mucosal bleeding or internal hemorrhage that requires immediate medical attention and intervention |
4 |
|
|
life-threatening (intracranial or any site that is life-threatening or fatal) |
5 |
|
epistaxis |
none |
0 |
|
|
minor (spotting on sheet or pillows; blood noted on nares; not active bleeding and no need to apply pressure) |
1 |
|
|
mild (1 or more episodes of active bleeding requiring pressure be applied for < 15 minutes) |
2 |
|
|
moderate (1 or more episodes of active bleeding requiring pressure be applied for >= 15 minutes) |
3 |
|
|
severe (multiple episodes of profuse and/or continuous bleeding) |
4 |
|
oral bleeding |
none |
0 |
|
|
minor (petechiae on palate or buccal mucosa) |
1 |
|
|
mild (1 or more buccal blood blisters with or without petechiae; no active bleeding) |
2 |
|
|
moderate (intermittent active bleeding from an oral site) |
3 |
|
|
severe (continuous bleeding from oral site) |
4 |
|
skin bleeding |
none |
0 |
|
|
minor (possibly a few new petechiae) |
1 |
|
|
mild (definitely <= 100 new petechiae and/or <= 5 small bruises. |
2 |
|
|
moderate (> 100 new petechiae and/or > 5 large bruises) |
3 |
|
|
severe (extensive petechiae AND > 5 large bruises) |
4 |
where:
• Internal hemorrhage includes brain, lung, muscle, joints, etc,
• A buccal blood blister is a hemorrhagic bullae and/or infiltrates.
• Oral sites includes the gums, lips, buccal mucosa or posterior oropharynx.
• A small bruise is < 3 cm in diameter and a large bruise is >= 3 cm.
Limitations:
• There are gaps in the criteria, such as > 5 small or < 5 large bruises. This could be handled by making a mild-to-moderate category.
Specialty: Hematology Oncology, Clinical Laboratory, Immunology/Rheumatology
