The World Health Organization (WHO) developed a scale for grading hemorrhage. More serious bleeding is classified as Grade 3 or 4.
Grade 3 bleeding - one or more of the following:
(1) any bleeding that requires RBC transfusion over routine needs
(2) (grossly bloody body cavity fluids) AND (organ dysfunction OR need to intervene OR need to transfuse)
(3) (cerebrospinal fluid showing visible red color after non-traumatic tap) AND (absence of symptoms)
(4) (moderate hemodynamic instability) AND (need for RBC transfusion over routine transfusion needs)
Grade 4 bleeding - one or more of the following
(1) fatal bleeding from any source
(2) retinal hemorrhage with visual impairment (visual field deficit)
(3) (cerebrospinal fluid showing visible red color after non-traumatic tap) AND (presence of symptoms)
(4) (severe hemodynamic instability) AND (need for RBC transfusion over routine transfusion needs) AND (tachycardia)
(5) CNS bleeding on imaging study (with or without dysfunction)
where:
• Moderate hemodynamic instability is associated with a 31-50 mm Hg and/or 31-50% fall in either systolic or diastolic blood pressure.
• Severe hemodynamic instability is associated with a > 50 mm Hg and/or > 50% fall in either systolic or diastolic blood pressure.
• Tachycardia for Grade 4 bleed is associated with an increase in heart rate >= 20% for 20 minutes.
• Red blood cell transfusions must be specifically related to the treatment of bleeding within 24 hours of onset of bleeding.
