International Society on Thrombosis and Haemostasis bleeding assessment tool (ISTH BAT)

Type of bleeding	Score
Type of bleeding	0	1	2	3	4
Epistaxis	None or trivial	>5 episodes per year or episode(s) lasting >10 minutes	Consultation only*	Required packing, cauterization, or antifibrinolytic therapy	Required blood transfusion, replacement therapy^¶, or desmopressin
Cutaneous (eg, bruising, ecchymoses, purpura)	None or trivial	≥5 (>1 cm) in exposed areas	Consultation only*	Extensive	Spontaneous hematoma requiring blood transfusion
Bleeding from minor wounds	None or trivial	>5 episodes per year or episode(s) lasting >10 minutes	Consultation only*	Required surgical hemostasis	Required blood transfusion, replacement therapy^¶, or desmopressin
Oral cavity	None or trivial	Present	Consultation only*	Required surgical hemostasis or antifibrinolytic therapy	Required blood transfusion, replacement therapy^¶, or desmopressin
Gastrointestinal bleeding	None or trivial	Present (not associated with ulcer, portal hypertension, hemorrhoids, angiodysplasia)	Consultation only*	Required surgical hemostasis or antifibrinolytic therapy	Required blood transfusion, replacement therapy^¶, or desmopressin
Hematuria	None or trivial	Present (macroscopic)	Consultation only*	Required surgical hemostasis or iron therapy	Required blood transfusion, replacement therapy^¶, or desmopressin
Bleeding after tooth extraction	None, trivial, or no prior extractions	Reported in ≤25% of all procedures, did not require intervention^Δ	Reported in >25% of all procedures, did not require intervention^Δ	Required resuturing or packing	Required blood transfusion, replacement therapy^¶, or desmopressin
Surgical bleeding	None, trivial, or no prior surgeries	Reported in ≤25% of all procedures, did not require intervention^Δ	Reported in >25% of all procedures, did not require intervention^Δ	Required surgical hemostasis or antifibrinolytic	Required blood transfusion, replacement therapy^¶, or desmopressin
Menorrhagia	None or trivial	Any of the following: Changing pads more frequently than every 2 hours Clot and flooding Consultation* without intervention	Required any of the following: Time off work/school >2 times per year Antifibrinolytic therapy Hormonal therapy Iron therapy	Either of the following: Present since menarche and has been ongoing for >12 months Required combined treatment with antifibrinolytics and hormonal therapy	Required any of the following: Hospital admission and emergency treatment Blood transfusion, replacement therapy^¶, or desmopressin D&C, endometrial ablation, or hysterectomy
Postpartum hemorrhage	No/trivial or no deliveries	Any of the following: Use of oxytocin Lochia (postpartum shedding of blood and decidua) lasting >6 weeks Consultation* without intervention	Required iron or antifibrinolytic therapy	Either of the following: Required blood transfusion, replacement therapy^¶, or desmopressin Required examination under anaesthesia and/or the use of uterine balloon/package to tamponade the uterus	Required surgical intervention or a procedure requiring critical care (eg, hysterectomy, internal iliac artery legation, uterine artery embolization, uterine brace sutures)
Muscle hematomas	Never	Post-traumatic, not requiring treatment	Spontaneous, not requiring treatment	Spontaneous or traumatic, requiring desmopressin or replacement therapy^¶	Spontaneous or traumatic, requiring surgical intervention or blood transfusion
Hemarthrosis	Never	Post-traumatic, not requiring treatment	Spontaneous, not requiring treatment	Spontaneous or traumatic, requiring desmopressin or replacement therapy^¶	Spontaneous or traumatic, requiring surgical intervention or blood transfusion
Intracranial hemorrhage	Never	N/A	N/A	Subdural	Intracerebral
Other: Umbilical stump bleeding^◊ Cephalohematoma^◊ Cheek hematoma (caused by sucking during breast/bottle feeding)^◊ Conjunctival hemorrhage Excessive bleeding following circumcision^◊ Excessive bleeding following venipuncture	None or trivial	More than trivial but did not require medical evaluation	Consultation only*	Required surgical hemostasis or antifibrinolytic therapy	Required blood transfusion, replacement therapy^¶, or desmopressin

The ISTH BAT is used to screen for the likelihood of a bleeding disorder (particularly VWD) in children with bleeding symptoms. In children, a score of ≥2 points is considered a positive screen. For additional details, refer to UpToDate topics on VWD and evaluation of bleeding symptoms in children.

ISTH BAT: International Society on Thrombosis and Haemostasis bleeding assessment tool; D&C: dilatation & curettage; VWD: von Willebrand disease.

* Consultation only means that the patient sought medical evaluation and was either referred to a specialist or offered laboratory investigation but did not require hemostatic therapy or transfusion.

¶ Replacement therapy includes use of hemostatic blood components and/or recombinant factor VIIa.

Δ For example, if the patient had ≥4 prior extractions/surgeries and experienced more than trivial bleeding only once without need for intervention, a score of 1 should be assigned. If the patient had ≤3 prior extractions/surgeries and experienced more than trivial bleeding in any of them (not requiring intervention), a score of 2 should be assigned. If the patient experienced bleeding that required intervention, the score to be assigned is a 3 or 4 depending on the type of intervention (as detailed in the table above).

◊ For these categories, the presence of more than trial bleeding in infancy requires detailed investigation independently from the overall score.

From: Rodeghiero F, Tosetto A, Abshire T, et al. ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. J Thromb Haemost 2010; 8:2063. https://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2010.03975.x. Copyright © 2010 John Wiley & Sons Ltd. Reproduced with permission of John Wiley & Sons Inc. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: [email protected] or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (https://onlinelibrary.wiley.com/).

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International Society on Thrombosis and Haemostasis bleeding assessment tool (ISTH BAT)