Practical-Manual-Scores-Algorithms-Haemostasis-Thrombosis

Bleeding assessment tool for the evaluationof bleeding severity in immune thrombocytopenia:the SMOG systemBleedingIndicationQuantitative assessment of the severity of bleeding symptoms in patients withimmune thrombocytopenia (ITP), observed at diagnosis or disease relapse.Proposed as a clinical guidance to drive need for therapy.The tool was developed by the International Working Group on ITP to standardizedefinitions of bleeding, and to grade symptom-specific and domain-specificbleedings. Bleeding signs/symptoms are grouped according to three majordomains: skin (S), visible mucosae (M) and organs (Og).Skin (epidermis, dermis and subcutaneous tissues) includes petechiae,ecchymosis (purpuric macula, bruise or contusion), subcutaneous hematomas,bleeding from minor wounds. Visible mucosae include epistaxis, oral cavity (gumbleeding, hemorrhagic bullae/blisters, bleeding from bites to lips & tongue or afterdeciduous teeth loss/extraction), subconjunctival hemorrhage.Organs include GI bleeding (hematemesis, melena, hematochezia, rectorrhagia),lung bleeding (hemoptysis), hematuria, menorrhagia, muscle hematoma,hemarthrosis, ocular bleeding, intracranial (intracerebral, intraventricular,subarachnoidal, subdural, extradural). Gradation of bleeding severity (SMOGsystem): each bleeding manifestation should be assessed at the time ofexamination. Its severity is graded from 0 to 4. Appreciation of bleeding basedon history only, without supporting medical documentation, will be given agrade 1 designation. Within each domain, the same grading is assigned to thesymptoms judged to have similar clinical relevance. For each symptom, theworst ever episode during the observation period is graded and then the worstepisode within the domain is recorded. For example if the highest grade is 2 forskin, 3 for mucosae and 2 for organs, SMOG is S2M3O2. The index producedby summing the worst ever grade in the 3 domains represents the final score forthat particular patient. In the example shown, the final score is 7.The data collection forms and grading tables are publicly available at:http://itpbat.fondazioneematologia.it/Reference• Rodeghiero F, Michel M, Gernsheimer T, et al. Standardization of bleedingassessment in immune thrombocytopenia: report from the International WorkingGroup. Blood. 2013;121:2596-606.53