Table 1

Classification and descriptions of the grades of bleeding

WHO bleeding grade and characteristics
Grade 1* 
    Mucocutaneous hemorrhage (oral blood blisters) 
    Petechiae (lesions < 2 mm in size) 
    Purpura < 2.54 cm (1-inch) diameter 
    Ecchymosis (lesions < 10 cm in size) 
    Oropharyngeal bleeding 
    Conjunctival bleeding 
    Epistaxis < 1 hour in duration and not requiring intervention 
    Abnormal vaginal bleeding (nonmenstrual) with spotting (< 2 pads per day) 
Grade 2* 
    Ecchymosis (lesions > 10 cm in size) 
    Hematoma 
    Epistaxis > 1 hour in duration or packing required 
    Retinal hemorrhage without visual impairment 
    Abnormal vaginal bleeding (not normal menses) using > 2 pads/day 
    Melena, hematemesis, hemoptysis, hematuria, hematochezia 
    Bleeding from invasive sites, musculoskeletal bleeding 
Grade 3 
    Melena 
    Hematemesis 
    Hemoptysis 
    Hematuria—including intermittent gross bleeding without clots 
    Abnormal vaginal bleeding 
    Hematochezia 
    Epistaxis 
    Oropharyngeal 
    Bleeding from invasive sites, musculoskeletal bleeding, or soft tissue bleeding 
Grade 4 
    Debilitating bleeding including retinal bleeding with visual impairment (defined as a field deficit and there must be a consult note documenting visual impairment) 
    Nonfatal CNS bleeding with neurologic signs and symptoms 
    Fatal bleeding from any source 
WHO bleeding grade and characteristics
Grade 1* 
    Mucocutaneous hemorrhage (oral blood blisters) 
    Petechiae (lesions < 2 mm in size) 
    Purpura < 2.54 cm (1-inch) diameter 
    Ecchymosis (lesions < 10 cm in size) 
    Oropharyngeal bleeding 
    Conjunctival bleeding 
    Epistaxis < 1 hour in duration and not requiring intervention 
    Abnormal vaginal bleeding (nonmenstrual) with spotting (< 2 pads per day) 
Grade 2* 
    Ecchymosis (lesions > 10 cm in size) 
    Hematoma 
    Epistaxis > 1 hour in duration or packing required 
    Retinal hemorrhage without visual impairment 
    Abnormal vaginal bleeding (not normal menses) using > 2 pads/day 
    Melena, hematemesis, hemoptysis, hematuria, hematochezia 
    Bleeding from invasive sites, musculoskeletal bleeding 
Grade 3 
    Melena 
    Hematemesis 
    Hemoptysis 
    Hematuria—including intermittent gross bleeding without clots 
    Abnormal vaginal bleeding 
    Hematochezia 
    Epistaxis 
    Oropharyngeal 
    Bleeding from invasive sites, musculoskeletal bleeding, or soft tissue bleeding 
Grade 4 
    Debilitating bleeding including retinal bleeding with visual impairment (defined as a field deficit and there must be a consult note documenting visual impairment) 
    Nonfatal CNS bleeding with neurologic signs and symptoms 
    Fatal bleeding from any source 
*

Does not require red cell transfusion.

Requiring red cell transfusion specifically for support of bleeding within 24 hours of onset.

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