Bleeding classification

Bleeding Microchapters
Home
Patient Information
Overview
Classification
Bleeding Academic Research Consortium
TIMI bleeding criteria
GUSTO bleeding criteria
CURE bleeding criteria
ACUITY HORIZONS bleeding criteria
STEEPLE bleeding criteria
PLATO bleeding criteria
GRACE bleeding criteria
Causes
Treatment
Emergency Bleeding Control
Reversal of Anticoagulation and Antiplatelet in Active Bleed
Perioperative Bleeding
Anemia Management
Coagulation Monitoring
Coagulation Management
Discontinuation, Bridging, and Reversal of Anticoagulation and Antiplatelet Therapy Antiplatelet Agents Heparin Fondaparinux Vitamin K Antagonists New Oral Anticoagulants Comorbidities Involving Hemostatic Derangement
Specific Surgeries Cardiovascular Surgery Gynecological Bleeding Obstetric Bleeding Orthopedic/Neurosurgery Visceral/Transplant Surgery Pediatric Surgery
Congenital Bleeding Disorders von Willebrand Disease Platelet Defects Hemophilia A and B Factor VII Deficiency Rare Bleeding Disorders
Bleeding classification On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Bleeding classification All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Bleeding classification
CDC on Bleeding classification
Bleeding classification in the news
Blogs on Bleeding classification
Directions to Hospitals Treating Bleeding
Risk calculators and risk factors for Bleeding classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

There are a variety of classification schemes that are designed to characterize the severity of bleeding. Some are used in clinical practice, others are used to quantitate bleeding in clinical trials.

American College of Surgeons' Advanced Trauma Life Support (ATLS) Scheme

Hemorrhage is broken down into 4 classes by the American College of Surgeons' Advanced Trauma Life Support (ATLS).

• Class I Hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary.
• Class II Hemorrhage involves 15-30% of total blood volume. A patient is often tachycardic (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient might start acting differently. Volume resuscitation with crystaloids (Saline solution or Lactated Ringer's solution) is all that is typically required. Blood transfusion is not typically required.
• Class III Hemorrhage involves loss of 30-40% of circulating blood volume. The patient's blood pressure drops, the heart rate increases, peripheral perfusion, such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystaloid and blood transfusion are usually necessary.
• Class IV Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death.

Individuals in excellent physical and cardiovascular shape may have more effective compensatory mechanisms before experiencing cardiovascular collapse. These patients may look deceptively stable, with minimal derangements in vital sounds, while having poor peripheral perfusion (shock). Elderly patients or those with chronic medical conditions may have less tolerance to blood loss, less ability to compensate and take medications, such as betablockers, which may blunt the cardiovascular response. Care must be taken in the assessment of these patients.

World Health Organization

The World Health Organization (WHO) standardized grading scale to measure the severity of bleeding is as follows:

• Grade 0: no bleeding

• Grade 1: petechial bleeding;

• Grade 2: mild blood loss (clinically significant);

• Grade 3: gross blood loss, requires transfusion(severe;

• Grade 4: debilitating blood loss, retinal or cerebral associated with fatality