Terms used in this guideline

Adults, young people and children

These are defined as:

  • Adults: aged 18 years and over.

  • Young people: aged 16 and 17 years. No evidence was found on transfusions specifically for young people. Recommendations for adults in this guideline will generally apply to young people as well, but healthcare professionals should use their clinical judgement on when this is not appropriate for individual patients.

  • Children: aged 1 to 15 years.

Major haemorrhage

This can be defined as any of the following:

  • The loss of more than 1 blood volume within 24 hours (around 70 ml/kg, or more than 5 litres in a 70 kg adult).

  • A loss of 50% of total blood volume in under 3 hours.

  • Bleeding in excess of 150 ml/minute in adults.

  • As a practical clinical definition, bleeding which leads to:

    • a systolic blood pressure of less than 90 mm/Hg or

    • a heart rate of more than 110 beats per minute in adults.

The modified World Health Organization (WHO) bleeding scale

This was used to assess bleeding in trials of platelet transfusions. Examples of bleeding at each grade are listed below:

WHO bleeding scale
World Health Organization Bleeding Grade Examples

1

  • Oropharyngeal bleeding, with the total duration of all episodes no more than 30 minutes in the last 24 hours.

  • Epistaxis, with the total duration of all episodes no more than 30 minutes in the last 24 hours.

  • Petechiae of oral mucosa or skin.

  • Purpura up to 2.5 cm (1 inch) in diameter.

  • Spontaneous haematoma in soft tissue or muscle.

  • Positive stool occult blood test.

  • Microscopic haematuria or haemoglobinuria.

  • Abnormal vaginal bleeding (spotting).

2

  • Epistaxis, with the total duration of all episodes over 30 minutes in 24 hours.

  • Purpura over 2.5 cm (1 inch) in diameter.

  • Joint bleeding.

  • Melanotic stool.

  • Haematemesis.

  • Gross/visible haematuria.

  • Abnormal vaginal bleeding (more than spotting).

  • Haemoptysis.

  • Visible blood in body cavity fluid.

  • Retinal bleeding without visual impairment.

  • Bleeding at invasive sites.

3

  • Bleeding needing red blood cell transfusion over routine transfusion needs.

  • Bleeding associated with moderate haemodynamic instability.

4

  • Bleeding associated with severe haemodynamic instability.

  • Fatal bleeding.

  • Central nervous system bleeding on imaging study with or without dysfunction.