Report treatment of the most severe episode

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Cutaneous symptoms

No      If Yes

,   Trivial        Signif

Signific in diam disprop

petechiae

icant

ant: Spontaneous bruises larger than 1 cm eter (the size of a pea) OR considered ortionate to trauma by the investigator. All

are considered to be significant.

AVERAGE PRESENTATION

Type

Petechiae Bruises Hematomas

Location of lesions (if any)

Exposed sites Unexposed sites Both

Size of average

< 1 cm

1 – 5 cm

> 5 cm

Minimal or no trauma

Yes

No

REPORT TREATMENT OF THE MOST SEVERE EPISODE

Required medical attention?                  Yes  If yes, please specify:

Consultation only

Notes

Bleeding from minor wounds

No       If Yes,   Trivial

Significant

Significant: Prolonged bleeding, lasting longer than 5 minutes, caused by a superficial cut.

AVERAGE PRESENTATION

Number episodes/year

< 1

>

- 5

- 12

Duration of average single episode

<

>

5 mins.

5 mins.

Required medical attention?

If yes, please specify:

Yes

                          No

Consultation or Steri-strips Surgical hemostasis Antifibrinolytics Desmopressin Replacement therapy Blood transfusion

# of times

# of times

# of times

# of times

# of times

# of times

Notes

Oral cavity bleeding        No      If Yes,   Trivial      Significant

Significant: Either spontaneous gum bleeding lasting for longer than a minute OR bites to lips/cheeks/tongue lasting longer than 5 minutes OR bleeding at tooth eruption requiring assistance by a physician.

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