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The Baltimore criteria for diagnosing veno-occlusive disease relies on evaluating four critical clinical features within the first 21 days post-transplantation. The evaluation process involves assessing the presence of the following conditions:

- Serum bilirubin greater than 34.2 micromol/L [2 mg/dL]
- Hepatomegaly
- Ascites
- Weight gain exceeding 5% from pre-transplant weight

The procedure to determine if a patient meets the criteria for veno-occlusive disease is as follows:

1. Confirm that the serum bilirubin level is above 34.2 micromol/L [2 mg/dL]. This is an essential requirement.
2. Next, check if at least two of the following conditions are present:
  - Hepatomegaly
  - Ascites
  - Weight gain greater than 5% from pre-transplant weight

For a positive diagnosis, the serum bilirubin condition must be met along with any of the following combinations of conditions:

- Hepatomegaly and ascites
- Hepatomegaly and weight gain
- Ascites and weight gain

If any of these combinations are observed along with elevated serum bilirubin, the patient meets the criteria for veno-occlusive disease. Otherwise, the diagnosis is not supported by these criteria. This systematic assessment provides a structured approach to identify this specific condition in the context of post-transplant physiological changes.

The Baltimore Criteria is a clinical calculator used for the diagnosis of Hepatic Veno-Occlusive Disease (VOD), also known as sinusoidal obstruction syndrome. This scoring system is specifically applicable to patients who have undergone hematopoietic stem cell transplantation (HSCT), a procedure often used in the treatment of conditions such as leukemia and lymphoma.

The Baltimore Criteria aids in the early identification of VOD, a potentially life-threatening complication of HSCT. It is based on the presence of three key clinical features within 20 days of transplantation: jaundice (with a bilirubin level of 2 mg/dL or higher), hepatomegaly or right upper quadrant pain of hepatic origin, and unexplained weight gain or fluid retention.

Exclusion criteria for the use of the Baltimore Criteria include the presence of other conditions that could explain these symptoms, such as graft-versus-host disease, viral hepatitis, sepsis, or cholestatic drug reactions. Therefore, it is crucial to rule out these conditions before applying the Baltimore Criteria for VOD diagnosis.

Baltimore criteria for diagnosis of veno-occlusive disease

The Seattle criteria for the diagnosis of veno-occlusive disease (VOD) is assessed by evaluating three clinical indicators following a transplant. Each indicator is assigned a score of 1 if present. Based on the presence or absence of these indicators, a total score is calculated to determine the likelihood of VOD.

This calculator involves the following inputs:

1. Bilirubin levels greater than 34.2 mcmol/L [2 mg/dL] within 20 days post-transplant.
2. The presence of hepatomegaly or pain in the right upper quadrant.
3. Weight gain exceeding 2% from the pre-transplant weight.

The computation involves checking each of these conditions for a true or false value. Each condition true is assigned a score of 1. The final score is the sum of all true conditions, ranging from a minimum of 0 to a maximum of 3.

Based on the total score, the interpretation is as follows:

- A score of 0 or 1 indicates that the criteria for veno-occlusive disease are not met.
- A score of 2 or 3 indicates that the criteria for veno-occlusive disease are met.

The Seattle Criteria is a diagnostic tool specifically designed for the diagnosis of Hepatic Veno-Occlusive Disease (VOD), also known as sinusoidal obstruction syndrome (SOS), in patients who have undergone hematopoietic stem cell transplantation (HSCT). This calculator is clinically useful in identifying patients who are at risk of developing this potentially life-threatening condition, which is characterized by occlusion of the small hepatic veins, leading to hepatomegaly, ascites, and jaundice. 

The Seattle Criteria includes three main parameters: bilirubin level, weight gain due to fluid retention, and hepatomegaly or right upper quadrant pain of hepatic origin. A diagnosis of VOD is made if these symptoms occur within 20 days of transplantation. 

There are no specific exclusion criteria for the use of the Seattle Criteria. However, it should be noted that this diagnostic tool may not be as effective in diagnosing VOD in patients who have received non-myeloablative conditioning regimens, as these patients may present with atypical symptoms. Additionally, other causes of liver dysfunction should be ruled out before a diagnosis of VOD is made using the Seattle Criteria.

Hepatic veno-occlusive disease

Guidelines

Key sources