1. Supplemental appendix 4 EXAMPLES OF BLEEDING MANIFESTATIONS* Skin domain: slides 2 to 23 Mucosal domain: slides 24 to 30 Organ domain: slides 31 to 32 *Where not otherwise specified, pictures are taken from patients with primary ITP

2. 1 cm2 cm3 cmActual scale: Courtesy by M. Michel A crop of scattered petechiae

3. Courtesy by F. Rodeghiero Purpuric manifestations in a patient with septicemia and thrombocytopenia

4. Courtesy by F. Rodeghiero Allergic (maculopapular) skin reaction secondary to cephalosporin (should not be recorded)

5. Courtesy by M. Michel Recent scattered petechiae with confluence to form a purpuric macule (arrow)

6. Courtesy by F. Rodeghiero Synchronous recent scattered petechiae. Abrupt presentation in ITP

7. Courtesy by F. Rodeghiero Same patient. Synchronous recent scattered petechiae extending to the sole.

8. Courtesy by F. Rodeghiero Petechiae of various size and age

9. Courtesy by F. Rodeghiero Palpable purpura in a non thrombocytopenic patient

10. Courtesy by R. Stasi Petechiae and one ecchymosis larger than a patient’s palm size

11. Six reddish-purple ecchymoses smaller than a patient’s palm size Courtesy by M. Michel

12. Leg ecchymoses and scattered petechiae (not recent)

13. Courtesy by M. Michel Several ecchymoses, one larger than patient’s palm size and no petechiae

14. Courtesy by F. Rodeghiero Old ecchymosis, dating more than 10-15 days and a small, recent one

15. Courtesy by F. Rodeghiero Extensive ecchymosis with underlying subcutaneous hematoma

16. Courtesy by F. Rodeghiero Simmetrical ecchymoses with underlying subcutaneous hematomas caused by self-administered LMWH in a patient with ITP and moderate thrombocytopenia (should not be recorded)

17. Courtesy by F. Rodeghiero Three old synchronous large ecchymoses and a few more recent petechiae

18. Courtesy by F. Rodeghiero Ecchymoses of various age

19. Courtesy by F. Rodeghiero Bullae and discoloration of skin not due to ITP (should not be recorded)

20. Courtesy by F. Rodeghiero Vaste ecchymosis secondary to constriction

21. Courtesy by F. Rodeghiero Old small ecchymoses (sometimes seen in healthy people, purpura simplex)

22. Courtesy by F. Rodeghiero An old ecchymosis

23. Courtesy by F. Rodeghiero Very old ecchymosis (weeks) and some more recent petechiae

24. Courtesy by M. Michel Hemorrhagic bullae of various age, two 1-day old on the left tongue margin

25. Courtesy by M. Michel Hemorrhagic bullae of various age, two 1-day old on the left tongue margin

26. Courtesy by M. Michel Old (2-3 days) hemorrhagic bullae and facial petechiae of various age

27. Courtesy by F. Rodeghiero Recent hemorrhagic bullae (less than 2 days)

28. Courtesy by F. Rodeghiero Sublingual recente ecchymosis

29. Partial hemorrhage in one eye and small peripalpebral ecchymosis in a patient with post-chemotherapy trombocytopenia Courtesy by F. Rodeghiero

30. Bilateral peripalpebral ecchymoses and complete subconjunctival hemorrhage in a patient with post-chemotherapy trombocytopenia Courtesy by F. Rodeghiero

31. Courtesy by M. Michel Intracerebral hemorrage

32. Pictorial Blood Assessment Chart In Rodeghiero et al, Haemophilia 2008; 14:68-75