The HScore

Using the HScore to diagnose hemophagocytic syndromes¹

The HScore is a diagnostic tool developed to estimate a patient’s risk of having a hemophagocytic syndrome, such as MAS. It features 9 clinical, biologic, and cytologic parameters that are individually weighted.

Parameter	Number of points (criteria for scoring)
Known underlying immunosuppression*	0 (no) or 18 (yes)
Temperature (°C)	0 (<38.4), 33 (38.4-39.4), or 49 (>39.4)
Organomegaly	0 (no), 23 (hepatomegaly or splenomegaly), or 38 (hepatomegaly and splenomegaly)
Number of cytopenias^†	0 (1 lineage), 24 (2 lineages), or 34 (3 lineages)
Ferritin (ng/mL)	0 (<2000), 35 (2000-6000), or 50 (>6000)
Triglyceride (mmol/L)	0 (<1.5), 44 (1.5-4), or 64 (>4)
Fibrinogen (g/L)	0 (>2.5) or 30 (<2.5)
Serum glutamic oxaloacetic transaminase (IU/L)	0 (<30) or 19 (≥30)
Hemophagocytosis features on bone marrow aspirate	0 (no) or 35 (yes)

*Human immunodeficiency virus positive or receiving long-term immunosuppressive therapy (ie, glucocorticoids, cyclosporine, azathioprine).
^†Defined as a hemoglobin level of ≤9.2 g/dL and/or a leukocyte count of ≤5000/mm³ and/or a PLT count of ≤110,000/mm³.

Probability of a hemophagocytic syndrome, such as MAS,
according to the patient’s HScore

HScore	Probability of hemophagocytic syndrome, %
90	<1
100	1
110	3
120	5
130	9
140	16
150	25
160	40
170	54
180	70
190	80
200	88
210	93
220	96
230	98
240	99
250	>99

Signs and symptoms

See how MAS can manifest in patients.

Learn the signs

Managing MAS

Learn about the management strategies for MAS.

Explore management

Reference: 1. Fardet L, Galicier L, Lambotte O, et al. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis Rheumatol. 2014;66(9):2613-2620. doi:10.1002/art.38690