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Haematopoietic system

AMA5 Chapter 9 (p 191) applies to the assessment of permanent impairment of the haematopoietic system, subject to the modifications set out below. Before undertaking an impairment assessment, users of the Guidelines must be familiar with:

  • the Introduction in the Guidelines
  • chapters 1 and 2 of AMA5
  • the appropriate chapter(s) of the Guidelines for the body system they are assessing
  • the appropriate chapter(s) of AMA5 for the body system they are assessing.

The Guidelines take precedence over AMA5.

Introduction

12.1 AMA5 Chapter 9 (pp 191–210) provides guidelines on the method of assessing permanent impairment of the haematopoietic system. Overall, that chapter should be followed when conducting the assessment, with variations indicated below.

12.2 Impairment of end organ function due to haematopoietic disorder should be assessed separately, using the relevant chapter of the Guidelines. The percentage whole person impairment (WPI) due to end organ impairment should be combined with any percentage WPI due to haematopoietic disorder, using the combined values table in AMA5 (pp 604–06).

Anaemia

12.3 Table 12.1 (below) replaces AMA5 Table 9-2 (p 193).

Table 12.1: Classes of anaemia and percentage whole person impairment

Class 1: 0-10% WPIClass 2: 11-30% WPIClass 3: 31-70% WPIClass 4: 71-100% WPI

No symptoms

and

haemoglobin 100-120g/L

and

no transfusion required

Minimal symptoms

and

haemoglobin 80-100g/L

and

no transfusion required

Moderate to marked symptoms

and

haemoglobin 50-80g/L before transfusion

and

transfusion of 2 to 3 units required, every 4 to 6 weeks

Moderate to marked symptoms

and

haemoglobin 50-80g/L before transfusion

and

transfusion of 2 to 3 units required, every 2 weeks

12.4 The assessor should exercise clinical judgement in determining WPI, using the criteria in Table 12.1. For example, if comorbidities exist which preclude transfusion, the assessor may assign class 3 or class 4, on the understanding that transfusion would under other circumstances be indicated. Similarly, there may be some claimants with class 2 impairment who, because of comorbidity, may undergo transfusion.

12.5 Pre-transfusion haemoglobin levels in Table 12.1 are to be used as indications only. It is acknowledged that for some claimants, it would not be medically advisable to permit the claimant’s haemoglobin levels to be as low as indicated in the criteria of Table 12.1.

12.6 The assessor should indicate a percentage WPI, as well as the class.

Polycythaemia and myelofibrosis

12.7 The level of symptoms (as in Table 12.1) should be used as a guide for the assessor in cases where non-anaemic tissue iron deficiency results from venesection.

White blood cell diseases

12.8 In cases of functional asplenia, the assessor should assign 3% WPI. This should be combined with any other impairment rating, using the Combined Values Table in AMA5 (pp 604–06).

Haemorrhagic and platelet disorders

12.9 AMA5 Table 9-4 (p 203) is to be used as the basis for assessing haemorrhagic and platelet disorders.

12.10 For the purposes of the Guidelines, the criteria for inclusion in class 3 of AMA5 Table 9-4 (p 203) are:

  • symptoms and signs of haemorrhagic and platelet abnormality
  • requires continuous treatment
  • interference with daily activities; requires occasional assistance.

12.11 For the purposes of the Guidelines, the criteria for inclusion in class 4 of AMA5 Table 9-4 (p 203) is:

  • symptoms and signs of haemorrhagic and platelet abnormality
  • requires continuous treatment
  • difficulty performing daily activities; requires continuous care.

Thrombotic disorders

12.12 AMA5 Table 9-4 (p 203) is used as the basis for determining impairment due to thrombotic disorder.