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

BCSH / BSBMT guideline: diagnosis and management of veno-occlusive disease (sinusoidal obstruction syndrome) following haematopoietic stem cell transplantation.