Clinical management of woman with bleeding disorders: A survey among European haemophilia treatment centres

Authors	VAN GALEN KPM LAVIN Michelle SKOUW-RASMUSSEN Naja IVANOVA Eva MAUSER-BUNSCHOTEN Eveline PUNT Marieke GERYCHOVÁ Romana ELFVINGE Petra D'OIRON Roseline ABDUL-KADIR Rezan
Year of publication	2020
Type	Article in Periodical
Magazine / Source	Haemophilia
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://onlinelibrary.wiley.com/doi/full/10.1111/hae.14043
Doi	http://dx.doi.org/10.1111/hae.14043
Keywords	bleeding disorder; haemophilia; heavy menstrual bleeding; postpartum haemorrhage and reproduction; survey; von Willebrand disease
Description	Introduction The impact of bleeding for women with bleeding disorders (WBD) is of increasing focus and importance. Despite this, optimal management strategies are unclear and knowledge gaps persist. Aim To examine practices and define research priorities on diagnosis and management of WBD in Europe. Methods An electronic survey on clinical management of WBD was sent to 136 European haemophilia treatment centres (HTCs), including open questions on knowledge gaps and research priorities. Results Fifty-nine HTCs from 12 Western (WE) and 13 Central/Eastern European (CEE) countries completed the survey. Less than half runs a joint clinic (24 HTCs, 42%). Most centres without a joint clinic have a named obstetrician (81%) and/or gynaecologist (75%) available for collaboration. Overall 18/54 (33%) European HTCs do not offer preimplantation genetic diagnosis. Third trimester amniocentesis to guide obstetric management is available 28/54 HTCs (52%), less frequent in CEE compared to WE countries (5/17 vs 23/37, P = .03). 53% of HTCs (28/53) reported that only 0%-25% of WBD seek medical advice for heavy menstrual bleeding (HMB). An algorithm managing acute HMB in WBD is lacking in 22/53 (42%) HTCs. The main reported knowledge and research gaps are lack of awareness & education on WBD among patients and caregivers, optimal diagnostic strategies and effective multidisciplinary management of pregnancy & HMB. Conclusion Joint clinics, prenatal diagnostics and algorithms for managing acute HMB are lacking in many European HTCs. HMB may be an underestimated issue. This survey highlights the need to prioritize improvement of knowledge and patient care for WBD across Europe.