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

Authors: van Galen, KPM, Lavin, M, Skouw-Rasmussen, N, Ivanova, E, Mauser-Bunschoten, E, Punt, M., Romana, G, Elfvinge, P, d’Oiron, R, and Abdul-Kadir, R.

Publication: Haemophilia; June 2020

Affiliations: Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands; Irish Centre for Vascular Biology, School of Pharmacy and Biomedical Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Haematology, Beaumont Hospital, Beaumont, Dublin, Ireland; European Haemophilia Consortium, Brussels, Belgium; Department of Haematology, University Hospital, Hradec Kralove, Czech Republic; Department of Gynaecology, University Hospital Brno, Brno, Czech Republic; Department of Haematology, Karolinska University, Stockholm, Sweden; Inserm U 1176, APHP Paris Saclay, Hôpital Bicetre, Le Kremlin Bicetre, France; Department of Obstetrics and Gynaecology, Royal Free Foundation Hospital and Institute for Women’s Health, University College London, London, UK.

Abstract: 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.