Wolfgang Miesbach on Transforming Care for Women and Girls with Bleeding Disorders: Key Guidelines 2021–2024
Wolfgang Miesbach, Professor of Medicine at Frankfurt University Hospital, shared a post on LinkedIn:
“Advancing Care for Women and Girls with Bleeding Disorders
The clinical landscape has transformed significantly through evidence-based guidelines (2021-2024), finally addressing historical gaps in care for this mainly unrecognized population:
2021 ISTH Nomenclature Revolution
Eliminated outdated ‘carrier’ terminology
Established 5 evidence-based categories from severe to asymptomatic women and girls with bleeding disorders
Improved diagnostic accuracy and research uniformity
2021 ASH/ISTH/NHF/WFH VWD Guidelines
Prioritized hormonal therapy and tranexamic acid over desmopressin for heavy menstrual bleeding
Set clear diagnostic thresholds: <0.30 IU/mL (regardless of bleeding) and <0.50 IU/mL (with bleeding)
2021 European Principles of Care
EAHAD and EHC established 10 comprehensive care principles
Promoted systematic screening across European centers
2024 NBDF MASAC Guidelines
Document 286: Most comprehensive update yet
Mandated iron deficiency screening even with normal hemoglobin
Addressed historical underdiagnosis gaps
Persistent Challenges:
Despite progress, women and girls with bleeding disorders remain systematically excluded from clinical trials, creating dangerous knowledge gaps that impact:
Diagnostic delays
Higher anemia & transfusion rates
Unnecessary hysterectomies
25% report severe reproductive decision impact
The path forward requires collaborative research and gender-specific treatment studies to truly close these healthcare disparities.”
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