Wolfgang Miesbach: The Diagnostic Challenge of Bleeding Disorder of Unknown Cause
Wolfgang Miesbach, Professor of Medicine at Frankfurt University Hospital, shared a post on LinkedIn:
“Insightful session at EAHAD 2026, Dublin on Bleeding Disorder of Unknown Cause (BDUC) by Floor Heubel-Moenen.
A thought-provoking presentation highlighting how much work still lies ahead.
Many patients referred for bleeding tendency — especially women — still receive no definitive diagnosis despite extensive testing.
BDUC is common and clinically relevant
In the Maastricht Bleeding Cohort, BDUC represented a substantial proportion of diagnoses, particularly among women.
Sex-specific patterns matter
Heavy menstrual bleeding (HMB) and postpartum hemorrhage (PPH) were more frequent in women with BDUC than in those with mild defined bleeding disorders — suggesting potential predictive value.
Limits of current tools
The ISTH-BAT is essential, but has clear limitations:
- Reduced sensitivity without hemostatic challenges
- Recall bias
- Score saturation
- Limited differentiation between mild bleeding disorders
Diagnosis by exclusion is not enough
Clinically significant bleeding plus normal lab results remains a major challenge.
We need better strategies that capture symptom and sex-specific bleeding phenotypes.”
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