TY - JOUR
T1 - Current Practice Regarding Bleeding Disorders of Unknown Cause in the Netherlands
T2 - A National Survey
AU - Mussert, Caroline M. A.
AU - Monard, Amaury L. L.
AU - van Duijl, Tirsa T.
AU - Henskens, Yvonne M. C.
AU - van den Biggelaar, Maartje
AU - Schutgens, Roger E. G.
AU - Schols, Saskia E. M.
AU - Fijnvandraat, Karin J.
AU - Meijer, Karina
AU - den Exter, Paul L.
AU - Nieuwenhuizen, Laurens
AU - van Moort, Iris
AU - Kruip, Marieke J. H. A.
AU - Cnossen, Marjon H.
AU - Heubel-Moenen, Floor C. J. I.
AU - BDUC-iN Study group
PY - 2025
Y1 - 2025
N2 - IntroductionAbout 40%-70% of persons with a clinically relevant bleeding tendency who are referred to haemostasis experts are classified as having a 'bleeding disorder of unknown cause' (BDUC) as no biological entity can be found after extensive laboratory testing. Currently, guidelines are under development regarding diagnostic assessment and management to minimize variation in clinical practice.AimInvestigate current practices regarding BDUC in the Netherlands.MethodsAn online survey on the best BDUC definition, associated bleeding phenotype, clinical and diagnostic approaches, treatment, registration, and follow-up was distributed amongst healthcare providers working in Dutch haemophilia treatment centres (HTCs).ResultsThe survey was completed by 39/54 (72%) respondents. Twenty percent did not register BDUC patients in their HTC. Healthcare professionals indicated that follow-up should depend on bleeding phenotype severity and bleeding history, and other potential causes for an increased bleeding tendency should be excluded. Moreover, the use of laboratory tests within the routine diagnostic pathway was demonstrated to be heterogeneous. Regarding treatment, tranexamic acid was most frequently prescribed for minor and major surgical interventions (79% and 86%), dental extractions (93%) and childbirth (93%). Desmopressin was prescribed for major surgical procedures by 79%.ConclusionOur survey shows that Dutch current practice varies but is generally in line with recent ISTH SSC recommendations. Additionally, it describes other clinically relevant topics not included in the international survey, such as follow-up and exclusion of other causes for bleeding. This survey therefore adds to international efforts to unify BDUC definition, diagnostic approach, treatment and follow-up, and to attain broadly supported guidelines.
AB - IntroductionAbout 40%-70% of persons with a clinically relevant bleeding tendency who are referred to haemostasis experts are classified as having a 'bleeding disorder of unknown cause' (BDUC) as no biological entity can be found after extensive laboratory testing. Currently, guidelines are under development regarding diagnostic assessment and management to minimize variation in clinical practice.AimInvestigate current practices regarding BDUC in the Netherlands.MethodsAn online survey on the best BDUC definition, associated bleeding phenotype, clinical and diagnostic approaches, treatment, registration, and follow-up was distributed amongst healthcare providers working in Dutch haemophilia treatment centres (HTCs).ResultsThe survey was completed by 39/54 (72%) respondents. Twenty percent did not register BDUC patients in their HTC. Healthcare professionals indicated that follow-up should depend on bleeding phenotype severity and bleeding history, and other potential causes for an increased bleeding tendency should be excluded. Moreover, the use of laboratory tests within the routine diagnostic pathway was demonstrated to be heterogeneous. Regarding treatment, tranexamic acid was most frequently prescribed for minor and major surgical interventions (79% and 86%), dental extractions (93%) and childbirth (93%). Desmopressin was prescribed for major surgical procedures by 79%.ConclusionOur survey shows that Dutch current practice varies but is generally in line with recent ISTH SSC recommendations. Additionally, it describes other clinically relevant topics not included in the international survey, such as follow-up and exclusion of other causes for bleeding. This survey therefore adds to international efforts to unify BDUC definition, diagnostic approach, treatment and follow-up, and to attain broadly supported guidelines.
KW - bleeding disorder of unknown cause
KW - current practice
KW - diagnostics
KW - haemostasis
KW - management
KW - TENDENCY
U2 - 10.1111/hae.70065
DO - 10.1111/hae.70065
M3 - Article
SN - 1351-8216
JO - Haemophilia
JF - Haemophilia
ER -