(PWBD-TH-07.2) Overview: Challenges in different countries, adapting guidelines to lower resource countries

Background and objectives: The recent guidelines on diagnosis and management of Von Willebrand Disease (VWD) published in 2021 were intended to standardize the care for patients with VVD. The guidelines were based on the health standards of care in high income countries (HICs). It was important to explore the resources and gaps for the diagnosis and management of patients with VWD in low middle income countries (LMICs); to adapt recent guidelines.

Materials and methods: A google survey was distributed among hematologists caring for inherited bleeding disorders in East Mediterranean Region (EMR). The survey aimed at evaluation of resources and gaps to implement the recent guidelines in the treatment centers in EMR.

Results: Responses of the survey demonstrated that diagnosis of VWD is based on bleeding assessment tools, laboratory diagnosis of VWD types 1, 2 and 3 based on results of VWF Antigen (Ag), FVIII and VWF activity (RCo). Desmopressin is not widely available for diagnosis of VWD and treatment of type 1 & 2 VWD. Tranexamic acid, Hormonal therapy for treatment of heavy menstrual bleeding (HMB), postpartum hemorrhage and mucocutaneous bleeding are available. VWF concentrates are relatively less available. Access to prophylaxis for severe bleeding patients with VWD is limited. There is lack of knowledge about VWD among patients, families and health care authorities.

Conclusion: Increasing awareness about VWD, multidisciplinary care, government support for patients with VWD and optimization of resource utilization can help to adapt and implement the recent guidelines for better quality of life.