Detection of bleeding disorders in Lebanon: outcomes of a pilot programme

Authors

  • C. Djambas Khayat,

    Corresponding author
    1. Lebanese Hemophilia Association, Care centre, Jal el Dib, Lebanon
    2. Departement Pediatric, Hotel Dieu de France Hospital, Beirut, Lebanon
    • Correspondence: C. Djambas Khayat, Lebanese Hemophilia Association, Care centre, Jal el Dib, 165191 Beirut, Lebanon.

      Tel.: +961 3704864; fax: +961 1613273;

      e-mail: claudiakhayat@yahoo.fr

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  • H. Samaha,

    1. Lebanese Hemophilia Association, Care centre, Jal el Dib, Lebanon
    2. Blood Bank Unit, Saint George Hospital University Medical Center, Beirut, Lebanon
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  • P. Noun,

    1. Lebanese Hemophilia Association, Care centre, Jal el Dib, Lebanon
    2. Pediatric Oncology Unit, Saint George Hospital University Medical Center, Beirut, Lebanon
    3. Departenment Pediatric, Notre Dame du Secour Hospital USEK, Beirut, Lebanon
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  • J. D. Bakhos Asmar,

    1. Lebanese Hemophilia Association, Care centre, Jal el Dib, Lebanon
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  • A. Taher,

    1. Lebanese Hemophilia Association, Care centre, Jal el Dib, Lebanon
    2. Hematology and Oncology, American University of Beirut Medical Center, Beirut, Lebanon
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  • S. Adib,

    1. Epidemiology and Public Health, Saint Joseph University, Beirut, Lebanon
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  • A. Inati,

    1. Lebanese Hemophilia Association, Care centre, Jal el Dib, Lebanon
    2. Division of Pediatric Hematology-Oncology, Rafik Hariri University Hospital, Beirut, Lebanon
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  • S. Sakr

    1. Lebanese Hemophilia Association, Care centre, Jal el Dib, Lebanon
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Summary

To promote management and awareness of bleeding disorders in Lebanon, a pilot programme was launched in 2009 by the Lebanese Hemophilia Association assisted by World Federation of Hemophilia. The aim of this study was to diagnose patients with bleeding disorders and to assess the potential challenges in implementing a screening programme. The pilot project was launched in 26 social health centres in the Bekaa valley. The study tools included the evaluation of the Tossetto Bleeding Score and the Pictorial Bleeding Assessment Chart (PBAC) for menstruation. Persons with a bleeding score higher than 2 and PBAC higher than 185 were eligible for further blood tests including the prothrombin time, partial thromboplastin time, complete blood count, bleeding time and von Willebrand ristocetin cofactor activity. 643 patients were enrolled, of whom 60.6% were women. Overall, 91 persons had an abnormal score. 50 eligible patients were tested: 32 had normal tests, nine new patients with severe Von Willebrand were discovered, 4 had VW:RiCo of 40, 3 prolonged APTT and 2 thrombocytopaenia. There was a clear correlation between the severity of the score and the willingness to perform the tests (P = 0.02). Women were reluctant to participate fully when investigators were men. The probability of adherence to the screening protocol is significantly increased when directed by women health care professional. For patients with milder forms, global screening programmes were neither feasible nor acceptable but those more severely affected have to be identified. Providers are crucial in preselecting patients with blood problems who are not coping well.

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