Assessment of Lebanese healthcare professionals’ awareness on acquired haemophilia: a cross-sectional study

Figures & data

Table 1. Demographic Characteristics of the Participants (n = 362).

Characteristics	No. (%)
Hospital / clinic area
Beirut	164 (45.3%)
Mount Lebanon	141 (39%)
North Lebanon	2 (0.6%)
South Lebanon	1 (0.3%)
Other*	5 (1.4%)
Unknown	47 (13%)
Specialty
Internal medicine / internist	106 (29.3%)
Gynaecologist	30 (8.3%)
Anaesthetist and intensivist	29 (8%)
Anaesthetist	27 (7.5%)
Family medicine specialist	26 (7.2%)
Emergency doctor	23 (6.4%)
Intensivist	10 (2.8%)
Geriatrician	7 (1.9%)
Family medicine and geriatrician	1 (0.3%)
Others	102 (28.2%)

*Other areas including France, Beirut and Mount Lebanon, not defined.

Table 2. Bleeding disorders encountered within the last 2 years.

Disorder*	No. (%)
Platelet disorder	255 (74.6%)
Coagulation disorders
Liver disease	192 (53.9%)
Disseminated intravascular coagulation	174 (48.9%)
Vitamin K deficiency	122 (34.3%)
Von Willebrand disease	118 (32.2%)
Congenital haemophilia	60 (16.9%)
Acquired haemophilia	24 (6.8%)
None of the above	24 (6.8%)

*Answers are not mutually exclusive.

Table 3. Assessment of knowledge on AHA.

AHA is a spontaneously occurring autoimmune disorder:	No.	%
Caused by inhibitory antibodies against a coagulation factor	308	89.3
That affects patients with no previous history of bleeding tendency	266	76.4
That affects all age groups	236	70.2
Is a life-threatening condition	235	68.1
When a lab test shows an aPTT prolongation:
I consider it as an alert for a bleeding problem	290	82.2
I order a second blood test then a mixing test	246	73.7
I order a second blood analysis as soon as possible	244	70.3
I call the lab to check the type of aPTT kit used	107	36.4
What do you rely on for diagnosing an AHA bleeding patient:
Laboratory results: aPTT prolongation, low FVIII level, uncorrected aPTT after a mixing test and a high inhibitor titre	333	94.9
Clinical features	258	75.2
A Mixing test:
Is performed on blood plasma to distinguish factor deficiencies from factor inhibitors	268	80.7
Is performed by mixing an equal volume of the patient’s plasma and normal pooled plasma	262	72.4
Is the final step to confirm the diagnosis of AHA	129	39.3
If a patient with aPTT prolongation is going to undergo surgery:
Postpone surgery if the patient has bleeding signs	299	87.9
I refer the case and check it with a haematologist	294	84.7
I investigate immediately the reason of the aPTT prolongation	288	84.5
Proceed with surgery if there is no active bleeding	59	17.9

Figure 1. Time to response of haematology consultant among HCPs.

Figure 2. Responses regarding the importance of increasing awareness on AHA among health care professionals by area.

Figure 3. Responses regarding the importance of increasing awareness on AHA among health care professionals by specialty.

Table 4. Agreement between the participants’ responses to the survey and the correct answers (n=362).

	Correct answers	% of participants with correct answers
According to you, AHA is a spontaneously occurring autoimmune disorder:
That affects patients with no previous history of bleeding tendency	Yes	76.4
Caused by inhibitory antibodies against a coagulation factor	Yes	89.3
Is a life-threatening condition	Yes	68.1
That affects all age groups	Yes	70.2
When a lab test shows an aPTT prolongation:
I consider it as an alert for a bleeding problem	Yes	82.2
I order a second blood analysis as soon as possible	Yes	70.3
I order a second blood test then a mixing test	Yes	73.7
I call the lab to check the type of aPTT kit used	Yes	36.4
Question 5: What do you rely on for diagnosing an AHA bleeding patient:
Clinical features	Yes	75.2
Laboratory results: aPTT prolongation, low FVIII level, uncorrected aPTT after a mixing test and a high inhibitor titre	Yes	94.9
A Mixing test:
Is the final step to confirm the diagnosis of AHA	No	60.7
Is performed on blood plasma to distinguish factor deficiencies from factor inhibitors	Yes	80.7
Is performed by mixing an equal volume of the patient’s plasma and normal pooled plasma	Yes	72.4
If a patient with aPTT prolongation is going to undergo surgery:
Postpone surgery if the patient has bleeding signs	Yes	87.9
Proceed with surgery if there is no active bleeding	No	82.1
I investigate immediately the reason of the aPTT prolongation	Yes	84.5
I refer the case and check it with a haematologist	Yes	84.7