One of the most startling revelations of the report is the dramatic delay women face in obtaining accurate diagnoses of bleeding disorders—averaging 14 to 16 years compared to roughly two years for men. This lag significantly exacerbates the health risks associated with these diseases, delaying necessary interventions and increasing morbidity. The report pinpoints heavy menstrual bleeding, impacting up to one-third of women, as a vital but often overlooked early indicator of inherited bleeding disorders, urging clinicians to adopt routine menstrual health assessments to facilitate earlier detection.

The Commission calls for an ambitious yet feasible goal: reducing the average diagnostic delay for women with bleeding disorders to less than 24 months by 2035. Achieving this requires integrating standardized screening protocols into clinical guidelines, bolstering clinician education, and building robust referral networks that prioritize female hematological health. Such systemic changes are essential to overcoming entrenched gender disparities that have long hindered progress.

Beyond delayed diagnosis, the report underscores the underrepresentation of women in clinical trials and the neglect of female-specific hematologic issues in research and policy. This gap has perpetuated a lack of tailored treatment strategies, leaving women vulnerable to adverse outcomes. The Commission advocates for renewed investment in women-centric research, updated clinical guidelines, and enhanced education to address these critical shortfalls.

Postpartum hemorrhage, a leading cause of maternal mortality globally, is another focal point, with the report recommending standardized protocols to improve management and outcomes. In parallel, the authors emphasize the necessity for personalized thrombosis care during pregnancy and the postpartum period, recognizing the unique physiological changes women undergo that influence clotting risks.

Experts hail this report as a pivotal advancement in women’s health and hematology. ISTH President Dr. Pantep Angchaisuksiri highlights its role in uniting clinicians, researchers, and policymakers to address the nuanced challenges women face throughout their lives. The Commission’s evidence-based roadmap provides a transformative call for immediate, coordinated action to deliver equitable, effective hematological care on a global scale.

Dr. Samuelson Bannow concludes with a hopeful vision: “Meaningful progress in bridging these gender gaps is entirely within reach. With focused collaboration across clinical care, research, and education, we can ensure that women and girls everywhere receive the lifesaving hematology care they deserve.” This landmark report offers a powerful blueprint for revolutionizing female blood health and wellbeing worldwide.

Subject of Research: Women’s hematological disorders and health inequities
Article Title: Reducing mortality, improving outcomes, and establishing equity for women with classical haematological disease: a Lancet Haematology Commission
News Publication Date: July 13, 2026
Web References: http://dx.doi.org/10.1016/S2352-3026(26)00079-7
Keywords: Hematology, bleeding disorders, heavy menstrual bleeding, postpartum hemorrhage, thrombosis, women’s health, diagnosis delay, clinical guidelines

Women experience unique hematological challenges due to physiological events such as menstruation, pregnancy, and childbirth, yet these aspects remain woefully underrepresented in clinical studies and health policies. Delayed diagnosis of bleeding disorders is alarmingly common, with women waiting 14 to 16 years on average to receive an accurate diagnosis—vastly longer than the roughly two years observed in men. This diagnostic lag not only perpetuates unnecessary suffering but also diminishes the potential impact of early intervention.

Central to the commission’s findings is the recognition of heavy menstrual bleeding as both a significant health burden and a leading early indicator of inherited bleeding disorders. Affecting up to one-third of women globally, heavy menstrual bleeding is frequently dismissed or inadequately treated, underlining a critical need for systematic menstrual health assessments. The report advocates for widespread adoption of bleeding assessment tools in clinical practice to facilitate earlier detection and referral to specialized care.

The commission sets a bold objective: reducing the average diagnostic delay for female bleeding disorders to under 24 months by 2035. Achieving this requires integrating screening recommendations into major clinical guidelines and equipping healthcare professionals with targeted education on female-specific hematological manifestations. Personalized care models—especially regarding thrombosis management during pregnancy and postpartum—are emphasized as essential for improving maternal outcomes.

Furthermore, the report highlights severe inequities such as higher rates of anemia and complications during pregnancy linked to hematological imbalances, which underscore the urgency of standardized postpartum hemorrhage protocols. The underrepresentation of women in clinical trials emerges as a systemic flaw that hampers the development of effective, evidence-based interventions tailored to female physiology.

Dr. Samuelson Bannow points out that while the existing diagnostic tools and treatments have the capacity to transform women’s hematological health worldwide, real change hinges on coordinated global action involving clinicians, researchers, and policymakers. Enhanced investment in women’s health, coupled with comprehensive prevention programs, could significantly elevate both quality of care and survival outcomes.

ISTH President Dr. Pantep Angchaisuksiri echoes these sentiments, describing the report as a pivotal resource that bridges gaps in knowledge and care delivery. As the conversation around gender-specific medical research gains momentum, this commission provides a scientifically robust roadmap for mitigating disparities and promoting equitable hematology care.

Ultimately, the commission’s work embodies a crucial step toward dismantling gender biases in medicine. Its forward-looking recommendations challenge the medical community to prioritize female hematological health, promising a future where timely diagnosis and personalized treatment become the standard rather than the exception.

Subject of Research: Female hematological conditions, including bleeding disorders and thrombosis
Article Title: Reducing mortality, improving outcomes, and establishing equity for women with classical haematological disease: a Lancet Haematology Commission
News Publication Date: July 13, 2026
Web References: http://dx.doi.org/10.1016/S2352-3026(26)00079-7
Keywords: Hematology, Blood flow, Bleeding, Thrombosis, Menstruation

Viscoelastic testing is a sophisticated hematological assay that evaluates the dynamic properties of blood clot formation, stability, and dissolution, providing a comprehensive picture of coagulation in real-time. Unlike traditional laboratory coagulation tests, which offer static and often delayed snapshots, VET delivers rapid bedside insights into the functional status of a patient’s hemostatic system. By analyzing parameters such as clot initiation time, clot strength, and fibrinolytic activity, VET enables clinicians to discern the precise deficiencies—be they platelet dysfunction, plasma coagulation factor deficits, or hyperfibrinolysis—that contribute to bleeding. This information directs targeted transfusion strategies, differentiating when to administer platelets, plasma, cryoprecipitate, or whole blood, thereby optimizing resource use and patient outcomes.

Although the utility of viscoelastic testing is well documented in cardiac surgery, trauma, and orthopedic procedures, its application in obstetrics, particularly for postpartum hemorrhage, is less established. The Blood-Brain Barrier Institute’s Southern California Evidence Review Center recently released a comprehensive scoping review, analyzing 156 studies that collectively underscore the promise of VET in maternity care but simultaneously highlight the scarcity of high-quality randomized controlled trials (RCTs) in this domain. The review, commissioned by the Patient-Centered Outcomes Research Institute (PCORI), also integrated perspectives from patients, healthcare practitioners, and policymakers to elucidate barriers hindering the widespread adoption of VET in U.S. obstetric practice.

One of the critical challenges identified by the review is the rarity of severe postpartum hemorrhage events, which complicates the design and implementation of large-scale clinical trials. Because PPH incidents are infrequent yet acutely critical, longitudinal data collection across multiple centers is necessary to generate statistically robust evidence. Moreover, variations in hospital protocols and blood management practices create heterogeneity that complicates the standardization of VET utilization. The researchers advocate for a coordinated, multi-center randomized trial framework, employing standardized VET protocols that would produce more definitive insights into the effectiveness and optimal implementation of this technology across diverse obstetric populations.

From a technical perspective, viscoelastic testing systems operate by measuring the viscoelastic properties of clotting blood using either rotational thromboelastometry (ROTEM) or thromboelastography (TEG). These devices apply mechanical stress to a blood sample and quantify the resistance and elasticity of the developing clot over time. The dynamic curves produced inform clinicians not only about the presence of coagulation abnormalities but also about their nature and severity. Such granularity is particularly valuable in PPH management, where rapid decision-making is crucial to prevent deterioration into hemorrhagic shock and multi-organ failure. The bedside availability of VET, requiring only small blood samples and delivering results within minutes, enhances clinical responsiveness in acute obstetric emergencies.

Despite these technological advances, the uptake of VET in obstetric settings has been hampered by economic and organizational impediments. Setting up VET-capable laboratories involves significant initial investment in equipment procurement, staff training, and integration into clinical workflows. Hospitals must weigh these costs against the prospective benefits, which, though compelling, remain insufficiently quantified in the obstetric context. Critics also point to the lack of standardized treatment algorithms derived from VET readouts, leading to uncertainty about clinical decision-making thresholds. Addressing these concerns requires both economic evaluations and protocol development based on rigorous clinical research and expert consensus.

Beyond survival, the adoption of viscoelastic testing carries important implications for healthcare equity and cost-effectiveness. Postpartum hemorrhage disproportionately affects marginalized populations, including Black women and those residing in rural areas, who face limited access to timely and precise obstetric interventions. Implementing VET technology has the potential to ameliorate these disparities by enabling more rapid diagnosis and personalized treatment at the point of care. Economically, by delineating exact transfusion needs, VET can minimize the unnecessary use of costly blood products, such as whole blood, and reduce wastage, ultimately translating into cost savings for healthcare systems burdened by rising expenditures.

The current evidence situation echoes broader debates on medical technology adoption, where the urgency of clinical need coexists with an imperfect evidence base. Researchers leading the review referenced the analogy of parachute use—widely accepted despite the absence of RCTs—emphasizing the logic of benefit over voluntary evidence accumulation. In the context of obstetric hemorrhage, the potential for VET to save lives provides a powerful argument for its phased integration into clinical practice, even as studies continue. This perspective advocates for a paradigm shift, accepting best-available evidence alongside rigorous ongoing research to hasten access to life-saving diagnostics.

Clinicians and hospital administrators contemplating VET incorporation must also consider workforce implications. Training physicians, nurses, and laboratory technicians in interpreting VET results and adapting treatment strategies is critical for effective deployment. Interdisciplinary collaboration becomes indispensable, as obstetricians, anesthesiologists, hematologists, and transfusion medicine specialists need to establish unified protocols. Simulation-based education platforms may accelerate proficiency, reducing cognitive load during actual hemorrhagic crises. Furthermore, integrating VET data into electronic health records can facilitate longitudinal monitoring and quality improvement initiatives.

The review authors encourage policymakers to prioritize funding for multi-center clinical trials that could solidify evidence-based guidelines. They highlight that protracted ambiguity surrounding VET standards has contributed substantially to its slow adoption. Clear clinical criteria defining when VET should be applied during labor and delivery—and specific thresholds for intervention based on test results—would catalyze uniformity in practice. This, in turn, would empower payers and regulators to endorse VET reimbursement, incentivizing hospitals to invest accordingly.

Innovations in viscoelastic testing hardware and software are underway, aiming to create more compact, user-friendly, and automated devices suitable for the obstetric unit environment. Advances such as improved sensor technology and artificial intelligence algorithms for interpreting complex coagulation patterns promise to enhance diagnostic accuracy and speed further. These developments could overcome current barriers related to cost and operator skill, making VET a routine component of obstetric hemorrhage management in the near future.

The synthesis of clinical evidence, expert insights, and patient experience contained in this landmark review serves as a clarion call to the medical community. Postpartum hemorrhage, though uncommon, carries catastrophic consequences, and viscoelastic testing represents a technological breakthrough with the potential to save countless lives. Through coordinated research efforts, protocol standardization, and policy advocacy, VET could become integral to obstetric care worldwide, shifting the paradigm from reactive to proactive management of maternal bleeding complications.

The path ahead will demand investment, collaboration, and iterative learning but the stakes could not be higher. Maternal mortality is a human tragedy that modern medicine can increasingly prevent. Viscoelastic testing embodies a scientific and clinical leap forward, bridging laboratory innovation and bedside care with the promise of timely, precise intervention. As the evidence base grows and health systems embrace this technology, the vision of safer childbirth can move closer to reality for women across the globe.

Subject of Research: People

Article Title: Viscoelastic testing in postpartum obstetric hemorrhage: a scoping review commissioned by the Patient-Centered Outcomes Research Institute (PCORI)

News Publication Date: 25-Aug-2025

Web References:

• Southern California Evidence Review Center
• Keck School of Medicine of USC
• International Journal of Obstetric Anesthesia article
• PCORI full report and issue brief

References:
Hempel, S., Janzen, C., et al. (2025). Viscoelastic testing in postpartum obstetric hemorrhage: a scoping review. International Journal of Obstetric Anesthesia. DOI: 10.1016/j.ijoa.2025.104763

Keywords:
Pregnancy complications, Obstetrics, Bleeding, Blood transfusion, Plasma, Platelets, Childbirth