Five decades of successive establishment of hemophilia care in Thailand.

Introduction: Management of patients with hemophilia in healthcare resource limited countries is challenging for healthcare providers.

Area covered: Thai patients with hemophilia initially received episodic treatment of cryoprecipitate and fresh frozen plasma (FFP) in 1965. Home treatment using cryoprecipitate at early bleeding episodes was initiated in 1979 and replaced with fresh dry plasma in 1982. Heat-treated, lyophilized cryoprecipitate commenced in 1997, and factor concentrate was imported for clinical use in 2000. A healthy diet, limit weight gain and exercise for the prominent vein constitute a commitment among every hemophiliac. National advocacy of home treatment using factor concentrates at early bleeding episodes started in 2006 and nationwide low-dose prophylaxis in 2018. Immune tolerance induction (ITI) was initially attempted in 1997. The dental splint was invented as a local measure for dental procedures in 1979, and fibrin glue has been applied to surgical sites. A computerized program for hereditary bleeding disorders registry was initiated in 1999 and became nationwide in 2020. Finally, nationwide nonfactor therapy of monthly low-dose emicizumab prophylaxis will be established soon.

Expert opinion: Hemophilia care in Thailand constitutes the real-world experience passing from generation to generation for five decades using our limited resources efficiently.