Hemophilia Daily

Wednesday, July 14

Download issue (PDF)

Excerpt

New mix of health problems confronts ageing bleeding disorders population

The bleeding disorders community is beginning to face the same challenges as the general population, as improved treatments and longer life spans bring problems of ageing to the forefront of hemophilia care.

“The fact that we’re having a debate in the first place is actually a major triumph,” Gerry Dolan of the U.K.’s Nottingham Haemophilia Comprehensive Care Centre told a Tuesday morning plenary. “In the past, many of our patients never made it to middle or older age.”

But hemophilia practitioners “have to look at what we really mean by comprehensive care, to make sure our patients receive the standard of care afforded to the general population” in different countries. He added that an ageing population with bleeding disorders will use substantially more factor concentrate, making it “relatively urgent that we do the economic modelling to prepare for this. Because one thing all providers in healthcare finance hate is a nasty surprise.”

Although the limited available research has been plagued by methodological issues, Dr. Dolan gave an overview of the new health issues people with hemophilia will face as they age. Heart disease, cancer, kidney failure, and osteoporosis all increase with age, so that 77% of seniors over 65 have two or more chronic conditions, but “we have very little experience managing multiple medical conditions in our older patients with hemophilia.”

One study of 1,805 patients with severe hemophilia A also pointed to a gradual increase in inhibitors as people age. The incidence of inhibitors peaks in the youngest age groups, falls off in early adulthood, then gradually increases from 1.67 per thousand cases in the 40-49 age group to 8.89 in people over 70. Dr. Dolan said the study raised the “intriguing question” of whether the risk of inhibitors increases with age, why that should be, and whether continuing prophylaxis can prevent the problem. At present, “we don’t really know.”

The limited epidemiological data on cardiovascular disease in people with hemophilia has yielded mixed results, but the markers and objective evidence seem to indicate minimal differences in atherosclerosis between test subjects with and without hemophilia. “My conclusion, and that of others, is that hemophilia does not protect the patient from the underlying mechanisms of atherosclerosis.”

Hypertension may increase with hemophilia, possibly due to renal factors and probably as a result of obesity and smoking. “You add age to that equation, and you’re immediately looking at significant cardiovascular risk.” Mature hemophilia patients are at particular risk during intensive replacement, suggesting that continuous infusions may be needed during surgeries to avoid peaks of factor VIII.
One question that still needs to be investigated, said Dr. Dolan, is whether older people with hemophilia are receiving the same prevention and health promotion services that are available to the general population. To help with advocacy for such services, more data needs to be collected on the magnitude of their age-related problems.

Last Updated July 2010