Managing older patients with hemophilia

Area of Science:

• Hematology
• Geriatrics
• Internal Medicine

Background:

• Factor replacement therapy has significantly increased life expectancy for persons with hemophilia (PWHs).
• Aging PWHs encounter age-related comorbidities similar to the general population, including hypertension, obesity, and diabetes.
• Coagulopathy's impact on chronic disease expression in PWHs requires further investigation.

Purpose of the Study:

• To review common age-related complications in the older hemophilia population.
• To highlight challenges in managing comorbidities and infections in aging PWHs.
• To provide guidance for hematologists managing complex cases.

Main Methods:

• Literature review focusing on cardiovascular disease, malignancy, liver disease, renal insufficiency, and joint disease in aging PWHs.
• Analysis of challenges posed by comorbidities and co-infections (HIV, hepatitis C).
• Synthesis of current understanding regarding management strategies.

Main Results:

• Aging PWHs are susceptible to hypertension, obesity, diabetes, cardiovascular disease, and chronic kidney disease.
• Chronic joint arthropathy increases fall and fracture risks.
• HIV and hepatitis C infections complicate cancer and liver disease incidence.

Conclusions:

• Elderly PWHs require management similar to the general population, with factor replacement as needed.
• Emphasis on primary prevention of risk factors and interdisciplinary coordination is crucial.
• Evidence-based guidelines are needed for optimal care of aging PWHs.