Thanks to comprehensive care at hemophilia treatment centers (HTCs), improved safety of clotting factor concentrates and effective treatments for hepatitis C and HIV, men with hemophilia today are experiencing the joys—and the aches and pains—of a life lived into middle age and beyond. (See “Growing Older Proactively.”) Because of their bleeding disorder, however, men with hemophilia have to pay particularly careful attention to their health as they age. Here are some things I encourage my mature patients to do:
Find a good primary care physician (PCP). It’s really important to make sure your PCP is a good fit and that you see him or her regularly. Your PCP coordinates age-related health maintenance, such as screening for high cholesterol and certain cancers. If possible, try to have a PCP in the same health system as your HTC, which will greatly enhance communication between your clinicians.
Pay attention to unusual bleeding. This is defined as bleeding that isn’t usual for you. Blood in the urine or stool may occur occasionally in men with hemophilia, but bleeding also can be the first sign of an age-related malignancy, such as colon cancer. Remember that many conditions are more easily treated if they are identified earlier, so don’t delay telling your PCP and HTC about new bleeding.
Undergo age-related tests. Sometimes routine screening tests for age-related conditions, such as a colonoscopy, or diagnostic procedures, such as a prostate biopsy, are thought to be too risky for men with bleeding disorders. These tests might be delayed or not performed. Aging men with hemophilia should undergo screening and diagnostic procedures as recommended for men without a bleeding disorder. It’s also important to insist that your HTC be contacted and that it supplies a regimen for factor replacement (and any other treatments) to minimize the risk of bleeding.
[Steps for Living: Treatment Basics]
Inform your HTC of new diagnoses or medicines. Finally, treatment of certain conditions that are more common in older men may require medications that can increase the risk of bleeding. Involving your hematologist in these discussions is essential, so make sure your HTC is aware of any new diagnoses or medications.
With a good primary physician, attentiveness to unusual bleeding and involvement of your hematologist in managing age-related medical conditions, you’ll meet the challenges—and joys—of growing older head-on.
Patrick F. Fogarty, MD, is director of the Penn Comprehensive Hemophilia and Thrombosis Program at the University of Pennsylvania Medical Center in Philadelphia.