Common Health Concerns

As you are getting older, you might have other health concerns. Your bleeding disorder treatment plan may be affected by these and your overall health management.  

This section of Common Health Concerns covers:

Screenings: What, When, Where

Anemia

Cancer

Cardiovascular Disease

Chronic Kidney Disease

Diabetes

Hepatitis and Liver Disease

Human Immunodeficiency Virus (HIV)

Joint Disease

Oral Health

Osteoporosis

Strokes

Substance Use

Vision Changes

Screenings: What, When, Where

Improved treatments and care mean people with bleeding disorders are living longer.  Meeting with your health care provider regularly and getting appropriate medical screenings is key to staying healthy as you get older.

Primary Care 

Having a good primary health care provider is very important for staying healthy. By scheduling regular visits with your health care provider, you can coordinate age-related screening for conditions like cancer and high cholesterol. If your primary health care provider is in the same health system as your Hemophilia Treatment Center (HTC), the members of your health care team can communicate easily.  

Know Your Body 

Pay attention to bleeding. Know what type of bleeding is usual for you and what bleeding is unusual. Bleeding episodes that aren't typical for you may be a sign of an age-related or other health issue. Be sure to talk about unusual bleeding with your health care providers and with your Hemophilia Treatment Center (HTC) team. This will help you to identify any health concerns and receive any needed treatment early. 

Get Tested for Age-Related Conditions 

People with blood and bleeding disorders should be tested for the same age-related conditions as people without blood and bleeding disorders. These will help you to stay healthy as you get older. Some screenings and tests, like colonoscopies and biopsies, need some coordination with your HTC to make sure you do not have bleeding related complications.  

Anemia

Anemia occurs when the body loses blood and/or does not produce enough red blood cells. One of the major activities of these cells is to carry oxygen. Low levels of red blood cells may stop the body from maintaining needed oxygen levels.¹⁸

Common Types of Anemia in People with Bleeding Disorders: 

Although there are several types of anemia, the most common one in people with a bleeding disorder is iron-deficiency anemia. 

Iron-deficiency anemia happens when there is not enough iron to make red blood cells. Iron deficiency usually results from repeated bleeding episodes. It may also be caused by unhealthy habits or other factors.¹⁸ Women, girls, and people with the potential to menstruate, who have bleeding disorders, often develop iron-deficiency from heavy menstrual bleeding. 

People with other medical conditions like infection with human immunodeficiency virus (HIV) or hepatitis C virus (HCV) often have mild anemia. A common diagnosis is anemia of chronic disease. This type of anemia happens when inflammation affects how red blood cells take up iron, even when it is present.¹⁸ 

What are the symptoms of anemia? 

Mild anemia may have no signs or symptoms. However, in some people it may cause¹⁸: 

• Tiredness 
• Weakness 
• Headache 
• Pale or yellowish skin (called pallor) 

Moderate to severe anemia may lead to more serious problems, including¹⁸: 

• Faintness or dizziness 
• Sweating 
• Weak or rapid pulse 
• Rapid breathing or shortness of breath 
• Lower leg cramps during exercise 
• Brain damage 
• Heart disorders (for example, an irregular heartbeat [called arrhythmia], heart murmur, enlarged heart, or heart failure) 

How do you treat anemia? 

Anemia is easily diagnosed with a blood test and physical exam. If you have iron-deficiency anemia, your health care provider may recommend changing your diet or taking iron^.16,19 For more severe anemia, a blood transfusion may be needed.^2,19  

If the source of the bleeding causing your iron-deficiency anemia is known, you should work with your health care provider to create the right treatment plan for your bleeding disorder.  

If the reason for iron deficiency is unknown, your health care provider should investigate possible sources of bleeding. 

Cancer

Cancer is a disease where your own cells start to grow uncontrollably. Normally, your cells die as they grow old or become damaged and new cells are formed. If you have cancer, abnormal or damaged cells grow and multiply. Often these cells will form tumors. However, some blood cancers, like leukemia, do not develop tumors.

How do you get cancer? 

Cancer is caused by changes in your genes. These genes are responsible for cell growth. These genetic changes can be inherited from your biological parents or be caused by your lifestyle and environment. Your risk for developing cancer increases with age. Your body can eliminate cancerous cells. This ability decreases as you age.  

People infected with the human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) should be aware of certain types of cancers. These cancers include non-Hodgkin's lymphoma, basal cell cancer (a type of skin cancer), Kaposi's sarcoma, and hepatocellular carcinoma (a type of liver cancer).^1,11,12,23 Liver cancer is the most common type of cancer in people with hemophilia and hepatitis C. 

You can lower your risks for getting cancer by vaccinating against human papillomavirus (HPV) and hepatitis B, as well as making healthy lifestyle choices. These include avoiding tobacco, protecting your skin, limiting alcohol, and keeping a healthy weight.  

How do you treat cancer? 

The exact protocol for the treatment of cancer depends on what type and stage of cancer you have. The protocol also depends on your personal preferences and values. The diagnosis and treatment of cancer, like biopsy, surgery, chemotherapy, and radiotherapy, may require additional bleeding disorder medication. It is important to work in collaboration with your health care provider team to create the best plan of care for you. 

The earlier cancer is identified the easier the treatment will be. The CDC recommends regular screening for several types of cancers and people with bleeding disorders should follow these recommendations. Cancer can sometimes be overlooked because symptoms of the cancer may be confused with symptoms of a bleeding disorder. 

Cardiovascular Disease

The term cardiovascular disease (CVD) describes many different conditions of the heart and blood vessels, including²⁵: 

• Heart attack 
• Stroke 
• Heart failure 
• Arrhythmia, a problem with the heart rate or rhythm    
• Heart valve defects

How do you get CVD? 

Risk factors for CVD are more common in people with bleeding disorders. These risk factors include high blood pressure (called hypertension), obesity, and metabolic syndrome. Metabolic syndrome is a combination of high blood pressure, excess fat around the waist, high cholesterol levels, and high blood sugar levels. Other risk factors include high cholesterol and triglyceride (a type of fat found in your body) levels, a family history of cardiovascular disease at a young age, and lack of exercise.¹⁷ 

How do you treat CVD? 

Treatment with highly active anti-retroviral therapy (ART) also increases the risk for negative cardiovascular events in people with bleeding disorders. 

You can reduce your risk for CVD by taking the same steps as people without bleeding disorders, including: 

• Eating a healthy, low-fat diet 
• Exercising and keeping active 
• Avoiding or stopping smoking 
• Reducing stress 
• Regular monitoring of blood pressure, cholesterol, and glucose levels 

Often people with CVD receive medication that prevents the formation of blood clots. This may sound very scary to a person with a bleeding disorder. However, your cardiologist (physician managing your CVD) and HTC team will work closely together to make sure your treatment plan will keep you healthy and safe.  

If you want more information about healthy eating, please go to Food Choices.  

If you want more information about options for stress reduction, please go to Managing Stress. 

Chronic Kidney Disease

Chronic kidney disease (CKD) happens when your kidneys are no longer able to filter your blood correctly. This will cause an increased amount of fluid and waste products to stay in your body. When this happens, it can lead to health issues, like cardiovascular disease or low red blood cells (anemia).¹⁴ 

How do you get CKD? 

People with bleeding disorders experience similar risk factors as people without bleeding disorders. However, some of these risk factors are more commonly found in people with bleeding disorders. Risk factors include¹⁴: 

• High blood pressure (called hypertension) 
• Human immunodeficiency virus (HIV) infection 
• Kidney bleeds 
• Diabetes 
• Cardiovascular disease 
• Family history of CKD 
• Obesity 

What are the symptoms of CKD? 

Hematuria, or blood in the urine, is usually not a major cause for concern in younger people with a bleeding disorder, even when medication is needed to stop it. In older adults with a bleeding disorder, hematuria may be a sign of CKD. However, many people with CKD do not experience any specific symptoms.¹⁴ 

How do you treat CKD? 

Screening for and managing renal disease is similar for people with and without bleeding disorders. If your health care provider thinks you might have kidney disease, you may be referred to a health care provider who treats kidneys (nephrologist). 

If you have CKD is important to eat a kidney-healthy diet. A dietician can help you develop an eating plan that will work for you. You should also maintain a healthy weight, be physically active, and control your high blood pressure or diabetes if you have them. If you smoke, it is important to quit, as smoking can worsen CKD.¹⁴ 

People with end-stage renal disease (ESRD) typically undergo dialysis. Dialysis can be performed safely in people with a bleeding disorder. There are two main types of dialysis: hemodialysis and peritoneal. Hemodialysis uses a machine to filter the blood while peritoneal dialysis uses the thin lining around the abdomen as the filter. Peritoneal dialysis may be the better option for people with a bleeding disorder because it's less likely to require blood-thinning agents or bleeding disorder medication.¹⁴  

Kidney transplantation is another treatment for some individuals with ESRD. It also can be performed safely in people with a bleeding disorder after taking the right precautions. 

Diabetes

Diabetes is a disease where sugar (called glucose) levels in the blood are too high. Normally, the body uses the hormone insulin to carry glucose from the foods we eat into the cells. When the glucose arrives in the cells, it is used for energy. In people with diabetes, the body doesn't produce enough or any insulin at all. The body may also not be able to use the insulin well. This results in glucose building up in the blood, which can damage blood vessels. 

The risk of diabetes increases with age. People who are inactive and/or have an unhealthy weight are also at increased risk of diabetes. Being a healthy weight and staying active may decrease this risk.

What are the symptoms of diabetes? 

Diabetes may cause serious health problems, including heart disease, blindness, kidney failure, poor circulation, and loss of sensation in the legs (called peripheral neuropathy). The poor circulation and neuropathy can lead to infections and possibly loss of a body part.  

Here are the most common symptoms of diabetes: 

• Frequent urination 
• Excessive thirst 
• Unexplained weight loss 
• Extreme hunger 
• Sudden vision changes 
• Tingling or numbness in the hands or feet 
• Tiredness 
• Very dry skin 
• Slow healing sores 
• Increased frequency of infections  

How do you treat diabetes? 

If you have diabetes, good blood glucose control is important to avoid serious health issues. Treatment for diabetes involves regular monitoring of blood glucose levels, a healthy diet, and exercise. In addition, oral medications or insulin may be necessary to keep sugar levels in check. Subcutaneous or under the skin insulin injections may be given safely without causing bleeding complications. 

Hepatitis and Liver Disease

Hepatitis is an inflammation of the liver. It is commonly caused by a virus infection. There are six types of viruses that cause hepatitis. The most common are hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV).^4,6,8,13  

How do you get hepatitis? 

The HAV virus is spread by stool and rarely blood. Hepatitis A does not typically lead to chronic (long-term) disease.^4,6,8,13  

HBV and HCV are spread by blood, semen, and other bodily fluids. These can cause chronic liver disease. Chronic liver disease is much more common with HCV than HBV.^4,6,8,13  

As many as 98% of people who received plasma-derived clotting factor in the 1970s and 1980s were infected with HCV. Between 1987 and 1991 people were no longer infected with HIV, however 3000 individuals were still infected with Hepatitis C.  

Human Immunodeficiency Virus (HIV)

The human immunodeficiency virus (HIV) attacks a person’s immune system, which decreases the body’s ability to fight off infections. While there is currently no cure for HIV, it can be managed with proper medical care.⁴  

How do you get HIV? 

HIV can be transmitted from person to person through blood, semen, per-seminal fluid, rectal fluids, vaginal fluids, and breastmilk. These fluids need to come into direct contact with your mucous membranes or enter your body through a wound or be injected. Most commonly this happens through sex, sharing needles, syringes, or other injection equipment.⁴ 

Joint Disease

Many people with bleeding disorders have joint disease (arthropathy). This is due to repetitive bleeding episodes into the joints. Treatments for bleeding disorders have improved over the years and people are able to prevent and manage joint bleeds much better today. This has led to less severe arthropathy for people with bleeding disorders. However, it has not eliminated it. Arthropathy significantly impacts people with severe hemophilia who have not received prophylactic treatment from a young age.    

Just like the general population, people with a bleeding disorder are also at risk for osteoarthritis (arthritis resulting from wear and tear on the joints) as they age. 

If you want more information about joint disease and how to manage it, please go to Joint Protection. 

Oral Health

Oral health is an important component of your overall health and well-being. As you age more oral health issues may arise. Older adults, who do not have insurance, are socioeconomically disadvantaged, and are a member of a racial or ethnic minority tend to have poorer oral health. Many older adults lose their dental insurance upon retirement^.7,9  

The most common oral health issues in older adults include untreated tooth decay, gum disease, tooth loss, and oral cancer. Chronic diseases, like diabetes or cardiovascular disease (CVD), can increase the development of oral health issues.^7,9  

What leads to oral health issues? 

Plaque, the thin, colorless, sticky film with bacteria that constantly forms on the teeth, can cause cavities and gum disease. Plaque must be removed each day to prevent it from building up, hardening, and forming tartar. The buildup of plaque can cause gingivitis and bleeding in your gums. Chronic periodontitis, which damages the membrane attaching the teeth to the jaw can also happen and lead to tooth loss.  

What can you do? 

Preventative dental care should be a priority for people with bleeding disorders. It is important to floss, brush, and visit a dentist who understands your bleeding disorder. Good dental habits can help prevent oral health complications. 

Here are some tips to help keep your teeth and gums healthy: 

• Avoid drinking or eating a lot of sugary or acidic foods and beverages. 
• Avoid smoking or chewing tobacco. 
• Brush and floss at least twice a day. Use a medium-textured brush and fluoride toothpaste. You can also rinse with fluoride mouthwashes or apply fluoride gels daily or weekly. 
• Visit the dentist regularly and choose a dentist who understands your bleeding disorder. They should work together with you, your Hemophilia Treatment Center (HTC) or hematologist to ensure safe, appropriate care. 
• If you wear dentures, be sure they fit properly and don't irritate your mouth or gums. Poor-fitting dentures can cause your gums to bleed. 

If you want more information about this topic, please go to Dental Health.  

Osteoporosis

Osteoporosis is a condition where bones become weak, porous, and fragile. Bones become weaker when the body breaks down bone tissue faster than it produces it. Osteoporosis is more common in aging adults, especially women. People with a bleeding disorder have lower bone mineral density.²⁰ This is possibly because of decreased activity. Lower bone mineral density puts people with bleeding disorders at an even greater risk for osteoporosis. 

What are the symptoms of osteoporosis? 

Osteoporosis has no obvious symptoms but increases the risk for bone fractures. Many people do not find out they have osteoporosis until they break a bone.  

How do you treat osteoporosis?  

Osteoporosis is diagnosed using a bone density test, which is a painless and safe procedure that measures the strength of the bones. If you have osteoporosis your health care provider can prescribe medications to help strengthen your bones. They will also review all your current medication to make sure they are not weakening your bones^.5 

There are a couple of steps you can take to strengthen your bones, and you don’t have to wait until you have osteoporosis.⁵ 

• Eat a healthy diet high in calcium and vitamin D 
• Perform weight bearing exercise  
• No smoking 
• Limited alcohol consumption 

Talk with your health care provider about the amount and type of vitamins, minerals, and supplements you should take. Everybody is different, but together you can create a plan that will work for you.  

Strokes

Your brain needs oxygen to function properly. A stroke occurs when the arteries in your brain are no longer able to deliver oxygen rich blood. There are two types of stroke: 

• Ischemic stroke, which occurs when blood flow to the brain is blocked 
• Hemorrhagic stroke, which results from bleeding into the brain or surrounding spaces. 

Both forms of stroke may cause a harmful lack of oxygen to the brain. This will lead to parts of the brain becoming damaged. Strokes can lead to long-term disability or even death. 

People with bleeding disorders face an increased risk of hemorrhagic stroke throughout their lives. The risk of either form of stroke increases with age.¹⁵   

Here are some risk factors for stroke: 

• High blood pressure (called hypertension) 
• Smoking 
• Heart disease 
• Diabetes 
• High cholesterol levels 
• Atherosclerosis, or buildup on the walls of arteries  
• Physical inactivity 
• Obesity 

Know the signs and symptoms of a stroke! Recognizing them quickly and getting treatment right away can save lives.

What are the symptoms of a stroke? 

Here are some of the signs and symptoms that may point to a stroke: 

• Trouble walking 
• Trouble speaking and understanding 
• Paralysis or numbness of the face, arm, or leg 
• Trouble seeing in one or both eyes 
• Sudden, severe headache 

The word FAST can help you remember the warning signs of a stroke and the action you should take if you see them. 

• Face: Check to see if one side of the face droops when smiling. 
• Arms: When both arms are raised, check to see if one drifts downward. 
• Speech: Check to see if speech is slurred or strange. 
• Time: Call 9-1-1 immediately if any of these signs are observed. 

Substance Use

Substance use disorder (SUD) is characterized by a repeated and harmful pattern of using one or more substances leading to cognitive, behavioral, and physiological symptoms. Many substances, like alcohol and illicit drugs, can become harmful to your body and negatively affect your bleeding disorder. It can impair your ability to correctly respond to an injury you may have and interfere with blood clotting. SUD can also affect your ability to work and your home life.  

How do you get SUD? 

Even with new treatment options, living with a bleeding disorder can still be challenging. Some people may use alcohol, prescription medication, or illicit drugs to address pain and cope with a chronic health condition.  

How do you treat SUD? 

Overcoming SUD is possible but will require coordinated care. There are many treatment approaches, and it will be up to you and your health care team to find the best plan of care for you. Treatments may include medication, especially for opioid use disorder, outpatient counseling, behavioral health care, and inpatient rehabilitation.  

Historically, many people with bleeding disorders have not been able to get admitted to inpatient substance use disorders programs. The reason for the denials most commonly is the need for self-treatment, like factor replacement. NBDF has partnered with the New England Hemophilia Association (NEHA), Hemophilia Federation of America (HFA), HTC providers, and community members to advocate for access to inpatient substance use and mental health facilities for people with bleeding disorders.  

If you are having problems with substance use, contact your primary care provider (PCP) or Hemophilia Treatment Center (HTC). You can also reach out to family, friends, and your support community. You are not alone. 

Vision Changes

As people age, the lenses in their eyes become less flexible. These changes may result in long-term changes in vision. Many adults begin to experience problems focusing on close distances (called presbyopia) in their early-to-mid-40s. This condition usually worsens before stabilizing around the age of 60 years. Corrective eyewear, contact lenses, or laser surgery can help manage vision. More serious eye problems also become more common as people age, including retinal detachment, glaucoma, cataracts, and age-related macular degeneration (AMD). These can all lead to blindness.^3,24

What are the symptoms of vision changes?^3,24 

There are several signs and symptoms people frequently experience as their vision changes with age.  

These include: 

• Needing more light to see well 
• Increased glare, a discomfort from bright light 
• Changes in how you see color 
• Dry eyes due to less tear production 

Additionally, you may experience signs and symptoms of more serious eye problems.

These include: 

• Frequent changes in how clearly you see 
• Spots, floaters, and flashes in your vision 
• Loss of peripheral (side) vision 
• Distorted vision 

How do you treat vision changes? 
It is important to identify any changes in vision or more serious eye problems as early as possible. Regardless of any symptoms, you should regularly check-in with your eye care professional. They can exam your eyes and determine if any support is needed. 

Most vision changes are treated with corrective eyewear, contact lenses, or laser surgery. More serious eye conditions may require medication or surgical interventions.³  

While aging is unavoidable, there are a few things you can do to keep your eyes as healthy as possible.  

These include: 

• Minimizing exposure to ultraviolet light 
• Avoiding any trauma to the eyes by wearing protective eyewear 
• Eating a healthy diet rich in antioxidants 
• Maintaining normal levels of blood sugar and cholesterol  
• Having a healthy body weight 
• Regular exercise 
• Not smoking