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Welcome to CME on ReachMD. This episode is part of our MinuteCE curriculum.

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Dr. Ambrose: 
Hi everyone. This is CME on ReachMD, and I am Dr. Stephanie Ambrose. I am joined today by Dr. Jenny McDaniel. Today, we'll be discussing the impact of hemophilia on overall health, some psychosocial factors, and lifestyle. Dr. McDaniel, would you provide us with a brief overview of these issues for patients with hemophilia?

Dr. McDaniel: 
Absolutely. Thanks, Dr. Ambrose. So first, we'll talk a little bit about the impact of factor levels on patients’ ability to perform physical activities, even including activities of daily living.

So patients that have factor levels between 40 and 100% generally are considered to have normal hemostasis, and we expect overall that they have very minimal impact, if any, on their ability to perform their activities of daily living, but also sports and physically strenuous activities. For patients with mild hemophilia, and that's factor levels between 5 and 40%, we know that there can start to be more impact on their activities, maybe not so much their activities of daily living, but when they start to do more physically strenuous activities or sports, they are at risk for bleeding, and so there can be some limitations there for patients with mild hemophilia.

As we progress down to lower factor levels, for our patients with moderate hemophilia, that's factor levels between 1 and 5%, we know we can start to see a lot more issues with bleeding with higher risk activity or physically strenuous activity. So patients may experience more issues with joint bleeding or muscle bleeds, with trauma, but also there is some risk for spontaneous bleeds for patients with moderate hemophilia as well. Patients with moderate hemophilia are also at more risk for pain and physical impairment related to bleeding.

And then, as we progress down to our patients with severe hemophilia with factor levels less than 1%, we know that even with just their normal activities of daily living, they're at risk for spontaneous bleeds that can result in significant physical impairment, joint problems, even with very low activity.

So what does this look like when it comes to the patient's lifestyle and their ability to do normal things throughout their life? So hemophilia can result in significant health concerns. This can be related to damage from bleeding into the joints, or hemarthroses, causing arthropathy or arthritis. We know patients can have a higher risk of bone fractures, nerve issues, and may potentially need surgical interventions like joint replacement, sometimes even fairly early in life.

The risk for inhibitor development is also a significant complication that we can see in our patients with hemophilia, and that can significantly impact the treatment options for these patients and the effectiveness of treatment options. Patients with hemophilia are at risk for bleeding, and it can be significant, life-threatening hemorrhage, intracranial hemorrhage, intraabdominal hemorrhage, joint bleeding, muscle bleeds.

There's also a significant impact on their psychosocial, their well-being. The treatment burden for patients with hemophilia is generally high. Patients may need regular infusions of clotting factor. They may not be able to do all the things that they want to do in their life, or the things their friends or family are able to do. They may need to be seen in the medical setting very frequently for treatment of bleeds, or for evaluations. So their burden of treatment is high. We know that about 50% of young adults with hemophilia report problems with anxiety or depression, and that's higher than the general population.

We also see there is some hesitation or limitation with how patients with hemophilia are able to participate in normal activities, physical activity and sports. There are also impacts on the patient's lifestyle and their family, so they may have to take a lot of additional considerations when traveling. They may not be able to travel to remote areas because treatment may not be as accessible, and they may not be entirely independent with their treatment.

Patients with hemophilia may also have limited or they may have to take into consideration their hemophilia when thinking about employment opportunities and what sort of careers they can pursue. They may not be able to pursue the physically strenuous career options. They may also have to miss work because of the need to treat their hemophilia or treat their bleeds.

Dr. Ambrose, do you have anything else to add?

Dr. Ambrose: 
Yeah. It's so interesting to hear about how hemophilia, every aspect of a patient's life is truly affected. So thank you so much for breaking that down to help us better understand. 

Well, this has been a great bite-sized discussion. Please make sure to tune in to the rest of the microlearning activities in this series for more information. Thanks for listening.

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