Procedures and Comorbid Conditions

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Circumcision

Among the male Registry participants, 43% of those with hemophilia A and 46% of those with hemophilia B have undergone circumcision; among these, 41% of hemophilia A participants and 32% of hemophilia B participants experienced excessive bleeding. In addition, among those participants with hemophilia A and B who were circumcised, clotting factor was used during the circumcision procedure for 19% and 18%, respectively (Table 18).

Table 18. History of having undergone circumcision and circumcision details, among male Registry participants, by hemophilia type

Table 18. History of having undergone circumcision and circumcision details, among male Registry participants, by hemophilia type
	Hemophilia A		Hemophilia B
	n	%	n	%
Undergone circumcision
Yes	3,118	42.9%	864	45.5%
No	2,307	31.7%	515	27.1%
Unknown	1,851	25.4%	518	27.3%
Excessive bleeding with circumcision
Yes	1,281	41.1%	273	31.6%
No	1,261	40.4%	391	45.3%
Unknown	576	18.5%	200	23.1%
Circumcision under clotting factor
Yes	603	19.3%	154	17.8%
No	1,985	63.7%	557	64.5%
Unknown	530	17.0%	153	17.7%

Comorbid Conditions and Surgical Procedures

Among male Registry participants with hemophilia A and B, the five most common non-bleeding disorder conditions experienced were bone fracture (14%), hypertension (10%), depression (10%), anxiety (9%), and iron deficiency anemia (6%) (Table 19).

Table 19. Select chronic diseases, conditions, and surgical procedures ever experienced among male Registry participants with hemophilia, by age

Table 19. Select chronic diseases, conditions, and surgical procedures ever experienced among male Registry participants with hemophilia, by age
	Age Group
	Less than 20		20–44 years		45–64 years		65+ years		All
	n	%	n	%	n	%	n	%	n	%
Cancer
Hepatocellular carcinoma (HCC)	*	*	*	*	14	1.2%	*	*	24	0.3%
Leukemia (any type)	*	*	6	0.2%	*	*	*	*	18	0.2%
Cancer other than HCC and leukemia	10	0.2%	32	1.1%	82	6.9%	71	20.3%	195	2.1%
Bone Disease
Fracture of a bone	384	8.2%	534	18.3%	300	25.1%	99	28.4%	1,317	14.4%
Osteopenia	10	0.2%	44	1.5%	54	4.5%	17	4.9%	125	1.4%
Osteoporosis	*	*	19	0.7%	52	4.4%	24	6.9%	97	1.1%
Cardiovascular Disease
Acute ischemic stroke (AIS)	*	*	*	*	12	1.0%	8	2.3%	29	0.3%
Atrial fibrillation	*	*	*	*	35	2.9%	38	10.9%	84	0.9%
Coronary artery disease	*	*	*	*	51	4.3%	41	11.7%	102	1.1%
Congestive heart failure	*	*	*	*	16	1.3%	15	4.3%	41	0.4%
Myocardial infarction	*	*	6	0.2%	14	1.2%	*	*	28	0.3%
Transient ischemic attack (TIA)	*	*	*	*	7	0.6%	10	2.9%	24	0.3%
Kidney Disease
Chronic kidney disease (CKD)	8	0.2%	18	0.6%	43	3.6%	23	6.6%	92	1.0%
Kidney stones	21	0.4%	161	5.5%	127	10.6%	54	15.5%	363	4.0%
Nephrotic syndrome	*	*	8	0.3%	9	0.8%	*	*	26	0.3%
Liver Disease
Ascites	*	*	11	0.4%	23	1.9%	*	*	42	0.5%
Cirrhosis	*	*	.	.	133	11.1%	32	9.2%	226	2.5%
Hepatic fibrosis	7	0.1%	49	1.7%	104	8.7%	18	5.2%	178	1.9%
Splenomegaly	7	0.1%	44	1.5%	59	4.9%	13	3.7%	123	1.3%
Varices	*	*	27	0.9%	54	4.5%	*	*	96	1.0%
Thrombosis
Deep vein thrombosis (DVT)	34	0.7%	25	0.9%	13	1.1%	6	1.7%	78	0.9%
Pulmonary embolism	*	*	7	0.2%	*	*	*	*	15	0.2%
Other
Anxiety	181	3.8%	412	14.1%	230	19.3%	43	12.3%	866	9.4%
Depression	120	2.5%	450	15.4%	267	22.4%	47	13.5%	884	9.6%
Diabetes mellitus	27	0.6%	58	2.0%	140	11.7%	66	18.9%	291	3.2%
Hypertension	26	0.6%	264	9.0%	457	38.3%	181	51.9%	928	10.1%
Iron deficiency anemia	252	5.3%	133	4.6%	127	10.6%	42	12.0%	554	6.0%
Pseudotumor	15	0.3%	21	0.7%	27	2.3%	14	4.0%	77	0.8%
Surgical procedures
Coronary artery angioplasty	*	*	*	*	19	1.6%	13	3.7%	40	0.4%
Coronary artery bypass graft	*	*	*	*	14	1.2%	25	7.2%	44	0.5%
Dialysis	.	.	6	0.2%	9	0.8%	*	*	19	0.2%
Heart valve replacement	8	0.2%	*	*	*	*	8	2.3%	22	0.2%
Kidney transplant	6	0.1%	8	0.3%	*	*	*	*	21	0.2%
Liver transplant	7	0.1%	6	0.2%	*	*	*	*	17	0.2%
Peripheral revascularization	*	*	6	0.2%	*	*	*	*	15	0.2%

* Counts less than six have been suppressed to protect patient confidentiality

History of hypertension was common among the older male participants with hemophilia A and B. Among male Registry participants 65 years of age and older, 50% of hemophilia A and 56% of hemophilia B participants had hypertension. Among male Registry participants ages 45–64 years, 38% of hemophilia A and 39% of hemophilia B participants had a history of hypertension, compared to approximately 9% and 10% for male participants with hemophilia A and B who were 20- 44 years old. History of bone fracture was also most common among hemophilia A and B participants who were ages 45 years and older. Anxiety and depression were more common among the male participants with hemophilia A and B who were ages 20 or older compared to those younger than 20, with the highest rates of both depression and anxiety seen among patients ages 45-64 years. Among male Registry participants with hemophilia A, iron deficiency anemia was most common among those ages 45 and older. There was less variation by age in iron deficiency anemia among hemophilia B participants. (Figures 31 and 32).

Figure 31: History of select diseases or conditions among male Registry participants with hemophilia A, by age

Figure 31: History of select diseases or conditions among male Registry participants with hemophilia A, by age
	Less than 20		20–44 years		45–64 years		65+ years
Fracture of a bone	299	7.9%	432	18.4%	218	24.8%	76	30.3%
Anxiety	146	3.8%	321	13.6%	172	19.6%	30	12.0%
Depression	102	2.7%	361	15.3%	205	23.3%	37	14.7%
Hypertension	18	0.5%	210	8.9%	333	37.9%	126	50.2%
Iron Deficiency Anemia	214	5.6%	94	4.0%	101	11.5%	34	13.5%

Figure 32: History of select diseases or conditions among male Registry participants with hemophilia B, by age

Figure 32: History of select diseases or conditions among male Registry participants with hemophilia B, by age
	Less than 20		20–44 years		45–64 years		65+ years
Fracture of a bone	85	9.3%	102	18.0%	82	26.0%	23	23.5%
Anxiety	35	3.8%	91	16.0%	58	18.4%	13	13.3%
Depression	18	2.0%	89	15.7%	62	19.7%	10	10.2%
Hypertension	8	0.9%	54	9.5%	124	39.4%	55	56.1%
Iron Deficiency Anemia	38	4.1%	39	6.9%	26	8.3%	8	8.2%