Procedures and Comorbid Conditions

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

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

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%