Evaluation of socio demographic factors and comorbidities in the patiens with hemophilia at ege adults hemophilia unit

Introduction: Hemophilia A and B which occur in the deficiency of orderly Factor 8 and 9 are X linked heritable coagulation disorders. The availability of replacement factor products and new treatment strategies over the past seven decades have led to increased life expectancy of the patients with hemophilia. Therefore, the age related morbidities are increased in this population. Both of the comorbities ,that are the reason of hemophilia and age related, affect the quality of life of hemophilia patients. It is known that decreasing the quality of life impress the sociodemografic factors such as education, work and home habitation. Herein, we described the prevelans of comorbidities in patients with hemophilia and seeked the association between socio-demographic factors and hemophilia status. Materials and Methods: 111 Hemophilia A and 24 Hemophilia B patients who were visited Ege adults Hemophlia unit from August 2016 through December 2016, were included in our study. The patients were filled a quastionare form about their socio-demographic factors (education, job, inhabitation, marriage, kids and kids' gender, payment, transportation way for the hospital). Retrospectively, we analized the severity of hemophilia according to the factor levels, inhibitör levels, comorbidities, treatment methods, hemophilic arthropathy and viral status. Joint bleeding, annual joint bleeding rate, epistaxis, gastrointestinal bleeding, muscle bleeding and gum bleeding were searched from the patients record in a year from September 2015 to September 2016. Results: Mean age was 39,6±1,13 years for 135 hemophilia patients who were included for this study group. %60 of all the patients had severe hemophilia disease and patients with severe hemophilia were significantly higher among Hemophilia A (p=0,000). %25 of patients were treated with on-demand therapy and rest of them were treated with prophylaxis therapy. Inhibitor possitivity was found %9,6 among the patients. The patients with hemophilic arthropathy at least one joint were XI %84,4. Unemployment rate was found %33,3 and %5,6 of patients were student. Nearly half of the patients (%53,3) were living in city center and most of the patiens (%60) were graduated from high school. HCV infection rate was found %9,6 and only one patient with HCV had hepatocellular carcinoma. The prevalence of cardiovascular disease was %6,7; hypertension was %17,8; diabetes mellitus was %13,3. Overweight (Body mass index (BMI) ≥ 25 kg/m2) and obesity (BMI ≥30 kg/m2) patients were %54,1 of all the patients. There is no association between obesity with joint bleeding, annual bleeding rate and hemophilic arthropathy. Discussion: Patients with hemophilia usually had some problems in their education and job life because of the bleeding attacks and disability of arthropathy. In our study, the rate of graduation from high school and university is the same as with normal population with the same age. We could not find any relationship between education and bleeding rates and treatment methods. Unemployment rate is relatively higher in our group according to other study. It may be related with economic status of our country. We found a association with joint bleeding rate and patients' working status. Joint bleeding rate is significantly higher in the patients who are working (P=0,005). Patients who are working usually do more physical exercise and that is why the bleeding rate is more higher among them. The prevalence of hypertension, cardiovasculary disease and diabetes mellitus in our study patients is similar to normal population of the same age in our country. There is no effect of these comorbidities on bleeding rates, athropathy and severity of hemophilia. It is a challenge for the hematologists to treat older hemophilia patients and manage their developing age related disease because of relatively little experience. Keywords: Hemophilia, comorbitdity, sociodemographic, adult