The management of hemophilia in elderly patients

Massimo Franchini1, Annarita Tagliaferri2, Pier Mannuccio Mannucci31Transfusion and Hemophilia Center, City Hospital of Verona, Italy; 2Regional Reference Center for Inherited Bleeding Disorders, University Hospital of Parma, Italy; 3Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Department of Medicine and Medical Specialties, IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, University of Milan, ItalyAbstract: After the increasing rate of deaths observed during the 1980s due to human immunodeficiency virus (HIV) infection, the health-related quality of life and life expectancy of persons with hemophilia have improved, mainly due to the progresses of replacement therapy and antiviral drugs and to the improvement of the global comprehensive care provided by specialized centers. As a consequence, an increasing number of hemophiliacs have reached an older age and nowadays physicians in hemophilia centers find that they must handle age-related clinical problems never previously observed in this population. The management of elderly persons with congenital hemophilia is discussed in the first part of this review. The second part describes the general aspects of acquired hemophilia due to anti-factor VIII autoantibodies, focusing on the clinical management of elderly patients, one of the groups most frequently affected by this acquired bleeding disorder.Keywords: hemophilia, factor VIII, elderly, aging, inhibitors, bleedin