Screenings for adults with hemophilia
Hemophilia is a rare bleeding disorder in which the blood does not clot properly, because of low levels of a clotting factor, usually factor VIII (8) or factor IX (9). (MedlinePlus) Men with the altered gene have symptoms, and women who carry it can have symptoms too, though this is less common. (NHS) People with hemophilia now live longer, so age-related conditions such as heart disease, high blood pressure, diabetes, kidney disease and cancer have become part of their care. (WFH 2020) This page covers screening only, not clotting factor, other medicines or surgery.
The main guideline
The World Federation of Hemophilia (WFH) published the 3rd edition of its guidelines in August 2020. It recommends that aging people with hemophilia get the same access to health education and prevention for age-related conditions as the general population, and that the hemophilia team stays closely involved. (WFH 2020) It also recommends assessing musculoskeletal and overall health at least once a year. (WFH 2020) A 2025 review notes that heart risk screening is often missed at hemophilia clinic visits on the assumption that a primary care doctor is doing it, while many people with hemophilia do not see one. (ASH 2025 review) MedlinePlus says people with hemophilia A should have regular checkups with a hematologist. (MedlinePlus encyclopedia)
Checks the guidance lists for adults
| Check | When | Source |
|---|---|---|
| Overall and joint health review | At least once a year | (WFH 2020) |
| Blood pressure | Regularly, for all people with hemophilia | (WFH 2020) |
| Height and weight for BMI | Regularly | (WFH 2020) |
| Cholesterol (total, HDL and LDL) | In aging adults at risk of heart disease | (WFH 2020) |
| Heart disease risk factors | Same as the general population | (WFH 2020) |
| Diabetes | Same as the general population | (WFH 2020) |
| DXA bone density scan | Age 50, or earlier with risk factors (one review); WFH says may be advisable with several risk factors | (ASH 2025 review)(WFH 2020) |
| Cancer screening | Age-appropriate, as for others the same age | (WFH 2020) |
| Hepatitis C test | If you had a transfusion before 1996 and were never tested; once for all adults 18 to 79 in the US | (NHS)(USPSTF hepatitis C, 2020) |
| Liver cancer surveillance | Ongoing for people with cirrhosis, even after hepatitis C is cured | (Ageing review 2026) |
Blood pressure, cholesterol and diabetes
The WFH says studies show people with hemophilia have higher average blood pressure and are twice as likely to have high blood pressure as the general population, and that high blood pressure raises the risk of heart and kidney disease and bleeding in the brain. It recommends regular blood pressure measurements for all people with hemophilia, noting the higher rate is seen at every age. (WFH 2020) It says people with hemophilia should have the same screening for heart disease risk factors as the general population, and that cholesterol should be measured in aging adults at risk of heart disease. (WFH 2020) It also says diabetes appears more common in people with hemophilia and recommends the same diabetes screening as for everyone else, along with regular height and weight checks for BMI. (WFH 2020) See blood pressure readings: what they mean, cholesterol test by age and A1C and blood sugar test results.
Kidney health
The WFH says kidney disease is reported more often in people with hemophilia than in the general population, with risk factors that include older age, high blood pressure, past kidney bleeding or blood in the urine, and HIV. (WFH 2020) It does not set a separate kidney test schedule. See kidney disease screening.
Bone density
The WFH says bone density is lower in people with hemophilia, linked to joint damage, loss of joint movement and inactivity. It says it is not clear whether routine monitoring is needed, and that it may be advisable for people at high risk or with several risk factors. (WFH 2020) A 2025 review cites a meta-analysis showing more than 4 times the fracture risk of the general population, and suggests a DXA scan at age 50, or earlier for people with risk factors such as HIV, hepatitis C or low hormone levels. (ASH 2025 review) A 2026 review reports osteoporosis in more than 40% of people over 50 with moderate or severe hemophilia. (Ageing review 2026) See bone density test: how often and osteoporosis screening.
Cancer screening
The WFH recommends age-appropriate cancer screening for people with hemophilia. It says cancer risk rises with age as it does for everyone, and that apart from liver cancer linked to chronic hepatitis, cancer death rates are about the same as in the general population. It adds that tests to diagnose cancer need a plan to keep bleeding risk low, made with the hemophilia team. (WFH 2020) In a Dutch study of the national bowel screening program, stool tests were positive in 14.8% of people with bleeding disorders compared with 4.3% of the general population, mostly false positives, but advanced polyps or cancer were found in 4.5% of people with hemophilia compared with 1.8% of men in general. (Kempers 2023) The USPSTF recommends colorectal cancer screening for adults 45 to 75. (USPSTF colorectal, 2021) See cancer screenings by age, colorectal cancer screening and screening colonoscopy: what to expect.
Hepatitis, HIV and liver checks
A 2026 review says many older people with hemophilia got hepatitis C or HIV from blood-derived clotting factor used before it was treated to kill viruses, with hepatitis C infections mostly before the mid-1980s. It says that even after hepatitis C is cured, people who already have cirrhosis remain at risk of liver cancer and need continued long-term surveillance under established guidelines. (Ageing review 2026) The NHS says anyone who had a blood transfusion before 1996 and has not been tested for hepatitis C should ask their specialist about tests, and that clotting factor used today is very safe. (NHS) MedlinePlus says people with hemophilia are more likely to get hepatitis B because they may receive blood products. (MedlinePlus encyclopedia) See hepatitis C test results, liver cancer surveillance and screenings if you have HIV.
When to contact a provider
MedlinePlus, Hemophilia A, when to contact a medical professional: (MedlinePlus encyclopedia)
Contact your provider if:
- Symptoms of a bleeding disorder develops
- A family member has been diagnosed with hemophilia A
- You have hemophilia A and you plan to have children; genetic counseling is available
Where they differ:
- Bone density. The WFH says it is unclear whether routine bone checks are needed, (WFH 2020) a 2025 review suggests a DXA scan at 50 or earlier with risk factors, (ASH 2025 review) and the USPSTF finds the evidence insufficient to recommend for or against screening men. (USPSTF osteoporosis, 2025)
- Blood pressure. The WFH asks for regular checks in all people with hemophilia because high blood pressure is more common at every age, (WFH 2020) while the USPSTF recommends screening all adults 18 and older. (USPSTF blood pressure, 2021)
- Bowel screening. The WFH and USPSTF recommend the usual age-based screening, (WFH 2020)(USPSTF colorectal, 2021) while a Dutch study found stool tests give more false positives in people with bleeding disorders and that the test performs differently. (Kempers 2023)
- Hepatitis C testing. The NHS points to anyone who had a transfusion before 1996, (NHS) while the USPSTF recommends screening all adults 18 to 79. (USPSTF hepatitis C, 2020)
- Who does the checks. The WFH says the hemophilia team should stay closely involved in age-related care, (WFH 2020) and a 2025 review suggests screening for heart risk factors at the yearly hemophilia clinic visit, since many patients do not see a primary care doctor. (ASH 2025 review)
Your doctor decides what your result means for you.
Questions people ask
Do adults with hemophilia need the usual age-based screenings?
Yes. The WFH guideline says aging people with hemophilia should have the same access to preventive care as everyone else, the same diabetes screening as the general population, the same screening for heart disease risk factors, and age-appropriate cancer screening. (WFH 2020)
Is blood pressure checked more often with hemophilia?
The WFH recommends regular blood pressure checks for all people with hemophilia as part of standard care, because studies show people with hemophilia are about twice as likely to have high blood pressure. (WFH 2020)
Can people with hemophilia have colorectal cancer screening?
Yes. The WFH recommends age-appropriate cancer screening. A Dutch study found stool tests were positive more often in people with bleeding disorders, but the rate of cancer or advanced polyps found in people with hemophilia was higher than in the general male population. (WFH 2020) (Kempers 2023)
When should bone density be checked?
The WFH says it is not clear whether routine bone checks are needed and that they may be advisable with several risk factors. A 2025 ASH review suggests a DXA scan at age 50, or earlier with risk factors such as HIV or hepatitis C. (WFH 2020) (ASH 2025 review)
Should I be tested for hepatitis C?
The NHS says anyone who had a blood transfusion before 1996 and has not been tested for hepatitis C should talk to their specialist about tests. The USPSTF recommends hepatitis C screening for all adults 18 to 79. (NHS) (USPSTF hepatitis C, 2020)
Related
- Screenings for adults with congenital heart disease
- Screenings if you have sickle cell disease
- Screenings if you have HIV
- Screenings if you have high blood pressure
- Liver cancer surveillance
- Bone density test: how often
- Cancer screenings by age
- Screenings by age and gender
- Questions to ask your doctor