Woman with hemophilia worried about colonoscopy

DEAR DR. ROACH: I am 68, and in fairly good health other than severe hemophilia A. When I experience a bleed, a painful and expensive hospital stay is usually required to receive treatment. With the flu and COVID-19 vaccines I've gotten, the bleeds were awful, but worth the risk. I am hesitant to get a colonoscopy now.

I'd like to know your thoughts on colonoscopy, as I'm really scared about a puncture, and they can't safely remove something. I have zero clotting factor with inhibitors. A scratch will bleed for seven days with my meds. I carry bandages and gauze in my purse. I love my doctors, but they don't understand my fears. Am I right to hesitate? C.G.

ANSWER: Hemophilia A is a bleeding disorder caused by the lack of blood clotting factor VIII. It is most often an inherited condition, almost exclusively found in males, as it is sex-linked, but can be found in both men and women. People with blood clotting factor deficiencies are at risk for persistent bleeding, especially in deep areas of the body, such as joints. Bleeding into the brain is unusual, but can be catastrophic. It can occur with or without trauma. Treatment is with concentrated clotting factors, which may also be given to prevent bleeding in people with hemophilia who are undergoing surgery or procedures like colonoscopy.

Hemophilia A is characterized as mild, moderate and severe based on the amount of factor VIII present. If less than 1% is present, the disease is severe, which sounds like what you have. People with 1% to 5% are moderate; those between 5% and 40% are mild. The definition of hemophilia requires a factor level below 40% (except in some cases of gene mutation).

People with severe hemophilia A are at risk for prolonged bleeding after a colonoscopy, so factor VIII is usually given before and sometimes during the colonoscopy. This allows a biopsy to be done or a polyp to be removed with a good safety record, although sometimes clotting factors still need to be given after the procedure.

Your gastroenterologist should absolutely consult with your hematologist before the procedure to discuss the preventive plan, and a treatment plan for continued bleeding if necessary.

DEAR DR. ROACH: I recently read some concerns about the safety of probiotics. I have been taking probiotics for years for irritable bowel symptoms and have no ill effects of which I am aware. — B.M.

ANSWER: Probiotics are bacteria that are normal components of a healthy person's colonic flora — the vast collection of microorganisms that help us digest food. Their effectiveness in irritable bowel syndrome has not been proven conclusively, but many people get relief from symptoms with diarrhea-predominant irritable bowel syndrome.

Because they are part of the normal colonic bacteria, they are generally safe. However, there have been reports of infection transmitted by probiotics in people with immune system disease. There is a theoretical risk of transmission of antibiotic resistance genes by using probiotics. Allergies to probiotics are often due to components in the preparation rather than the bacteria themselves.

I do not recommend probiotics for people with no symptoms, but they can be a useful treatment for intestinal symptoms in certain circumstances, such as irritable bowel syndrome and some people with inflammatory bowel disease, when recommended by a physician.