Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Hemophilia A

hemophilia a in italiano (Italia)

Related Terms

  • Classic Hemophilia
  • Congenital Factor VIII Disorder
  • Factor VIII Deficiency
  • Factor VIII Deficiency Hemophilia

Differential Diagnosis

  • Hemophilia B
  • Hemophilia C
  • Liver disease
  • Platelet function disorders
  • von Willebrand's disease

Specialists

  • Hematologist
  • Medical Geneticist
  • Neurologist
  • Neurosurgeon
  • Orthopedic (Orthopaedic) Surgeon

Comorbid Conditions

  • Gastrointestinal disorders
  • Hepatic disease
  • Immune system disorders

Factors Influencing Duration

Factors influencing duration include the severity of the disorder, associated complications, degree of joint involvement, location of external bleeding, complications of the disease, ability to maintain adequate levels of factor VIII, and development of antibodies to replacement factor VIII.

Medical Codes

ICD-9-CM:
286.0 - Hemophilia A

Overview

Hemophilia A is the most common severe bleeding disorder, in which the blood does not clot normally. Blood clotting depends on the presence of specific substances in the blood called clotting factors. Individuals with hemophilia A do not have factor VIII, one of these important clotting factors. Without an adequate amount of factor VIII, spontaneous bleeding can occur and the blood cannot clot normally following an injury. The most common sites for spontaneous bleeding are into the joints (knees, ankles, and elbows), muscles, and from the mucous membranes.

The severity of hemophilia A varies according to how much factor VIII activity the individual retains. Up to 70% of individuals with hemophilia A retain less than 1% of normal factor VIII activity, and consequently have severe hemophilia (Kilcoyne). The remaining individuals either have factor VIII levels between 1% and 5% of normal (a moderate condition), or greater than 5% to 10% (a mild condition) (Janz 1695). Individuals with severe hemophilia are typically diagnosed following an episode of active bleeding during childhood. Individuals with mild or moderate hemophilia, however, may not be diagnosed until adulthood when bleeding occurs in association with an injury, dental work, or surgery.

Hemophilia A is an inherited disorder. Because the gene for this disease is on the X chromosome, it is a sex-linked disease. The recessive gene is carried by women who show no symptoms, and is passed to their daughters and sons. When a daughter inherits the gene, she also becomes a carrier and is asymptomatic but when a son inherits the gene, he is affected by hemophilia A. Up to 30% of cases, however, occur from a new gene mutation not present in the mother (Janz 1694).

Individuals with hemophilia A will typically bleed in the weight bearing joints (hemarthrosis), muscles, genitourinary tract, gastrointestinal tract, and central nervous system. Hemophilia A can result in joint deterioration from repeated bleeding episodes, increased susceptibility to blood-borne viral infections (HIV, hepatitis), and death from intracranial hemorrhage.

Incidence and Prevalence: The prevalence is approximately 20.6 cases per 100,000 individuals, and an estimated 90% of hemophiliacs are reported to be HIV-positive (Agaliotis).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The disease affects only males and occurs with equal frequency in all races. Hemophilia affects males prior to age 2 and progresses as they approach the teen years (Kilcoyne).

Source: Medical Disability Advisor



Diagnosis

History: The symptoms associated with hemophilia A are determined by the amount of factor VIII. Individuals with severe anemia have frequent spontaneous bleeding into joints and other tissues such as the brain, GI tract, muscles, leaving those joints and tissues stiff and painful. In addition, these anemic individuals typically experience severe bleeding after trauma, injury, or surgery. Among individuals with mild or moderate hemophilia, spontaneous bleeding is uncommon, although bleeding can still occur after trauma, injury, or surgery.

Physical exam: Evidence of active bleeding may be present such as blood in the urine or large areas of bruising (hematomas). Joints may be swollen and stiff, hot, and tender, and there may be a rash on the skin covering the joint. Mobility of the joint may be reduced.

Tests: A panel of coagulation studies is done to identify the presence of coagulation abnormalities. The diagnosis of hemophilia A may be confirmed based on assays of factor VIII and factor IX (the factor associated with hemophilia B). In hemophilia A, a factor VIII assay is reduced. Von Willebrand disease can also be ruled out by testing for von Willebrand factor antigen. X-rays and MRI studies can help visualize hemarthrosis (bleeding into the joint).

Source: Medical Disability Advisor



Treatment

Treatment is directed at stopping and preventing the bleeding. Both are accomplished by the infusion of factor VIII replacement. The two types of available replacement products are factor VIII concentrate made from purified pooled human plasma, and a newer product called recombinant DNA-derived factor VIII. The recombinant DNA product has an advantage: Since it is not made from human plasma, it cannot transmit blood-borne viruses such as HIV or hepatitis B and C. Individuals who are HIV-positive may benefit from products that have been additionally purified.

To stop or prevent imminent bleeding, factor VIII replacement is given in sufficient quantity to bring up levels to 30% of normal for minor bleeding, to 50% for severe bleeding, or up to 80% to 90% for life-threatening bleeding, major surgery, or trauma (Agaliotis).

Primary preventive (prophylaxis) treatment prevents spontaneous bleeding. This treatment involves the administration of factor VIII replacement. Prophylaxis treatment may not be necessary for an individual with mild hemophilia.

Another major goal of primary prophylaxis treatment is to prevent joint deformity caused by repeated bleeding into joints (hemarthrosis). Pain associated with hemarthrosis is treated with narcotic analgesics, temporary immobilization, and restraint from weight bearing.

The progression of joint damage may be delayed but not completely stopped by removing all or part of a joint's synovial membrane (synovectomy). This may be done during open surgery or by arthroscopy. The inflamed tissue is removed, thereby reducing bleeding and pain. An alternative procedure called synoviorthosis is a nonsurgical synovectomy that uses an injection of a radioisotope.

If the joint pain is unrelenting or if the joint destruction is severe, a prosthetic replacement may be necessary. Chronic pain in the ankle may require surgical joint fusion (arthrodesis).

Additional agents are available to help stop bleeding. Antifibrinolytic agents may be used to stop bleeding from mucous membranes and fibrin glue can stop bleeding at the site of the injury. A specific antidiuretic hormone may be used intravenously or by nasal spray to temporarily raise factor VIII levels in the blood.

Individuals must be advised to never take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) as either would interfere with platelet function and thereby increase the risk of bleeding. All individuals with hemophilia should be vaccinated against hepatitis A and B.

Source: Medical Disability Advisor



Prognosis

Life expectancy is related to the severity of the hemophilia. The mortality rate is 4 to 6 times greater in individuals with a severe condition than those with a mild condition (Agaliotis).

If factor VIII levels are maintained at greater than 2% of normal, overall health is improved (Janz 1695).

.

Source: Medical Disability Advisor



Rehabilitation

Individuals with arthritis associated with hemophilia A may require physical and occupational therapy. Individuals learn to perform these exercises independently to help reduce impairment due to arthritis. For individuals with severe joint deformities, physical therapists can order assistive devices for walking to decrease stress through the legs. Occupational therapists may also teach energy conservation techniques where activities of daily living such as meal preparation are broken into smaller components to make tasks more manageable.

Source: Medical Disability Advisor



Complications

Individuals may develop severe, life-threatening bleeding episodes. Bleeding may occur anywhere, particularly inside the skull (intracranial hemorrhage), central nervous system, genitourinary tract, and abdominal cavity. Bleeding of the tongue or back of the throat can cause life-threatening blockage of the airway.

Bleeding into joints causes joint disease (arthropathy). Repeated bleeding into a joint leads to permanent damage and deformity. Bleeding can also occur into muscles. Continued bleeding into muscles can cause cysts to develop within the muscle tissue or on the covering of bone. These cysts are also called pseudotumors, which are painful and must be surgically excised.

Individuals may develop antibodies against the replaced clotting factor VIII. Estimates of individuals with antibody formation are close to 15% (Kilcoyne).

Individuals may also develop HIV, hepatitis A, and parvovirus.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals with hemophilia A need a safe work environment where they can avoid the risk of personal injury that could trigger an acute bleed. Where indicated, protective gear, especially to the head, should be worn. Office work or sedentary work would probably be more appropriate than strenuous work involving heavy lifting or other physical exertion. The employer should be aware of the condition so that the appropriate level of care can be obtained quickly in the event of an on-the-job injury. Joint pain and lack of mobility may require specific accommodations. Time off will be needed if joint surgery (arthrodesis, synovectomy, or prosthetic joint replacement) or treatment of a severe bleeding episode is required.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was diagnosis of hemophilia A made by testing the coagulation ability of factor VIII? Is the deficiency of factor VIII mild, moderate, or severe?
  • Does individual complain of stiff and painful joints?
  • Has individual recently experienced trauma or injury, undergone surgery, or had dental work done?
  • Does individual participate in contact sports or other activities with an increased risk of injury? Does individual understand the risk?
  • Has individual noted blood in the urine, bruising of the skin, or a rash?

Regarding treatment:

  • Did individual experience a bleeding episode? Have episodes of bleeding been successfully managed?
  • Is prophylactic treatment successful in maintaining factor VIII levels?
  • If individual has a permanent, indwelling catheter, is it functioning properly?
  • Are joints frequently stiff and painful due to bleeding inside the joint?
  • Is pain successfully managed? If not, have all treatments for pain such as, narcotic analgesics, temporary immobilization, restrained from weight bearing, acupuncture, transdermal nerve stimulation, or hypnosis, been tried?
  • Has an orthopedic surgeon been consulted regarding surgical procedures to help slow the progression of joint disease or repair damaged areas?
  • Are additional agents required to help stop bleeding?
  • Did individual take aspirin or nonsteroidal anti-inflammatory drugs?

Regarding prognosis:

  • Has individual undergone surgical procedures, such as, synovectomy, synoviorthosis, or arthrodesis?
  • What is the severity of the disease? Does individual have HIV infection?
  • Has individual experienced one or more life-threatening bleeding episodes?
  • Has individual formed antibodies against factor VIII?
  • Does individual have any infections, including hepatitis A, B, C, HIV, or parvovirus?
  • Has individual been vaccinated against hepatitis A and B?
  • Does individual have adequate family, social, and economic support to meet the challenges of the disease?

Source: Medical Disability Advisor



References

Cited

"What is Hemophilia?" Canadian Hemophilia Society. 20 May 2005 <http://www.hemophiliabc.ca/hemophilia.html>.

Agaliotis, Dimitrios P. "Hemophilia, Overview." eMedicine. Eds. Karen Seiter, et al. 23 Jun. 2004. Medscape. 10 Jan. 2005 <http://emedicine.com/med/topic3528.htm>.

Janz, Timothy G., and Glenn C. Hamilton. "Disorders of Hemostasis." Rosen’s Emergency Medicine: Concepts and Clinical Practice. Eds. J. A. Marx, et al. 5th ed. St. Louis: Mosby, Inc., 2002. 1694-1698.

Kilcoyne, Ray F. "Hemophilia, Musculoskeletal Complications." eMedicine. Eds. Amilcare Gentili, et al. 23 Jun. 2004. Medscape. 10 Jan. 2005 <http://emedicine.com/radio/topic909.htm>.

Source: Medical Disability Advisor






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