Accommodation and Compliance Series:
Employees with Bleeding Disorders
JAN’s Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.
The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee’s individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.
For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar.
What are bleeding disorders?
Bleeding disorders are a group of conditions that result in poor blood clotting and extended bleeding time. People with bleeding disorders do not bleed more quickly than other people, just for a longer period of time.
How prevalent are bleeding disorders?
Some bleeding disorders are present at birth and are caused by rare inherited disorders. Others develop during certain illnesses such as vitamin K deficiency and severe liver disease, or during treatments such as with the use of anticoagulant drugs or prolonged use of antibiotics (National Hemophilia Foundation, 2006a). Von Willebrand disease and hemophilia are the most common hereditary bleeding disorders. Von Willebrand disease affects at least 1% of the population (National Hemophilia Foundation, 2006c). About 1 out of every 10,000 people is born with hemophilia A, and around 1 out of 50,000 people is born with hemophilia B (World Federation of Hemophilia, 2011). It is estimated that 20,000 Americans have hemophilia (CDC, 2011a)
What are symptoms or complications of bleeding disorders?
Generally, bleeding disorders make it difficult to stop bleeding when an injury occurs. With von Willebrand disease, excessive bleeding may occur after an invasive procedure or dental work (MedlinePlus, 2010). With hemophilia, internal bleeding into the joints is more common, especially into the knees, elbows, and ankles. This can cause stiffness and decreased range of motion and strength in the extremities and may ultimately cause chronic joint deformities (World Federation of Hemophilia, 2011).
How are bleeding disorders treated?
There are many plasma proteins called factors that are involved in the blood coagulation process, and if one or more are missing or deficient the blood clotting process is affected. Treatment may consist of replacing the missing factors by an injection or nasal spray of desmopressin acetate (DDAVP). Other individuals may need infusions of blood clotting factors before a scheduled surgery (National Hemophilia Foundation, 2006). In the past, cryoprecipitate was used to control serious bleeding and is still used in most developing countries. However, it is no longer used as the current standard of treatment in the US because there is no method to remove blood-borne viruses, such as HIV and hepatitis. (CDC, 2011b).
Is a bleeding disorder a disability under the ADA?
The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC Regulations . . ., 2011). Therefore, some people with bleeding disorders will have a disability under the ADA and some will not.
A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment (EEOC Regulations . . . , 2011). For more information about how to determine whether a person has a disability under the ADA, visit http://AskJAN.org/corner/vol05iss04.htm.
Note: People with bleeding disorders may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with bleeding disorders will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee with a bleeding disorder experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Has the employee with a bleeding disorder been consulted regarding possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee with a bleeding disorder to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training regarding bleeding disorders?
- Gross Motor Impairment:
- Modify the work-site to make it accessible
- Provide parking close to the work-site
- Install automatic door openers
- Provide an accessible restroom and break room
- Provide an accessible route of travel to other work areas used by the employee
- Adjust desk height if wheelchair or scooter is used
- Move workstation close to other work areas, break rooms and restrooms
- Fine Motor Impairment:
- Implement ergonomic workstation design
- Provide alternative computer input devices and telephone access
- Reduce or eliminate physical exertion and workplace stress
- Schedule periodic rest breaks away from the workstation
- Allow a flexible work schedule and flexible use of leave time
- Allow work from home
- Implement ergonomic workstation design
- Provide a scooter or other mobility aid if walking cannot be reduced
- Recurrent Need for Medical Intervention or Transfusions:
- Permit flexible scheduling
- Provide time off for medical appointments
- Allow periodic rest breaks
- Consider permitting work from home
- Allow additional unpaid leave if employee exhausts accrued time off
- Promote an Inclusive Workplace:
- Provide general disability awareness to coworkers while keeping the individual and his/her condition confidential
- Provide sensitivity training to coworkers and supervisors
- Offer peer counseling to the individual with the bleeding disorder, allow telephone calls to emotional supports, negotiate time for accommodations and time off for counseling or therapy
- Institute an “open-door policy” so employees with disabilities may approach their supervisors candidly
Plan of Action:
Employers who have an individual with a bleeding disorder on staff may want to become educated about bleeding disorders and have a plan set up in the event that a bleed occurs. Employers and coworkers may want to be able to recognize the signs and symptoms of a bleed. These can include an employee complaining of tingling, bubbling, or stiffness in a joint, visible swelling in a body part, bruising, nose bleeds, or bleeding of the gums (World Federation of Hemophilia, 2011).
Employees with bleeding disorders may want to have a letter at their place of work written in advance to take to the emergency room with them describing their disorder and treatment. They should also let their employers know if they have an emergency supply of factor that needs to go to the emergency room with them. Employees with bleeding disorders may wear a medical alert necklace or bracelet. If basic first aid is needed for small surface cuts, caregivers should maintain Universal Precautions at all times, including the use of latex gloves. Additional first aid treatment information should be obtained from qualified healthcare providers.
Situations and Solutions:
A mental health employee with hemophilia was restricted by her physician from repetitive bending and twisting at the waist. JAN suggested the employee use a reacher to pick up lighter objects to prevent bending.
A forklift driver had difficulty grasping the steering wheel. The forklift was fitted with a spinner ball to eliminate the need for grasping.
An office worker with a bleeding disorder was limited in the amount of time she could work at a keyboard. JAN suggested using speech recognition software to decrease keyboarding time and suggested implementing an ergonomic workstation.
An insurance clerk was experiencing pain in her back, neck, and hands from sitting for long periods of time doing computer work. She was accommodated with speech recognition software, an ergonomic chair, and an adjustable sit/stand workstation.
There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.
Centers for Disease Control & Prevention. (2011a). Data & statistics. Retrieved December 29, 2011, from http://www.cdc.gov/ncbddd/hemophilia/data.html
Centers for Disease Control & Prevention. (2011b). Treatment. Retrieved December 29, 2011, from http://www.cdc.gov/ncbddd/hemophilia/treatment.html
EEOC Regulations To Implement the Equal Employment Provisions of the Americans With Disabilities Act, as Amended, 29 C.F.R. § 1630 (2011).
MedlinePlus (2010). Medical encyclopedia: Von Willebrand's disease. Retrieved December 29, 2011, from http://www.nlm.nih.gov/medlineplus/ency/article/000544.htm
National Hemophilia Foundation. (2006a). What is a bleeding disorder? Retrieved December 29, 2011, from http://www.hemophilia.org/bleeding_disorders/what_is_bleeding_disorder.htm
National Hemophilia Foundation. (2006b). Hemophilia a (factor VIII deficiency). Retrieved December 29, 2011, from http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=179&contentid=45&rptname=bleeding
National Hemophilia Foundation. (2006c). Von Willebrand disease. Retrieved December 29, 2011, from http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=182&contentid=47&rptname=bleeding
World Federation of Hemophilia. (2011). Frequently asked questions about hemophilia. Retrieved December 29, 2011, from http://www.wfh.org