Practical Solutions • Workplace Success 

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Accommodation and Compliance Series

Employees with 

Bleeding Disorders 
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Preface 

The Job Accommodation Network (JAN) is a service of the Office of Disability 

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contact JAN. 

Updated 03/22/10. 
JAN’S ACCOMMODATION AND COMPLIANCE SERIES

Introduction 

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. 

Information about Bleeding Disorders 

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 (MedlinePlus, 2006). 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, 2006). About 17,000 

Americans have hemophilia (National Hemophilia Foundation, 2006b). 

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 with minor cuts or during 

dental work (National Hemophilia Foundation, 2006c). 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 

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and may ultimately cause chronic joint deformities. Some individuals who have joint 

deformities may undergo joint replacement operations (World Federation of Hemophilia, 

2006). 

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. In emergency situations, 

cryoprecipitate may be used, and although screening techniques for viruses have 

greatly improved, this method still carries a risk of hepatitis and HIV infection (National 

Hemophilia Foundation, 2006). 
Bleeding Disorders and the Americans with Disabilities Act 

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. 

Therefore, some people with bleeding disorders will have a disability under the ADA and 

some will not (EEOC, 2005). 

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 such an impairment. For more information about how to determine whether a 

person has a disability under the ADA, visit http://askjan.org/corner/vol02iss04.htm. 

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Accommodating Employees with Bleeding Disorders 

(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: 

1. What limitations is the employee with a bleeding disorder experiencing? 

2. How do these limitations affect the employee and the employee’s job performance? 

3. What specific job tasks are problematic as a result of these limitations? 

4. What accommodations are available to reduce or eliminate these problems? Are all 

possible resources being used to determine possible accommodations? 

5. Has the employee with a bleeding disorder been consulted regarding possible 

accommodations? 

6. 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? 

7. Do supervisory personnel and employees need training regarding bleeding 

disorders? 

Accommodation Ideas: 

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 
Fatigue/Weakness: 

• 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 (National Hemophilia Foundation, 2006). 

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. 

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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. 

Products: 

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. 
Resources 

Job Accommodation Network 

West Virginia University 

PO Box 6080 

Morgantown, WV 26506-6080 

Toll Free: (800)526-7234 

TTY: (877)781-9403 

Fax: (304)293-5407 

jan@askjan.org 

http://askjan.org 

The Job Accommodation Network (JAN) is a free consulting service that provides 

information about job accommodations, the Americans with Disabilities Act (ADA), and 

the employability of people with disabilities. 

Office of Disability Employment Policy 

200 Constitution Avenue, NW, Room S-1303 

Washington, DC 20210 

Toll Free: (866)633-7635 

TTY: (877)889-5627 

Fax: (202)693-7888 

http://www.dol.gov/odep/ 

The Office of Disability Employment Policy (ODEP) is an agency within the U.S. 

Department of Labor. ODEP provides national leadership to increase employment 

opportunities for adults and youth with disabilities while striving to eliminate barriers to 

employment. 

ADVOY 

1 Baxter Way 

Westlake Village, CA 91362 

contactus.US@advoy.com 

http://www.advoy.com 

Advoy is a healthcare website for patients with chronic diseases such as hemophilia or 

primary immune deficiency, their caregivers, and their healthcare professionals to share 

therapy data and get access to other information about treatment resources and their 

disease. 

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HANDI 

Toll Free: (800)424-2634 

Fax: (212)328-3799 

handi@hemophilia.org 

http://www.hemophilia.org/resources/handi.htm 

HANDI is the information service of the National Hemophilia Foundation (NHF) and 

provides up-to-date resources on bleeding disorders. 

National Hemophilia Foundation 

116 W. 32nd Street, 11th Floor 

New York, NY 10001 

Toll Free: (800)424-2634 

Direct: (212)328-3700 

Fax: (212)328-3777 

handi@hemophilia.org 

http://www.hemophilia.org 

The National Hemophilia Foundation is dedicated to finding better treatments and cures 

for bleeding and clotting disorders and to preventing the complications of these 

disorders through education, advocacy, and research. 

Passport for Life 

Toll Free: (866)433-9284 

http://www.passportforlife.com 

Passport for Life is a hemophilia support program designed for caregivers, teenagers, 

and adults. It offers personalized strategies to overcome many of the hurdles that 

people with hemophilia face. 

Project Red Flag 

Direct: (212)328-3705 

adesimone@hemophilia.org 

http://www.projectredflag.org/ 

Project Red Flag is the National Hemophilia Foundation's (NHF) public awareness 

campaign to reach the more than two and a half million women nationwide with 

undiagnosed bleeding disorders. The campaign will educate women and their 

healthcare providers about the symptoms of bleeding disorders, especially von 

Willebrand disease (VWD), and encourage proper diagnosis and treatment. 
World Federation of Hemophilia 

1425 René Lévesque Blvd. W. 

Suite 1010 

Montreal, Quebec H3G 1T7 , PQ 

Direct: (514)875-7944 

Fax: (514)875-8916 

wfh@wfh.org 

http://www.wfh.org 

The World Federation of Hemophilia (WFH) is an international not-for-profit organization 

dedicated to improving the lives of people with hemophilia and related bleeding 

disorders. 

thereforyou.com 

formerly Hemophilia Galaxy 

One Baxter Parkway 

Deerfield, IL 60015 

Toll Free: (800)423-2090 

hemophiliagalaxy@baxter.com 

http://www.thereforyou.com/ 

Thereforyou.com, formerly known as Hemophilia Galaxy, provides information for 

patients and caregivers about hemophilia including how to manage treatment plans, 

plus provides hemophilia resources, news, and events. 

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References 

Equal Employment Opportunity Commission. (1992). A technical assistance manual of 

the employment provisions (title I) of the Americans with disabilities act. 

Retrieved September 4, 2008, from http://askjan.org/links/ADAtam1.html 

MedlinePlus (2006). Medical encyclopedia: Von Willebrand’s disease. Retrieved 

September 4, 2008, from 

http://www.nlm.nih.gov/medlineplus/ency/article/000544.htm 

National Hemophilia Foundation. (2006a). What is a bleeding disorder? Retrieved 

September 4, 2008, from 

http://www.hemophilia.org/bleeding_disorders/what_is_bleeding_disorder.htm 

National Hemophilia Foundation. (2006b). Hemophilia a (factor VIII deficiency). 

Retrieved September 4, 2008, from 

http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=179&cont

entid=45&rptname=bleeding 

National Hemophilia Foundation. (2006c). Von Willebrand disease. Retrieved 

September 4, 2008, from 

http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=182&cont

entid=47&rptname=bleeding 

World Federation of Hemophilia. (2006). Frequently asked questions about hemophilia. 

Retrieved September 4, 2008, from http://www.wfh.org/index.asp?lang=EN 
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This document was developed by the Job Accommodation Network, funded by a 

contract agreement from the U.S. Department of Labor, Office of Disability Employment 

Policy (DOL079RP20426). The opinions expressed herein do not necessarily reflect the 

position or policy of the U.S. Department of Labor. Nor does mention of trade names, 

commercial products, or organizations imply endorsement by the U.S. Department of 

Labor.