Blood Disorders Hemophilia Symptoms, Risk Factors, Types, and Treatment By Amber Yates, MD twitter linkedin Amber Yates, MD, is a board-certified pediatric hematologist and a practicing physician at Baylor College of Medicine. Learn about our editorial process Amber Yates, MD Medically reviewed by Medically reviewed by Douglas A. Nelson, MD on August 24, 2020 linkedin Douglas A. Nelson, MD, is a board-certified oncologist and hematologist who previously served for 13 years as a physician in the US Air Force. Learn about our Medical Review Board Douglas A. Nelson, MD on August 24, 2020 Print Hemophilia is an inherited bleeding disorder. A person with hemophilia is missing a blood factor needed to clot the blood which results in excessive bleeding. JPM/Image Source / Getty Images Symptoms People with hemophilia are sometimes referred to as “free bleeders,” meaning they bleed easily. Depending on the severity, bleeding may occur spontaneously (without injury) or after surgery or trauma. Symptoms include: Prolonged nosebleedsBleeding from gumsLarge bruisesProlonged bleeding after surgery or shots, including circumcisionSwelling of the large joints (shoulders, elbows, knees, ankles) from bleeding into the jointPain from bleeding into joint or muscle Who Is at Risk? Men born into families with a history of hemophilia in other relatives are at risk. To understand the inheritance of hemophilia, we need to talk a little about genetics. Males have an X chromosome from their mother and a Y chromosome from their father. Females inherit an X chromosome from both their father and mother. The defect for hemophilia is found on the X chromosome, meaning mothers (who are carriers for the disorder) pass this genetic defect to their sons; this is called X-linked inheritance. Because they have two X chromosomes, daughters are generally not affected (but can be in rare circumstances). Diagnosis Hemophilia is suspected when a boy or man has bleeding that seems excessive. It is diagnosed by measuring the coagulation factors (proteins needed to clot the blood and stop bleeding). Your physician will likely start with laboratory tests to assess the entire coagulation system. These are called the prothrombin time (PT) and partial thromboplastin time (PTT). In hemophilia, the PTT is prolonged. If the PTT is prolonged (above normal range), a deficiency of a coagulation factor may be the reason. Then your physician will order a test of coagulation factors 8, 9, and 11. Unless there is a clear family history, usually all three factors are tested at the same time. These tests give your physician the percent of the activity of each factor, which is low in hemophilia. Diagnosis can be confirmed by genetic testing. Types Hemophilia can be classified by the particular coagulation factor missing. Hemophilia A results from a deficiency in factor 8.Hemophilia B (also called Christmas disease) results from a deficiency in factor 9.Hemophilia C (also called Rosenthal syndrome) results from a deficiency in factor 11. Hemophilia can also be classified by the amount of coagulation factor found. The less coagulation factor you have, the more likely you are to bleed. Mild: 6–40%Moderate: 1-5%Severe: < 1% Treatment Hemophilia is treated with factor concentrates. These factor concentrates are infused via a vein (IV). Hemophilia can be treated in two different methods: on demand only (when bleeding episodes occur) or prophylaxis (receiving factor once, twice, or three times per week to prevent bleeding episodes). How you are treated is determined by multiple factors, including the severity of your hemophilia. In general, people with mild hemophilia are more likely to be treated on demand as they have significantly less bleeding. Fortunately, the majority of hemophilia treatments are administered at home. Parents can learn how to administer the factor to their children through a vein at home or a home health nurse can administer the factor. Children with hemophilia can also learn how to administer factor concentrates to themselves, often before becoming teenagers. Although factor concentrates are the preferred treatment, this treatment is not available in all countries. Hemophilia can also be treated with blood products. Factor 8 deficiency can be treated with cryoprecipitate (a concentrated form of plasma). Fresh frozen plasma can be used to treat factor 8 and factor 9 deficiency. In mildly affected patients, a medication called desmopressin acetate (DDAVP) can be administered via a vein or nasal spray. It stimulates the body to release stores of factor 8 to assist in cessation of bleeding. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit