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Medical Author:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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In this Article

• What is hemophilia?
• What causes hemophilia?
• What are the signs and symptoms of hemophilia?
• How is hemophilia diagnosed?
• Is it possible to know if you are a carrier of hemophilia?
• What are treatments for hemophilia?
• What are complications of treatment?
• Inhibitors
• Infections
• Can hemophilia be prevented?
• What is the outlook (prognosis) for hemophilia?
• What are possible future treatments for hemophilia?
• Hemophilia At A Glance
• Find a local Doctor in your town
• Hemophilia Index

Hemophilia can vary in its severity, depending upon the particular type of mutation (genetic defect). The degree of symptoms depends upon the levels of the affected clotting factor. Severe disease is defined as <1% factor activity, 1% to 5% factor activity is moderate disease, and greater than 5% factor activity constitutes mild disease. The extent of bleeding is dependent upon the severity (the amount of factor activity) and is similar for hemophilia A and B.

With severe hemophilia (A or B), bleeding begins at an early age and may occur spontaneously. Those with mild hemophilia may only bleed excessively in response to injury or trauma. Female carriers of hemophilia have variable degrees of factor activity; some may have near normal levels and do not show any bleeding tendencies, while some may have less than the predicted 50% reduction and may bleed more often than non-carrier females.

In severe hemophilia, bleeding episodes usually begin within the first 2 years of life. Heavy bleeding after circumcision in males is sometimes the first sign of the condition. Symptoms may develop later in those with moderate or mild disease. The bleeding of hemophilia can occur anywhere in the body. Common sites for bleeding are the joints, muscles, and gastrointestinal tract. Specific sites and types of bleeding are discussed below.

• Hemarthrosis (bleeding into the joints) is characteristic of hemophilia. The knees and ankles are most often affected. The bleeding causes distension of the joint spaces, significant pain, and over time, can be disfiguring. Over time, joint destruction occurs, and joint replacement surgeries can be required.
  
  
• Bleeding into the muscles may occur with hematoma formation (compartment syndrome).
  
  
• Bleeding from the mouth or nosebleeds may occur. Bleeding after dental procedures is common, and oozing of blood from the gums may occur in young children when new teeth are erupting.
  
  
• Bleeding from the gastrointestinal tract can lead to blood in the stool.
  
  
• Bleeding from the urinary tract can lead to blood in the urine (hematuria).
  
  
• Intracranial hemorrhage (bleeding into the brain or skull) can lead to symptoms such as nausea, vomiting, and/or lethargy.
  
  
• Increased bleeding after surgery or trauma is characteristic of hemophilia.