Hemophilia pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]Fahd Yunus, M.D. [3]


Hemophilia is a genetic bleeding disorder resulting from the insufficient levels of clotting factors in the body. The clotting factors irregularity causes a lack of clumping of blood required to form a clot to plug a site of a wound. The genes involved in the pathogenesis of hemophilia include the F8 gene in hemophilia A, F9 gene in hemophilia B, and F11 gene in C. Hemophilia predominantly affects the male population but the sub-type hemophilia C, with an autosomal inheritance pattern, can affect the males as well as females.



The normal physiology of hemostasis can be summarized as follows:

1. Primary hemostasis

2. Secondary hemostasis

3. Fibrinolysis

Cell-Based Model of Coagulation

a. Initiation

b. Amplification

c. Propagation


  • Mild (factor level > 0.05–0.40 IU/mL)
  • Moderate (factor level = 0.01–0.05 IU/mL)
  • Severe (factor level < 0.01 IU/mL)

Hemophilia A

  1. Classic mutations in the F8 gene that cause structural changes in the FVIII molecule or even produce a truncated protein lacking essential functional domains.[18][19]
  2. Mutations in proteins that interact intracellularly in the correct folding and trafficking of the FVIII protein or mutations in extracellular plasma proteins such as von Willebrand factor (VWF).[20][21][22][23]
  3. The third category encompasses patients who have the clinical disease but have no mutations in the F8 gene or in any of the known interacting partners.[16]

Hemophilia B

Hemophilia C


Hemophilia A

Hemophilia B

Hemophilia C

Associated Conditions

  • Hemophilia can be associated with the following conditions:

Gross Pathology

On gross pathology, hemophilia is characterized by the following findings:

Microscopic Pathology

On microscopic histopathological analysis, hemophilia can be characterized by the following findings:


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