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Factors that influence the bleeding phenotype in severe hemophilic patients

Rendo, Pabloa; Shafer, Franka; Korth-Bradley, Joan M.a; Sivamurthy, Krupaa; Korin, Jorgeb

Blood Coagulation & Fibrinolysis: October 2013 - Volume 24 - Issue 7 - p 683–690
doi: 10.1097/MBC.0b013e3283614210

Hemophilia A and B are rare, X-linked bleeding disorders resulting from a partial or total deficiency of functionally active coagulation factor VIII or factor IX, respectively. Endogenous factor levels have traditionally been used to characterize the severity of the disorder, with severe hemophilia considered as circulating levels of factor less than 1% of normal. Identifying patients with severe hemophilia is essential to effective treatment, since these patients are at highest risk of spontaneous life or limb-threatening bleeding and disability resulting from repeated joint bleeding and are most likely to benefit from prophylaxis. However, there is variability in bleeding tendency, even among patients with severe hemophilia. This article will review potential modifiers of hemophilia-associated bleeding other than endogenous factor activity, which may influence bleeding tendencies and complications in hemophilic patients considered to have severe hemophilia. These potential modifiers include physiologic factors, such as elements of the hemostatic system; pathophysiologic factors, such as hemophilic arthropathy, associated inflammation, and angiogenesis; and others, such as seasonal variation, body weight, and physical activity.

aPfizer Inc, Collegeville, Pennsylvania, USA

bConsultorios Hematológicos, Buenos Aires, Argentina

Correspondence to Pablo Rendo, MD, Senior Medical Director, Pfizer Inc, 500 Arcola Road, Collegeville, PA 19426, USATel: +1 484 865 4120; fax: +1 484 323 7561; e-mail:

Received 21 November, 2012

Revised 6 March, 2013

Accepted 9 March, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins