Hemophilia is not one disease but rather one of a group of inherited
bleeding disorders that cause abnormal or exaggerated bleeding and poor
blood clotting. The term is most commonly used to refer to two specific
conditions known as hemophilia A and hemophilia B, which will be the
main subjects of this article. Hemophilia A and B are distinguished by
the specific gene that is mutated (altered to become defective) and
codes for a defective clotting factor (protein) in each disease. Rarely,
hemophilia C (a deficiency of Factor XI) is encountered, but its effect
on clotting is far less pronounced than A or B.
Hemophilia A and B
are inherited in an X-linked recessive genetic pattern and are
therefore much more common in males. This pattern of inheritance means
that a given gene on the X chromosome expresses itself only when there
is no normal gene present. For example, a boy has only one X chromosome,
so a boy with hemophilia has the defective gene on his sole X
chromosome (and so is said to be hemizygous for hemophilia). Hemophilia
is the most common X-linked genetic disease.
Although
it is much rarer, a girl can have hemophilia, but she would have to
have the defective gene on both of her X chromosomes or have one
hemophilia gene plus a lost or defective copy of the second X chromosome
that should be carrying the normal genes. If a girl has one copy of the
defective gene on one of her X chromosomes and a normal second X
chromosome, she does not have hemophilia but is said to be heterozygous
for hemophilia (a carrier). Her male children have a 50% chance of
inheriting the one mutated X gene and thus has a 50% chance of
inheriting hemophilia from their carrier mother.
Hemophilia A
occurs in about 1 out of every 5000 live male births. Hemophilia A and B
occurs in all racial groups. Hemophilia A is about four times more
common than B. B occurs in about 1 out of 20- 30,000 live male births.
Hemophilia
has been called the Royal Disease because Queen Victoria, Queen of
England from 1837 to 1901, was a carrier. Her daughters passed the
mutated gene on to members of the royal families of Germany, Spain, and
Russia. Alexandra, Queen Victoria's granddaughter, who became Tsarina of
Russia in the early 20th century when she married Tsar Nicholas II, was
a carrier. Their son, the Tsarevich Alexei, suffered from hemophilia
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