Hemophilia pathophysiology
Jump to navigation
Jump to search
| https://https://www.youtube.com/watch?v=nkC1vZaUpxs%7C350}} |
|
Hemophilia Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Hemophilia pathophysiology On the Web |
|
American Roentgen Ray Society Images of Hemophilia pathophysiology |
|
Risk calculators and risk factors for Hemophilia pathophysiology |
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]
Overview
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.
Pathophysiology
Physiology
The normal physiology of hemostasis can be summarized as follows:
- Hemostasis is a tightly regulated process whereby the body maintains a homeostatic balance to permit normal blood flow, without thrombosis or bleeding.[1]
- The process of hemostasis involves a fine balance between the procoagulant and anticoagulant factors. It attempts to maintain blood flow within the vascular compartment and promotes the formation of blood clots following vascular injury.[2]
- It also enables repair after vascular injury, promotes vessel healing, and maintains vessel integrity.
- Hemostasis can be divided into three phases
- Each phase is explained as follows:
1. Primary hemostasis
- Endothelial damage marks the beginning of this phase.[3]
- It involves platelet adhesion, activation and aggregation, to form a platelet plug at the injury site.
- Circulating platelets and endothelial cells, both provide the source of von Willebrand factor (VWF).
- Von Willebrand factor (VWF) has two main functions. First, it acts as a mediator in binding of platelets to the sub-endothelium. Then it protects the circulating factor VIII from proteolytic degradation.[4][5]
- The endothelial cells, which normally promote anticoagulation, switch from anticoagulant to procoagulant upon vascular injury. They promote platelet aggregation by releasing the contents of their Weibel-Palade bodies and hence leading to enhanced local concentrations of von Willebrand factor (VWF) and tissue factor (TF).[6]
- The released von Willebrand factor (VWF) binds to the collagen on the exposed sub-endothelial surface, and is then utilized for platelet binding via the glycoprotein Ib (GPIb) complex.
- The platelets release their granules after undergoing a shape change. This event marks the formation of a platelet plug.
2. Secondary hemostasis
- The main goal of secondary hemostasis is to stabilize the platelet plug.[7]
- It involves the activation of coagulation system and coagulation factors to eventually produce cross-linked fibrinogen (“fibrin”).
- The process of platelet plug stabilization has been always referred to as the “Coagulation cascade” which can be separated into the intrinsic, extrinsic, and common pathways.
3. Fibrinolysis
- Fibrinolysis involves the process of physiological lysis of the clot, generated by the actions of primary and secondary hemostasis, to permit tissue repair under the supervision and help of multiple proteins.[8]
Cell-Based Model of Coagulation
- The cell-based model of hemostasis basically says that blood has to be exposed to cells containing the tissue factor (TF) for the initiation of the clotting process.[9]
- It better reflects true in vivo hemostasis.
- The model proposes three overlapping phases of hemostasis which are explained as follows:
a. Initiation
- It occurs on the surface of the tissue factor-bearing cell.
- Tissue factor-bearing cells such as the fibroblasts bind to the surface of platelets in an evolving thrombus.[9]
- Factor VII comes into direct contact with the tissue factor-bearing extravascular cells during vascular injury, and rapidly undergoes activation via the extrinsic pathway.
- Effective initiation means bringing FVIIa/TF activity into close proximity to the activated platelet surfaces.
b. Amplification
- It occurs on the surface of the platelets as they get activated.[10]
- Platelets adhere at the site of endothelial injury and get activated by thrombin.
- Platelet activation is marked by the execution of the following processes:
- The release of alpha granules which contain Factor V and von Willebrand factor (VWF)
- Binding to plasma proteins including von Willebrand factor (VWF)
- Promoting the assemblage of procoagulant complexes
- Ensuring prompt thrombin generation.
c. Propagation
- Propagation occurs on the surface of activated platelets.[11]
- It involves the assembly of “tenase” (FVIIa and FIXa/FVIIIa) and “prothrombinase” (FXa/FVa) complexes on the platelet surface, thus allowing thrombin generation to take place on a large scale which is necessary to form a hemostatic fibrin clot.[12]
Pathogenesis
- Hemophilia is an X-linked bleeding disorder caused by a deficiency or complete absence of coagulation factor VIII (hemophilia A) or factor IX (hemophilia B).[13]
- Bleeding in hemophilia occurs due to the failure of secondary hemostasis.[14]
- Primary hemostasis and the formation of platelet plug occurs normally but stabilization of the plug by fibrin is defective because of the generation of inadequate amounts of thrombin.[14]
- Clinical expression of hemophilia usually correlates with the activity of the coagulation factor and the disease can be classified as:
- 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)
- Excessive bleeding in mild hemophilia patients occurs only after major injuries, surgery, or other invasive procedures.[13]
- In patients with moderate hemophilia, hemarthroses and muscle hematomas may occur after relatively minor injuries.[13]
- Bleeding occurs frequently and spontaneously in patients with severe hemophilia and this group can rarely also experience life-threatening episodes such as retroperitoneal and intracranial bleeds.[13][15]
- Peculiar pathology of the types of hemophilia is discussed below:
Hemophilia A
- Hemophilia A is caused by an absence or deficiency of factor VIII (FVIII) protein activity.[16]
- It is a lifetime disease that is transmitted from usually asymptomatic carrier females to their male offspring.[16]
- Hemophilia A is characterized by recurrent bleeding, in particular into joints.[14]
- The recurrent bleeding in joints leads almost inevitably to severe arthropathy.[17]
- The molecular causes of FVIII deficiency can be divided into 3 main categories:
- 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]
- 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]
- 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]
- Less than 1/3 of the patients (mostly elderly with comorbidities) of hemophilia develop autoantibodies (inhibitors) against factor VIII (FVIII) that can lead to spontaneous and severe bleeding.[24][25]
Hemophilia B
- Hemophilia B is an X-linked bleeding disorder caused by the deficiency of factor IX (FIX).[26]
- Factor IX is a vitamin K–dependent plasma protease that plays a role in the intrinsic pathway of hemostasis and whose function is to cleave and activate Factor X.[27]
- Bleeding tendency in hemophilia B is in good accordance with the severity of factor deficiency.[28]
- Patients with the severe form (Factor IX <1%), a significant proportion of 30 to 45% of all affected by hemophilia B, usually suffer from recurrent joint, soft-tissue, and muscle bleeds.[28]
Hemophilia C
- Hemophilia C is an autosomal genetic disorder involving a lack of functional clotting factor XI.[29]
- This condition is not completely recessive, as heterozygous individuals also show increased bleeding.[29]
- The bleeding diathesis in hemophilia C is considerably milder than in hemophilia A or B.[30][31]
- The spontaneous soft tissue bleeds and hemarthroses characteristic of hemophilia A and B are not features of hemophilia C.[32]
- Menorrhagia and epistaxis are the most common bleeding episodes encountered in hemophilia C.[33]
- Factor XI deficiency can especially be a problem when trauma involves the oral and nasal cavities or the urinary tract.[30][34]
- Symptoms in hemophilia C patients correlate poorly with factor XI activity measured by aPTT-based assays.[31][35][36][37]
Genetics
Hemophilia A
- Hemophilia A can be characterized by the detection of inversions of intron 22 (reported in 40–45% of severe patients) and intron 1 (reported in 1–6% of severe patients) of F8 gene (which encodes factor VIII).[38][39]
- The F8 gene is located on the X chromosome.[40]
- Point mutations (missense, nonsense, and splice site mutations) account for 67% of molecular defects described.
- Small insertions and deletions represent 25% of such defects.[41]
- Roughly 6% of all mutations are large deletions.[41]
Hemophilia B
- Missense, nonsense, and splice site mutations in the F9 gene (which is located on the X chromosome and encodes factor XI) are the most common, accounting for around 70% of mutations.[42][43][44]
- Frameshift mutations in the F9 gene account for approximately 17%.[42]
- Large deletions and promoter region mutations are relatively rare, accounting for 3% and 2% respectively.[42]
Hemophilia C
- Hemophilia C, characterized by a deficiency of factor XI, results from mutations (splice site, nonsense, or missense mutation) in the F11 gene.[45]
- Homozygous or compound heterozygous deficiency of factor XI results in a variable bleeding phenotype but the clinical presentation in heterozygotes is less predictable.[46]
Associated Conditions
- Hemophilia can be associated with the following conditions:
- End-stage liver disease[47][48]
- Autoimmune thyroiditis[49]
- Autoimmune pancreatitis[50]
- Hematologic malignancies[51]
- Hepatocellular carcinoma (HCC)[52]
- Pregnancy[53]
- Polymyositis[25]
- Autoimmune hemolytic anemia[25]
- Hepatitis A, B, and C[54][55][56][57]
- Osteoporosis[58][59]
- Rheumatoid arthritis[25]
- Myasthenia Gravis[60]
- Systemic lupus erythematosus (SLE)[25]
- Moyamoya syndrome[61]
Gross Pathology
On gross pathology, hemophilia is characterized by the following findings:
- Hemarthroses[13]
- Muscle hematomas[13]
- Subcutaneous bleeding[62]
- Gross hematuria[62]
- Extremity swelling[63]
- Epistaxis[33]
- Menorrhagia[33]
- Excessive uncontrollable bleeding after major/minor injuries[13][15]
Microscopic Pathology
On microscopic histopathological analysis, hemophilia can be characterized by the following findings:
- Reduced red blood cell (RBC) count[64]
References
- ↑ Lippi G, Favaloro EJ, Franchini M, Guidi GC (February 2009). "Milestones and perspectives in coagulation and hemostasis". Semin. Thromb. Hemost. 35 (1): 9–22. doi:10.1055/s-0029-1214144. PMID 19308889.
- ↑ Lippi G, Franchini M, Guidi GC (2007). "Diagnostic approach to inherited bleeding disorders". Clin. Chem. Lab. Med. 45 (1): 2–12. doi:10.1515/CCLM.2007.006. PMID 17243907.
- ↑ Favaloro, Emmanuel (2017). Hemostasis and thrombosis : methods and protocols. New York: Humana Press Springer. ISBN 9781493971961.
- ↑ Sadler JE, Budde U, Eikenboom JC, Favaloro EJ, Hill FG, Holmberg L, Ingerslev J, Lee CA, Lillicrap D, Mannucci PM, Mazurier C, Meyer D, Nichols WL, Nishino M, Peake IR, Rodeghiero F, Schneppenheim R, Ruggeri ZM, Srivastava A, Montgomery RR, Federici AB (October 2006). "Update on the pathophysiology and classification of von Willebrand disease: a report of the Subcommittee on von Willebrand Factor". J. Thromb. Haemost. 4 (10): 2103–14. doi:10.1111/j.1538-7836.2006.02146.x. PMID 16889557.
- ↑ Yee A, Kretz CA (February 2014). "Von Willebrand factor: form for function". Semin. Thromb. Hemost. 40 (1): 17–27. doi:10.1055/s-0033-1363155. PMID 24338608.
- ↑ Favaloro, Emmanuel (2017). Hemostasis and thrombosis : methods and protocols. New York: Humana Press Springer. ISBN 9781493971961.
- ↑ Favaloro, Emmanuel (2017). Hemostasis and thrombosis : methods and protocols. New York: Humana Press Springer. ISBN 9781493971961.
- ↑ Kwaan H, Lisman T, Medcalf RL (March 2017). "Fibrinolysis: Biochemistry, Clinical Aspects, and Therapeutic Potential". Semin. Thromb. Hemost. 43 (2): 113–114. doi:10.1055/s-0036-1598000. PMID 28253534.
- ↑ 9.0 9.1 Hoffman, Maureane (2003). "A cell-based model of coagulation and the role of factor VIIa". Blood Reviews. 17: S1–S5. doi:10.1016/S0268-960X(03)90000-2. ISSN 0268-960X.
- ↑ Favaloro, Emmanuel (2017). Hemostasis and thrombosis : methods and protocols. New York: Humana Press Springer. ISBN 9781493971961.
- ↑ Favaloro, Emmanuel (2017). Hemostasis and thrombosis : methods and protocols. New York: Humana Press Springer. ISBN 9781493971961.
- ↑ Bonar RA, Lippi G, Favaloro EJ (2017). "Overview of Hemostasis and Thrombosis and Contribution of Laboratory Testing to Diagnosis and Management of Hemostasis and Thrombosis Disorders". Methods Mol. Biol. 1646: 3–27. doi:10.1007/978-1-4939-7196-1_1. PMID 28804815.
- ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 Mannucci PM, Tuddenham EG (June 2001). "The hemophilias--from royal genes to gene therapy". N. Engl. J. Med. 344 (23): 1773–9. doi:10.1056/NEJM200106073442307. PMID 11396445.
- ↑ 14.0 14.1 14.2 Bolton-Maggs, Paula HB; Pasi, K John (2003). "Haemophilias A and B". The Lancet. 361 (9371): 1801–1809. doi:10.1016/S0140-6736(03)13405-8. ISSN 0140-6736.
- ↑ 15.0 15.1 Berntorp E, Shapiro AD (April 2012). "Modern haemophilia care". Lancet. 379 (9824): 1447–56. doi:10.1016/S0140-6736(11)61139-2. PMID 22456059.
- ↑ 16.0 16.1 16.2 Oldenburg, Johannes; El-Maarri, Osman (2006). "New Insight into the Molecular Basis of Hemophilia A". International Journal of Hematology. 83 (2): 96–102. doi:10.1532/IJH97.06012. ISSN 0925-5710.
- ↑ Roosendaal G, Lafeber FP (July 2006). "Pathogenesis of haemophilic arthropathy". Haemophilia. 12 Suppl 3: 117–21. doi:10.1111/j.1365-2516.2006.01268.x. PMID 16684006.
- ↑ Morris JA, Dorner AJ, Edwards CA, Hendershot LM, Kaufman RJ (February 1997). "Immunoglobulin binding protein (BiP) function is required to protect cells from endoplasmic reticulum stress but is not required for the secretion of selective proteins". J. Biol. Chem. 272 (7): 4327–34. PMID 9020152.
- ↑ Pipe SW, Morris JA, Shah J, Kaufman RJ (April 1998). "Differential interaction of coagulation factor VIII and factor V with protein chaperones calnexin and calreticulin". J. Biol. Chem. 273 (14): 8537–44. PMID 9525969.
- ↑ Nichols WC, Seligsohn U, Zivelin A, Terry VH, Hertel CE, Wheatley MA, Moussalli MJ, Hauri HP, Ciavarella N, Kaufman RJ, Ginsburg D (April 1998). "Mutations in the ER-Golgi intermediate compartment protein ERGIC-53 cause combined deficiency of coagulation factors V and VIII". Cell. 93 (1): 61–70. PMID 9546392.
- ↑ Zhang B, Cunningham MA, Nichols WC, Bernat JA, Seligsohn U, Pipe SW, McVey JH, Schulte-Overberg U, de Bosch NB, Ruiz-Saez A, White GC, Tuddenham EG, Kaufman RJ, Ginsburg D (June 2003). "Bleeding due to disruption of a cargo-specific ER-to-Golgi transport complex". Nat. Genet. 34 (2): 220–5. doi:10.1038/ng1153. PMID 12717434.
- ↑ Nishino M, Girma JP, Rothschild C, Fressinaud E, Meyer D (October 1989). "New variant of von Willebrand disease with defective binding to factor VIII". Blood. 74 (5): 1591–9. PMID 2506947.
- ↑ Gaucher C, Mercier B, Jorieux S, Oufkir D, Mazurier C (August 1991). "Identification of two point mutations in the von Willebrand factor gene of three families with the 'Normandy' variant of von Willebrand disease". Br. J. Haematol. 78 (4): 506–14. PMID 1832934.
- ↑ Kruse-Jarres R, Kempton CL, Baudo F, Collins PW, Knoebl P, Leissinger CA, Tiede A, Kessler CM (July 2017). "Acquired hemophilia A: Updated review of evidence and treatment guidance". Am. J. Hematol. 92 (7): 695–705. doi:10.1002/ajh.24777. PMID 28470674.
- ↑ 25.0 25.1 25.2 25.3 25.4 Yang F, Zhou YS, Jia Y (December 2018). "[Systemic lupus erythematosus with acquired hemophilia A: a case report]". Beijing Da Xue Xue Bao (in Chinese). 50 (6): 1108–1111. PMID 30562791.
- ↑ Castaman, G.; Bonetti, E.; Messina, M.; Morfini, M.; Rocino, A.; Scaraggi, F. A.; Tagariello, G. (2013). "Inhibitors in haemophilia B: the Italian experience". Haemophilia. 19 (5): 686–690. doi:10.1111/hae.12158. ISSN 1351-8216.
- ↑ Goodeve AC (July 2015). "Hemophilia B: molecular pathogenesis and mutation analysis". J. Thromb. Haemost. 13 (7): 1184–95. doi:10.1111/jth.12958. PMC 4496316. PMID 25851415.
- ↑ 28.0 28.1 Chitlur M, Warrier I, Rajpurkar M, Lusher JM (September 2009). "Inhibitors in factor IX deficiency a report of the ISTH-SSC international FIX inhibitor registry (1997-2006)". Haemophilia. 15 (5): 1027–31. doi:10.1111/j.1365-2516.2009.02039.x. PMID 19515028.
- ↑ 29.0 29.1 Shearin-Patterson T, Davidson E (April 2013). "Hemophilia C". JAAPA. 26 (4): 50. PMID 23610841.
- ↑ 30.0 30.1 Duga S, Salomon O (September 2013). "Congenital factor XI deficiency: an update". Semin. Thromb. Hemost. 39 (6): 621–31. doi:10.1055/s-0033-1353420. PMID 23929304.
- ↑ 31.0 31.1 Bolton-Maggs PH (2009). "Factor XI deficiency--resolving the enigma?". Hematology Am Soc Hematol Educ Program: 97–105. doi:10.1182/asheducation-2009.1.97. PMID 20008187.
- ↑ Wheeler AP, Gailani D (July 2016). "Why factor XI deficiency is a clinical concern". Expert Rev Hematol. 9 (7): 629–37. doi:10.1080/17474086.2016.1191944. PMID 27216469.
- ↑ 33.0 33.1 33.2 Kadir RA, Economides DL, Lee CA (January 1999). "Factor XI deficiency in women". Am. J. Hematol. 60 (1): 48–54. PMID 9883805.
- ↑ Asakai R, Chung DW, Davie EW, Seligsohn U (July 1991). "Factor XI deficiency in Ashkenazi Jews in Israel". N. Engl. J. Med. 325 (3): 153–8. doi:10.1056/NEJM199107183250303. PMID 2052060.
- ↑ Santoro C, Di Mauro R, Baldacci E, De Angelis F, Abbruzzese R, Barone F, Bochicchio RA, Ferrara G, Guarini A, Foà R, Mazzucconi MG (July 2015). "Bleeding phenotype and correlation with factor XI (FXI) activity in congenital FXI deficiency: results of a retrospective study from a single centre". Haemophilia. 21 (4): 496–501. doi:10.1111/hae.12628. PMID 25623511.
- ↑ Ragni MV, Sinha D, Seaman F, Lewis JH, Spero JA, Walsh PN (March 1985). "Comparison of bleeding tendency, factor XI coagulant activity, and factor XI antigen in 25 factor XI-deficient kindreds". Blood. 65 (3): 719–24. PMID 3871646.
- ↑ Bolton-Maggs PH, Patterson DA, Wensley RT, Tuddenham EG (February 1995). "Definition of the bleeding tendency in factor XI-deficient kindreds--a clinical and laboratory study". Thromb. Haemost. 73 (2): 194–202. PMID 7792729.
- ↑ Lakich, Delia; Kazazian, Haig H.; Antonarakis, Stylianos E.; Gitschier, Jane (1993). "Inversions disrupting the factor VIII gene are a common cause of severe haemophilia A". Nature Genetics. 5 (3): 236–241. doi:10.1038/ng1193-236. ISSN 1061-4036.
- ↑ Bagnall, R. D. (2002). "Recurrent inversion breaking intron 1 of the factor VIII gene is a frequent cause of severe hemophilia A". Blood. 99 (1): 168–174. doi:10.1182/blood.V99.1.168. ISSN 0006-4971.
- ↑ Gitschier J, Wood WI, Goralka TM, Wion KL, Chen EY, Eaton DH, Vehar GA, Capon DJ, Lawn RM (1984). "Characterization of the human factor VIII gene". Nature. 312 (5992): 326–30. PMID 6438525.
- ↑ 41.0 41.1 Lannoy, N.; Abinet, I.; Dahan, K.; Hermans, C. (2009). "Identification ofde novodeletion in the factor VIII gene by MLPA technique in two girls with isolated factor VIII deficiency". Haemophilia. 15 (3): 797–801. doi:10.1111/j.1365-2516.2008.01974.x. ISSN 1351-8216.
- ↑ 42.0 42.1 42.2 Peyvandi, Flora; Garagiola, Isabella; Young, Guy (2016). "The past and future of haemophilia: diagnosis, treatments, and its complications". The Lancet. 388 (10040): 187–197. doi:10.1016/S0140-6736(15)01123-X. ISSN 0140-6736.
- ↑ Davie EW, Fujikawa K (1975). "Basic mechanisms in blood coagulation". Annu. Rev. Biochem. 44: 799–829. doi:10.1146/annurev.bi.44.070175.004055. PMID 237463.
- ↑ Yoshitake S, Schach BG, Foster DC, Davie EW, Kurachi K (July 1985). "Nucleotide sequence of the gene for human factor IX (antihemophilic factor B)". Biochemistry. 24 (14): 3736–50. PMID 2994716.
- ↑ Asakai R, Chung DW, Ratnoff OD, Davie EW (October 1989). "Factor XI (plasma thromboplastin antecedent) deficiency in Ashkenazi Jews is a bleeding disorder that can result from three types of point mutations". Proc. Natl. Acad. Sci. U.S.A. 86 (20): 7667–71. PMC 298131. PMID 2813350.
- ↑ Bauduer F, de Raucourt E, Boyer-Neumann C, Trossaert M, Beurrier P, Faradji A, Peynet J, Borg JY, Chamouni P, Chatelanaz C, Henriet C, Bridey F, Goudemand J (July 2015). "Factor XI replacement for inherited factor XI deficiency in routine clinical practice: results of the HEMOLEVEN prospective 3-year postmarketing study". Haemophilia. 21 (4): 481–9. doi:10.1111/hae.12655. PMC 4657494. PMID 25817556.
- ↑ Goedert JJ, Eyster ME, Lederman MM, Mandalaki T, De Moerloose P, White GC, Angiolillo AL, Luban NL, Sherman KE, Manco-Johnson M, Preiss L, Leissinger C, Kessler CM, Cohen AR, DiMichele D, Hilgartner MW, Aledort LM, Kroner BL, Rosenberg PS, Hatzakis A (September 2002). "End-stage liver disease in persons with hemophilia and transfusion-associated infections". Blood. 100 (5): 1584–9. PMID 12176875.
- ↑ Qvigstad C, Tait RC, Rauchensteiner S, Berntorp E, de Moerloose P, Schutgens RE, Holme PA (September 2018). "The elevated prevalence of risk factors for chronic liver disease among ageing people with hemophilia and implications for treatment". Medicine (Baltimore). 97 (39): e12551. doi:10.1097/MD.0000000000012551. PMC 6181599. PMID 30278553.
- ↑ Pathirana UG, Gunawardena N, Abeysinghe H, Copley HC, Somarathne MG (December 2014). "Acquired haemophilia A associated with autoimmune thyroiditis: a case report". J Med Case Rep. 8: 469. doi:10.1186/1752-1947-8-469. PMC 4320580. PMID 25547669.
- ↑ Narazaki T, Haji S, Nakashima Y, Tsukamoto Y, Tsuda M, Takamatsu A, Ohno H, Matsushima T, Matsumoto T, Nogami K, Shima M, Shiratsuchi M, Ogawa Y (September 2018). "Acquired hemophilia A associated with autoimmune pancreatitis with serum IgG4 elevation". Int. J. Hematol. 108 (3): 335–338. doi:10.1007/s12185-018-2441-3. PMID 29582334.
- ↑ Mulliez SM, Vantilborgh A, Devreese KM (June 2014). "Acquired hemophilia: a case report and review of the literature". Int J Lab Hematol. 36 (3): 398–407. doi:10.1111/ijlh.12210. PMID 24750687.
- ↑ Shetty S, Sharma N, Ghosh K (March 2016). "Epidemiology of hepatocellular carcinoma (HCC) in hemophilia". Crit. Rev. Oncol. Hematol. 99: 129–33. doi:10.1016/j.critrevonc.2015.12.009. PMID 26754251.
- ↑ Barg AA, Livnat T, Kenet G (March 2017). "An extra X does not prevent acquired hemophilia - Pregnancy-associated acquired hemophilia A". Thromb. Res. 151 Suppl 1: S82–S85. doi:10.1016/S0049-3848(17)30074-9. PMID 28262242.
- ↑ Makris M, Konkle BA (March 2017). "Hepatitis C in haemophilia: time for treatment for all". Haemophilia. 23 (2): 180–181. doi:10.1111/hae.13183. PMID 28300362.
- ↑ Kasper CK (March 2004). "AIDS, hepatitis and hemophilia". J. Thromb. Haemost. 2 (3): 516–8. PMID 15009473.
- ↑ Goodman, Catherine (2015). Pathology : implications for the physical therapist. St. Louis, Missouri: Elsevier Saunders. ISBN 9781455745913.
- ↑ Murphy N, O'Mahony B, Flanagan P, Noone D, White B, Bergin C, Norris S, Thornton L (September 2017). "Progression of hepatitis C in the haemophiliac population in Ireland, after 30 years of infection in the pre-DAA treatment era". Haemophilia. 23 (5): 712–720. doi:10.1111/hae.13244. PMID 28752601.
- ↑ Eldash HH, Atwa ZT, Saad MA (January 2017). "Vitamin D deficiency and osteoporosis in hemophilic children: an intermingled comorbidity". Blood Coagul. Fibrinolysis. 28 (1): 14–18. doi:10.1097/MBC.0000000000000519. PMID 26825623.
- ↑ Albayrak C, Albayrak D (April 2015). "Vitamin D levels in children with severe hemophilia A: an underappreciated deficiency". Blood Coagul. Fibrinolysis. 26 (3): 285–9. doi:10.1097/MBC.0000000000000237. PMID 25485786.
- ↑ Cano LM, Quesada H, García-Alhama J, Cardona P (August 2013). "[Acquired haemophilia associated to myasthenia gravis]". Med Clin (Barc) (in Spanish; Castilian). 141 (4): 185–6. doi:10.1016/j.medcli.2012.12.005. PMID 23395131.
- ↑ Saini AG, Goswami JN, Suthar R, Sankhyan N, Vyas S, Singhi P (February 2017). "Probable Moyamoya Syndrome in Association with Hemophilia A in an Infant". Indian J Pediatr. 84 (2): 164–165. doi:10.1007/s12098-016-2229-5. PMID 27638653.
- ↑ 62.0 62.1 Kimura H, Uegaki M, Aoyama T, Miyoshi T, Nagai K, Hashimura T (May 2013). "[Acquired hemophilia presenting as gross hematuria and perineal subcutaneous hemorrhage after prostate biopsy: a case report]". Hinyokika Kiyo (in Japanese). 59 (5): 305–8. PMID 23719140.
- ↑ Maesako, Yoshitomo; Shimomura, Daiki; Ohno, Hitoshi (2013). "Acquired hemophilia A". Tenri Medical Bulletin. 16 (2): 133–135. doi:10.12936/tenrikiyo.16-015. ISSN 1344-1817.
- ↑ Centers for Disease Control and Prevention. Hemophilia Diagnosis. http://www.cdc.gov/ncbddd/hemophilia/diagnosis.html