Hemophilia B
Hemophilia B
Updated: 07/25/2023
© Jun Wang, MD, PhD
General features
- AKA Christmas disease
- X-linked recessive
- Less common than Hemophilia A
- May be result of spontaneous mutation
- Almost exclusively affects males
Clinical presentations
- Easy bruising
- Bleeding into joints (hemarthrosis), soft tissue, GI/ GU tract
- Excessive bleeding after surgery
- Mild: > 5% factor VIII activity, bleeding after trauma or surgery
- Moderate: 1% - 5% activity; bleeding after surgery or trauma, may have spontaneous bleeding
- Severe: < 1% activity; spontaneous bleeding, may be life-threatening
Key pathogenesis
- Factor IX deficiency
- Presentation in female patients due to
High degree of X-inactivation
Homozygosity
Hemizygosity in Turner syndrome
- May be caused by inhibitory antibodies against factor IX
Key Laboratory findings
- Normal to prolonged aPTT
- Reduced factor IX
Mild: > 5%
Moderate: > 1-5%
Severe: < 1%
- Usually normal platelet count, PT
- Mixing studies to determine deficiency or inhibitor
- Rule out Hemophilia A and Von Willebrand disease
Treatment
- Factor replacement: Factor IX, factor IX complex, recombinant factor IX, etc
- Management of bleeding
- Rehabilitation of hemarthrosis and hemophilia arthropathy
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