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Questions and Answers
Which of the following is NOT a clinical feature of Hemophilia A in infants?
Which of the following is NOT a clinical feature of Hemophilia A in infants?
What is the main characteristic that differentiates Hemophilia A from Hemophilia B?
What is the main characteristic that differentiates Hemophilia A from Hemophilia B?
Which of the following statements about Hemophilia A is INCORRECT?
Which of the following statements about Hemophilia A is INCORRECT?
What is the most serious complication that can result from recurrent hemarthrosis in Hemophilia A?
What is the most serious complication that can result from recurrent hemarthrosis in Hemophilia A?
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Which of the following laboratory tests is NOT typically included in the initial assessment of Hemophilia A?
Which of the following laboratory tests is NOT typically included in the initial assessment of Hemophilia A?
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Why is Hemophilia often referred to as "love of bleeding"?
Why is Hemophilia often referred to as "love of bleeding"?
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Which of the following is a TRUE statement about Hemophilia B?
Which of the following is a TRUE statement about Hemophilia B?
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The term "Hemophilic pseudo tumor" refers to:
The term "Hemophilic pseudo tumor" refers to:
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Which of the following statements is TRUE regarding the inheritance pattern of Hemophilia B?
Which of the following statements is TRUE regarding the inheritance pattern of Hemophilia B?
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A patient presents with prolonged bleeding time, low FVIII, prolonged aPTT, and low vWF. Which of the following is the MOST likely diagnosis?
A patient presents with prolonged bleeding time, low FVIII, prolonged aPTT, and low vWF. Which of the following is the MOST likely diagnosis?
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What is the primary function of Von Willebrand factor (vWF)?
What is the primary function of Von Willebrand factor (vWF)?
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Why is FVIII level reduced in Von Willebrand Disease?
Why is FVIII level reduced in Von Willebrand Disease?
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Which type of Von Willebrand Disease is characterized by abnormally high affinity of vWF for platelets?
Which type of Von Willebrand Disease is characterized by abnormally high affinity of vWF for platelets?
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What is the most common cause of Hemophilia B?
What is the most common cause of Hemophilia B?
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Which laboratory test is used to assess the concentration of vWF protein in plasma?
Which laboratory test is used to assess the concentration of vWF protein in plasma?
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Which of the following is NOT a typical characteristic of Von Willebrand Disease?
Which of the following is NOT a typical characteristic of Von Willebrand Disease?
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Identify the most likely underlying cause of acquired dysfibrinogenemia in a patient with liver disease.
Identify the most likely underlying cause of acquired dysfibrinogenemia in a patient with liver disease.
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Which of the following conditions can contribute to both thrombocytopenia and disseminated intravascular coagulation (DIC) in a patient with liver disease?
Which of the following conditions can contribute to both thrombocytopenia and disseminated intravascular coagulation (DIC) in a patient with liver disease?
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A patient with severe liver disease presents with prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT). What is the most likely cause of the prolonged clotting times?
A patient with severe liver disease presents with prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT). What is the most likely cause of the prolonged clotting times?
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Which of the following is NOT a characteristic laboratory finding typically associated with disseminated intravascular coagulation (DIC)?
Which of the following is NOT a characteristic laboratory finding typically associated with disseminated intravascular coagulation (DIC)?
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Which of the following is a potential trigger for disseminated intravascular coagulation (DIC) in a patient with liver disease?
Which of the following is a potential trigger for disseminated intravascular coagulation (DIC) in a patient with liver disease?
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A patient with liver disease presents with hemolytic anemia and red blood cell fragmentation. What is the most likely explanation for this finding?
A patient with liver disease presents with hemolytic anemia and red blood cell fragmentation. What is the most likely explanation for this finding?
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What is the primary mechanism by which oral vitamin K administration helps in treating coagulation factor deficiencies associated with liver disease?
What is the primary mechanism by which oral vitamin K administration helps in treating coagulation factor deficiencies associated with liver disease?
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Which of the following explains why fresh frozen plasma (FFP) is a potential treatment for disseminated intravascular coagulation (DIC)?
Which of the following explains why fresh frozen plasma (FFP) is a potential treatment for disseminated intravascular coagulation (DIC)?
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In a mixing study, if the PTT normalized after the addition of normal plasma, what does this indicate?
In a mixing study, if the PTT normalized after the addition of normal plasma, what does this indicate?
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Which of the following statements is TRUE regarding acquired hemophilia A?
Which of the following statements is TRUE regarding acquired hemophilia A?
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Which of the following tests is NOT used for carrier detection and antenatal diagnosis of Hemophilia A?
Which of the following tests is NOT used for carrier detection and antenatal diagnosis of Hemophilia A?
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Why is it important to consider that factor IX levels can be low at birth?
Why is it important to consider that factor IX levels can be low at birth?
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Which of the following treatments is NOT used for hemophilia A?
Which of the following treatments is NOT used for hemophilia A?
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A patient presents with prolonged PTT, normal PT and BT. A mixing study normalizes the PTT. What is the most likely diagnosis?
A patient presents with prolonged PTT, normal PT and BT. A mixing study normalizes the PTT. What is the most likely diagnosis?
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What is the significance of the fact that the gene for FIX is close to the gene for FVIII?
What is the significance of the fact that the gene for FIX is close to the gene for FVIII?
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Why is prophylactic treatment with stored FVIII recommended for patients with Hemophilia A?
Why is prophylactic treatment with stored FVIII recommended for patients with Hemophilia A?
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Which of the following is a type of acquired coagulation disorder that can be treated with Vitamin K?
Which of the following is a type of acquired coagulation disorder that can be treated with Vitamin K?
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What is the primary reason for the bleeding symptoms associated with Von Willebrand's disease?
What is the primary reason for the bleeding symptoms associated with Von Willebrand's disease?
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Which of the following statements accurately describes a characteristic difference between Hemophilia A and Von Willebrand's disease?
Which of the following statements accurately describes a characteristic difference between Hemophilia A and Von Willebrand's disease?
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Which of the following laboratory findings would be most likely observed in a patient with Vitamin K deficiency?
Which of the following laboratory findings would be most likely observed in a patient with Vitamin K deficiency?
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How does the drug warfarin (Vitamin K antagonist) affect the clotting process?
How does the drug warfarin (Vitamin K antagonist) affect the clotting process?
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What is the primary mechanism by which the antibiotic ristocetin promotes platelet aggregation?
What is the primary mechanism by which the antibiotic ristocetin promotes platelet aggregation?
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Which of the following conditions is NOT associated with an increased risk of bleeding due to a clotting factor deficiency?
Which of the following conditions is NOT associated with an increased risk of bleeding due to a clotting factor deficiency?
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Which statement regarding Hemorrhagic disease of the newborn (HDN) is TRUE?
Which statement regarding Hemorrhagic disease of the newborn (HDN) is TRUE?
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Flashcards
Hemophilia A
Hemophilia A
A hereditary bleeding disorder caused by deficiency of Factor VIII.
Hemophilia B
Hemophilia B
A hereditary bleeding disorder caused by deficiency of Factor IX.
von Willebrand's disease
von Willebrand's disease
An inherited bleeding disorder characterized by lack of von Willebrand factor (vWf).
Recessive X-Linked Inheritance
Recessive X-Linked Inheritance
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Spontaneous bleeding
Spontaneous bleeding
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Hemarthrosis
Hemarthrosis
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Severity of Hemophilia
Severity of Hemophilia
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Laboratory tests for Hemophilia
Laboratory tests for Hemophilia
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PTT Prolongation
PTT Prolongation
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Mixing Study
Mixing Study
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Factor VIII Activity
Factor VIII Activity
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Antenatal Diagnosis
Antenatal Diagnosis
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Desmopressin
Desmopressin
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Hemophilia B treatments
Hemophilia B treatments
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Acquired Hemophilia A
Acquired Hemophilia A
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Laboratory findings in Hemophilia B
Laboratory findings in Hemophilia B
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Von Willebrand's Disease (vWD)
Von Willebrand's Disease (vWD)
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Factor IX Deficiency
Factor IX Deficiency
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Types of Von Willebrand's Disease
Types of Von Willebrand's Disease
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Carrier Detection
Carrier Detection
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Function of vWF
Function of vWF
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Laboratory findings in vWD
Laboratory findings in vWD
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VWF:Ag assay
VWF:Ag assay
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Ristocetin
Ristocetin
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Von Willebrand’s Disease (vWD)
Von Willebrand’s Disease (vWD)
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Bleeding Symptoms in VWD
Bleeding Symptoms in VWD
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Vitamin K deficiency
Vitamin K deficiency
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Hemorrhagic Disease of the Newborn
Hemorrhagic Disease of the Newborn
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Laboratory findings in Vitamin K deficiency
Laboratory findings in Vitamin K deficiency
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Prophylaxis in liver disease
Prophylaxis in liver disease
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Vitamin K absorption and liver
Vitamin K absorption and liver
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Thrombocytopenia causes
Thrombocytopenia causes
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Disseminated Intravascular Coagulation (DIC)
Disseminated Intravascular Coagulation (DIC)
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DIC pathogenesis triggers
DIC pathogenesis triggers
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Laboratory findings of DIC
Laboratory findings of DIC
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Thromboplastin secretion in liver disease
Thromboplastin secretion in liver disease
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DIC treatment options
DIC treatment options
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Study Notes
Coagulation Disorders
- Coagulation disorders are conditions affecting the body's ability to form blood clots.
- Inherited disorders include Hemophilia A and B, von Willebrand's Disease.
- Acquired disorders are more common than inherited ones.
Inherited Coagulation Disorders: Overview
- Hemophilia A: Deficiency in Factor VIII (FVIII)
- Hemophilia B: Deficiency in Factor IX (FIX)
- von Willebrand's Disease: Deficiency or abnormality in von Willebrand Factor (vWF).
Hemophilia
- Also known as "love of bleeding"
- Bleeding symptoms of both types (A & B) are the same
- Some infants are asymptomatic until they experience minor trauma
- Symptoms include easy bruising, spontaneous bleeding into deep tissues (joints, muscles, soft tissues), life-threatening bleeding after injury or surgery
- Results in lifelong bleeding problems.
Hemophilia A
- Bleeding due to a deficiency of FVIII coagulant activity
- Severity is related to FVIII level in blood
- Low FVIII (< 1 IU/dL) levels cause significant bleeding
- Transmission is recessive X-linked
- Males are affected, females are carriers
- Gene mutation causes a lack/low level of plasma factor VIII
X-linked Recessive Inheritance
- The inheritance pattern for bleeding disorders, such as hemophilia,
- Unaffected father has no affected sons
- Unaffected mother will have unaffected sons
- Carrier mother has affected sons
- Affected father has no affected daughters
- Carrier mother can have affected daughters
Clinical Features of Hemophilia A
- Infants can develop joint and soft tissue bleeding and excessive bruising
- Bleeding after dental extractions can be prolonged
- Hemarthrosis (bleeding into joints) is common and can cause joint deformities and disabilities
- Hemophilic pseudo tumors are a rare complication (cystic swellings in muscles or bones)
- Hematuria (blood in urine)
- Gastrointestinal bleeding
Recurrent Hemarthrosis
- Repeated bleeding into joints causes joint deformities and disabilities.
Severity of Hemophilia A Based on Factor VIII Levels
- Severe: Factor level 0-1 IU/dL, spontaneous bleeds, serious bleeding
- Moderate: Factor level 2-5 IU/dL, few bleeds, primarily traumatic
- Mild: Factor level 5-30 IU/dL, post-traumatic bleeds, few episodes
Coagulation Pathway
- Illustration of the complex cascade of proteins involved in blood clotting
- Intrinsic pathway (activated by damage inside the vessel) uses aPTT test
- Extrinsic pathway (initiated by tissue damage) uses PT test
- Many clotting factors are involved in the cascade
Laboratory Investigations for Hemophilia
- Complete blood count (CBC)
- Prothrombin time (PT)
- Partial thromboplastin time (PTT)
- Bleeding time (BT)
- The PTT test will be prolonged
- The PT test and BT will be normal
Other Laboratory Investigation for Carrier Detection and Antenatal Diagnosis
- Measuring factor VIII plasma levels
- DNA probes to detect mutations in carriers
- Fetal biopsies from 8-10 weeks gestation
- Fetal DNA analysis for factor VIII at 16–20 weeks gestation using UV-guided ultrasound
Treatments for Hemophilia
- Factor VIII replacement therapy (recombinant factor or frozen concentrate) used to replace the missing or deficient clotting factor
- Desmopressin (synthetic vasopressin analogue) stimulates FVIII and vWF release from endothelial cells, thereby increasing levels in the plasma
- Prophylactic treatments — storing and administering FVIII — can reduce bleeding and improve patient quality of life
- Social and physiological care plays a critical supporting role
Non-Genetic Form of Hemophilia A
- Caused by autoantibodies against factor VIII, called acquired haemophilia A
- Associated with cancers, immune issues, after childbirth responses to treatment
Hemophilia B
- Also known as Christmas disease
- Primarily involves a deficiency in factor IX
- Clinical features are virtually identical to Hemophilia A
- Distinguished using coagulation assays
- Incidence approximately 1/5 of Hemophilia A cases
- Factor IX levels can be low at birth; umbilical cord blood testing is more accurate
- Treatments involve factor IX infusions
Laboratory Findings in Hemophilia B
- Prolonged aPTT assay
- Reduced FIX clotting assay
- Normal bleeding time
- Normal PT
Additional Information on Hemophilia
- Hemophilia is a hereditary condition, but not always associated with family history
- Can result from spontaneous mutations in genes controlling clotting factor proteins F8 or F9
- There are over a thousand mutations in F8, F9, causing factor VIII and IX deficiency
Von Willebrand's Disease
- Abnormalities either from reduced level or abnormal function of vWF
- vWF is a large protein forming multimers
- Inheritance is autosomal dominant
- Symptoms include typical mucosal bleeding (nose, gum), bleeding after dental work, and post-traumatic hemorrhaging
- Severity depends on the type of VWD
vWF (von Willebrand Factor) and Function
- vWF is a multi-functional protein
- Promotes platelet adhesion to damaged endothelium and subsequent platelet aggregation.
- Acts as a carrier molecule for factor VIII protecting it from premature destruction.
Von Willebrand's Disease Types
- VWD type 1: Reduced vWF quantity
- VWD type 2: Abnormal vWF structure or function
- VWD type 3: Little or no vWF present
Type 2 Subtypes
- Type 2A, loss of high molecular weight (HMW) multimers, affects platelet aggregation
- Type 2B, very high affinity for platelets (abnormal attachment), causing platelet removal (thrombocytopenia)
Laboratory Findings in Von Willebrand's Disease
- Prolonged bleeding time
- Low FVIII
- Prolonged aPTT
- Decreased vWF levels
- Defective platelet aggregation
- Platelets are usually normal except in type 2B
Specialized Lab Investigations for Von Willebrand's Disease
- VWF:Ag (immunoassay) measures concentration of vWF in plasma
- VWF:RCo (ristocetin cofactor activity) —assesses the ability of vWF to interact with platelets
- Factor VIII coagulant assay
Treatments for Von Willebrand's Disease
- Antifibrinolytic agents — for type 2B
- Desmopressin — for type 1
- FVIII and vWF infusions— for patients with very low vWF
Hemophilia A vs Von Willebrand's disease
- Gender: Hemophilia A — mainly males, Von Willebrand's Disease — both genders are affected
- Bleeding Symptoms: Hemophilia A— deep tissues, musculoskeletal, internal organs; Von Willebrand's disease — mucosal (nosebleeds, gum bleeds)
Acquired Coagulation Disorders
- More common than inherited types
- Often involve multiple clotting factor deficiencies
Vitamin K Deficiency
- Caused by inadequate diet, malabsorption of vitamin K, or by drugs inhibiting vitamin K
- Deficiency affects factors II, VII, IX, X as well as protein C&S
- Has a hemorrhagic form in newborns
Hemorrhagic Disease of the Newborn
- Vitamin K deficiency in newborns, often due to inadequate absorption or lack of gut bacteria for vitamin K synthesis
- Prolonged PT, aPTT; normal platelet count and fibrinogen
- Treatment— oral vitamin K
Vitamin K Deficiency in Liver Disease
- Due to obstructive jaundice, pancreatic or small bowel disease
- Prolonged PT, APTT; normal platelet count and fibrinogen
- Deficiency of factors II, VII, IX, X
Hemostasis Disorders in Liver Disease
- Impaired vitamin K absorption
- Reduced synthesis of coagulation factors
- Reduced fibrinogen synthesis
- Thrombocytopenia
- Increased levels of coagulation inhibitors leading to DIC
Disseminated Intravascular Coagulation (DIC)
- Widespread intravascular fibrin deposition; causes depletion of coagulation factors and platelets
- Often due to many disorders releasing procoagulants
- Causes extensive endothelial damage leading to activation of the coagulation pathway
DIC Pathogenesis
- Procoagulant substances enter circulation, triggering massive clotting and consumption of clotting factors and platelets.
- Causes include amniotic fluid embolism, liver disease, placental separation, cancer cells, snake bites, infections, endothelial damage & severe burns
DIC Laboratory Findings
- Low platelet count
- Prolonged PT, aPTT, and Thrombin Time (TT)
- Elevated D-dimers or fibrin degradation products
- Hemolytic anemia and red blood cell fragmentation
DIC Treatments
- Fresh frozen plasma or plasma concentrate
- Red blood cell transfusion
- Antithrombin and protein C to inhibit coagulation
Coagulation Deficiency Caused by Antibodies
- Alloantibodies against factor VIII may occur in 5-10% of hemophilia cases
- SLE autoimmune disease may lead to lupus anticoagulants interfering with coagulation
- Treatments include immunosuppression or factor replacement
Massive Transfusion Syndrome
- Further decreased platelets and coagulation factors due to large volume blood transfusion
- Extended storage of blood (24 hrs at 4°C) affects platelet function and clotting factors
- Some patients may have underlying bleeding disorders
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Description
Test your knowledge on the clinical features and complications of Hemophilia A and B. This quiz covers inheritance patterns, laboratory assessments, and specific characteristics distinguishing the two types of Hemophilia. Perfect for medical students and professionals looking to refresh their understanding of this condition.