Although hemophilia is present from birth, in uncommon instances, such as this case report, the disease may lie dormant for several decades. Therefore, it cannot be ruled out by age alone, and it must be considered in certain clinical settings. For reasons not known, adequate correction of factor deficiencies after the patient has had significant symptoms often will not halt the bleeding. In contrast, prophylactic correction prior to trauma, such as surgery, is usually preventive. Although normal coagulation studies usually eliminate the possibility of hemophilia, studies without factor assays may fail to make the diagnosis.
Coy J, Bivins BA, Belin RP. Surgical Procedures in Unsuspected Hemophilia. Arch Surg. 1974;109(6):835-836. doi:10.1001/archsurg.1974.01360060101028