We have learned a great deal in the past decade about the molecular characteristics of factors VIII and IX. As a result, hemophilias A and B can be diagnosed in utero, tests for the carrier state are more accurate, and a few of the veils of mystery around von Willebrand's disease have parted. We also have become accustomed to the therapeutic advantages of concentrated clotting factor preparations. In children, attention is shifting from treatment to prevention. The accumulating population of hemophilic adults, who often have disabilities, is challenging the talents of orthopedic surgeons and social scientists.
Care of Severe Hemophilia
Great progress has been made in the management of severe hemophilia. Before blood banks were developed in the 1940s, three of every four patients with severe hemophilia died by the age of 15 years, most commonly of exsanguination from minor wounds.1 Severe crippling arthritis was commonplace, as repeated
Kasper CK. Hematology. JAMA. 1982;247(21):2951–2953. doi:10.1001/jama.1982.03320460051019
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