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Haemophilia A and B, explained for families | CION Cancer Clinics
Haemophilia A and B are lifelong conditions in which blood clots too slowly because one clotting protein is low. In haemophilia A it is factor VIII; in haemophilia B it is factor IX. They look almost the same day to day, but the treatment must match the missing factor. This page explains the difference, how it shows up, and which bleeds cannot wait. At CION Cancer Clinics, our haematologist cares for anaemia, bleeding, clotting and inherited blood disorders, with ArogyaSri, CGHS and cashless insurance accepted.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is haemophilia, and how are A and B different?
- Which kind of haemophilia is on the report?
- How does haemophilia usually show up?
- What do families believe about haemophilia that is not true?
- What do the words on a haemophilia report mean?
- How is haemophilia confirmed and treated?
- Common questions about haemophilia A and B
The short answer
What is haemophilia, and how are A and B different?
Haemophilia is a lifelong condition in which the blood does not clot properly, because one clotting protein is missing or too low. In haemophilia A the missing protein is factor VIII. In haemophilia B it is factor IX.
What a clotting factor does
When a blood vessel is injured, a chain of proteins in the blood works one after another to build a firm plug. These proteins are called clotting factors. If one link in the chain is weak, the plug forms slowly and breaks down easily. You do not bleed faster than anyone else. You bleed for longer, and bleeding can start again after it seemed to stop.
Why the letter matters
Day to day, A and B look almost the same. The bruising, the joint bleeds and the risks around surgery are alike. The difference matters for treatment, because the factor that is replaced has to be the one that is missing. Giving factor VIII to a child with haemophilia B does not help. This is why the exact type must be confirmed with a blood test, not guessed from the symptoms.
How serious it is depends on the level
Each person has a measured factor level, and that level sets the severity: mild, moderate or severe. A boy with severe haemophilia may bleed into a joint with no injury at all. A man with mild haemophilia may only find out after a tooth is pulled.
This page explains the condition. It cannot tell you your child's severity or plan. Only a factor level test, read by a haematologist, can do that.
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Bleeds that cannot wait
Any knock to the head, even if the person seems fine, needs the emergency department the same day. So does bleeding in the neck or throat, severe pain in the stomach or back, blood in vomit or stools, or a swollen, hot, painful joint that will not bend. Go to the nearest emergency department or call 108, and say clearly that the person has haemophilia and which type. Carry the treatment card if you have one. Do not wait to see whether it settles.
Not sure whether this applies to you?
Ask an oncologistThe types
Which kind of haemophilia is on the report?
Most families will only ever deal with A or B. A third, rarer form appears in adults with no family history.
Haemophilia A
Low factor VIII. It is the more common of the two, making up most people with haemophilia. It is also sometimes called classic haemophilia.
Usually treated with
- Factor VIII replacement
- Emicizumab, a newer injection under the skin, in some cases
Haemophilia B
Low factor IX. It is less common, and older books call it Christmas disease, after the first family described. The bleeding pattern is much the same as in A.
Usually treated with
- Factor IX replacement
What A and B share
Both are inherited through the mother's side, so they mostly affect boys and men. Both carry the same risk of joint damage if bleeds are left untreated, and both can be affected by inhibitors, where the body starts fighting the replaced factor.
Acquired haemophilia
A rare condition in which an adult's own immune system attacks factor VIII. It is not inherited and does not pass to children. It often shows as sudden large bruises in an older person.
It needs urgent specialist care and is treated differently.When families notice
How does haemophilia usually show up?
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At birth or soon after
A bleed after a heel-prick, a vaccination or circumcision that will not stop is often the first sign in severe haemophilia. Many families have no idea it runs in the family.
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When a baby starts crawling and walking
Large, raised bruises on the knees, shins and back, from bumps other children shrug off. Parents are sometimes wrongly suspected of harming the child.
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Early childhood
Bleeds into joints, most often the knees, ankles and elbows. The child limps, refuses to use the arm or leg, and the joint feels warm and swollen.
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After a cut, tooth extraction or operation
In milder haemophilia this may be the first clue. Bleeding goes on for hours, or restarts a day or two later.
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In adult life
Some men with mild haemophilia are only diagnosed during testing before surgery, or when a relative is diagnosed first.
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Commonly believed
What do families believe about haemophilia that is not true?
"A small cut can make him bleed to death."
Small surface cuts usually stop with firm pressure, just as they do in anyone. The dangerous bleeds are the hidden ones: inside joints, muscles, the head or the stomach. Those are the ones to watch for and act on quickly.
"Only boys can have it, so our daughter is safe."
Boys are affected far more often. But girls who carry the gene can have low factor levels and bleed heavily, especially with periods, after childbirth or after surgery. A carrier girl deserves a factor level test too.
"He must never play or go to school normally."
With regular treatment and a plan agreed with the school, most children attend normally. Swimming and cycling are often encouraged. Rough contact sports are usually avoided, and the team will guide you on the rest.
"Nobody in our family has it, so it cannot be haemophilia."
A sizeable share of children with haemophilia are the first in their family. The gene change can arise new. A normal family history is not a reason to skip the test.
On your report
What do the words on a haemophilia report mean?
- APTT
- A clotting time test. It is often longer than normal in haemophilia, and is usually the first clue. On its own it does not tell you which factor is low.
- PT
- A different clotting time test. It is usually normal in haemophilia, which helps the doctor narrow down the cause.
- Factor VIII assay
- A direct measure of your factor VIII level. A low result points to haemophilia A, or sometimes von Willebrand disease.
- Factor IX assay
- A direct measure of factor IX. A low result points to haemophilia B.
- Inhibitor
- An antibody that stops replaced factor from working. It is checked with a separate blood test.
- Carrier
- Someone, usually a woman, who has one copy of the changed gene. She can pass it on and may have lower factor levels herself.
What happens next
How is haemophilia confirmed and treated?
Haemophilia is confirmed with blood tests, not with a scan. Clotting times come first. If they are long, the laboratory measures factor VIII and factor IX directly. Reference ranges differ between laboratories, and a single result is read alongside symptoms and repeat tests before anyone gives it a name.
The main treatments
Treatment replaces the missing factor through a drip or an injection into a vein. Some people get it only when a bleed happens. Others, especially with severe haemophilia, get it regularly to prevent bleeds and protect the joints. For haemophilia A, emicizumab is a newer option given under the skin. It does not suit everyone, and it is not used for haemophilia B. Your haematologist sets the medicine and the schedule.
Who needs a different plan
People who develop inhibitors, girls and women who carry the gene, and anyone facing surgery or a dental extraction all need a plan made in advance. Aspirin and some common painkillers can make bleeding worse, so always ask before taking a new medicine.
What CION does
CION's haematology team reviews the reports, explains the type and severity, and coordinates care and factor access with qualified centres. Some states supply factor free through government programmes, and the rules change, so check what applies to you now.
Nothing on this page replaces a plan made with your own haematologist.Questions we are asked
Common questions about haemophilia A and B
Is haemophilia A worse than haemophilia B?
Not in any simple way. How serious it is depends mainly on the factor level, which sets severity as mild, moderate or severe. A person with severe haemophilia B can bleed more than a person with mild haemophilia A. The type matters most for choosing the right treatment.
Can haemophilia go away as my son grows up?
No. It is lifelong, because the gene change is present from birth. What changes with good care is how often he bleeds and how well his joints are protected. Many boys learn to recognise a bleed early and manage treatment themselves as teenagers.
Can a girl have haemophilia?
Yes, though it is uncommon. Many carrier girls and women have lower factor levels and bleed more than they should, with heavy periods, after childbirth or after surgery. Some have levels low enough to be called mild haemophilia. If a male relative has it, ask for her factor level to be tested.
Is haemophilia the same as a low platelet count?
No. Platelets are the small cells that form the first plug. In haemophilia the platelet count is usually normal; it is a clotting protein that is low. A low platelet count, called thrombocytopenia, is a different problem with different causes and treatment.
Is haemophilia a type of blood cancer?
No. Haemophilia is an inherited clotting disorder, not a cancer. It does not spread and does not turn into leukaemia. It is looked after by haematologists, who also treat blood cancers, which is why you may see it listed alongside them at a clinic.
Can my son have vaccinations and injections?
Yes, vaccinations are important. Tell the nurse about the haemophilia first. Many teams prefer vaccines given under the skin rather than into the muscle, with a fine needle and firm pressure afterwards. Your haematologist will advise what suits your son.
Which painkillers are safe with haemophilia?
Paracetamol is generally used. Aspirin and many anti-inflammatory painkillers, such as ibuprofen, can make bleeding worse and are usually avoided. Doses and choices depend on the person, so ask your haematologist or pharmacist before giving anything new, including from a local chemist.
Is factor treatment available free in Telangana or Andhra Pradesh?
Several states run programmes that supply factor through government hospitals, and schemes such as Aarogyasri and PM-JAY may cover some care. Entitlements change, so check the current rules with the treating hospital. Our helpline can tell you what to ask and where to start.
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Sources
- NHS — Haemophilia
- NHLBI — Hemophilia
- American Society of Hematology — Hemophilia
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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