Hemophilia pathophysiology: Difference between revisions

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*The process of [[hemostasis]] involves a fine balance between the [[Coagulation|procoagulant]] and [[anticoagulant]] factors. It attempts to maintain [[blood flow]] within the [[vascular]] compartment and promotes the formation of [[Thrombus|blood clots]] following [[vascular injury]].<ref name="pmid17243907">{{cite journal |vauthors=Lippi G, Franchini M, Guidi GC |title=Diagnostic approach to inherited bleeding disorders |journal=Clin. Chem. Lab. Med. |volume=45 |issue=1 |pages=2–12 |date=2007 |pmid=17243907 |doi=10.1515/CCLM.2007.006 |url=}}</ref>
*The process of [[hemostasis]] involves a fine balance between the [[Coagulation|procoagulant]] and [[anticoagulant]] factors. It attempts to maintain [[blood flow]] within the [[vascular]] compartment and promotes the formation of [[Thrombus|blood clots]] following [[vascular injury]].<ref name="pmid17243907">{{cite journal |vauthors=Lippi G, Franchini M, Guidi GC |title=Diagnostic approach to inherited bleeding disorders |journal=Clin. Chem. Lab. Med. |volume=45 |issue=1 |pages=2–12 |date=2007 |pmid=17243907 |doi=10.1515/CCLM.2007.006 |url=}}</ref>
*It also enables repair after [[vascular injury]], promotes [[Blood vessel|vessel]] healing, and maintains [[Blood vessel|vessel]] integrity.
*It also enables repair after [[vascular injury]], promotes [[Blood vessel|vessel]] healing, and maintains [[Blood vessel|vessel]] integrity.
*[[Hemostasis]] can be divided into three phases. Each phase is explained as follows:
*[[Hemostasis]] can be divided into three phases
**Each phase is explained as follows:
'''1. Primary hemostasis'''
'''1. Primary hemostasis'''
*[[Endothelium|Endothelial]] damage marks the beginning of this phase.<ref>{{cite book | last = Favaloro | first = Emmanuel | title = Hemostasis and thrombosis : methods and protocols | publisher = Humana Press Springer | location = New York | year = 2017 | isbn = 9781493971961 }}</ref>
*[[Endothelium|Endothelial]] damage marks the beginning of this phase.<ref>{{cite book | last = Favaloro | first = Emmanuel | title = Hemostasis and thrombosis : methods and protocols | publisher = Humana Press Springer | location = New York | year = 2017 | isbn = 9781493971961 }}</ref>
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*The model proposes three overlapping phases of [[hemostasis]] which are explained as follows:
*The model proposes three overlapping phases of [[hemostasis]] which are explained as follows:
'''a. Initiation'''
'''a. Initiation'''
*It occurs on the surface of the [[tissue factor]]-bearing cell.
*It occurs on the surface of the [[tissue factor]]-bearing [[Cell (biology)|cell]].
*[[Tissue factor]]-bearing cells such as the [[Fibroblast|fibroblasts]] bind to the surface of [[Platelet|platelets]] in an evolving [[thrombus]].<ref name="Hoffman2003">{{cite journal|last1=Hoffman|first1=Maureane|title=A cell-based model of coagulation and the role of factor VIIa|journal=Blood Reviews|volume=17|year=2003|pages=S1–S5|issn=0268960X|doi=10.1016/S0268-960X(03)90000-2}}</ref>
*[[Tissue factor]]-bearing cells such as the [[Fibroblast|fibroblasts]] bind to the surface of [[Platelet|platelets]] in an evolving [[thrombus]].<ref name="Hoffman2003">{{cite journal|last1=Hoffman|first1=Maureane|title=A cell-based model of coagulation and the role of factor VIIa|journal=Blood Reviews|volume=17|year=2003|pages=S1–S5|issn=0268960X|doi=10.1016/S0268-960X(03)90000-2}}</ref>
*[[Factor VII]] comes into direct contact with the [[tissue factor]]-bearing [[Vascular|extravascular]] [[Cell (biology)|cells]] during [[vascular injury]], and rapidly undergoes activation via the [[Coagulation|extrinsic pathway]].  
*[[Factor VII]] comes into direct contact with the [[tissue factor]]-bearing [[Vascular|extravascular]] [[Cell (biology)|cells]] during [[vascular injury]], and rapidly undergoes activation via the [[Coagulation|extrinsic pathway]].  
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*[[Bleeding]] in hemophilia occurs due to the failure of [[Coagulation|secondary hemostasis]].<ref name="Bolton-MaggsPasi2003">{{cite journal|last1=Bolton-Maggs|first1=Paula HB|last2=Pasi|first2=K John|title=Haemophilias A and B|journal=The Lancet|volume=361|issue=9371|year=2003|pages=1801–1809|issn=01406736|doi=10.1016/S0140-6736(03)13405-8}}</ref>
*[[Bleeding]] in hemophilia occurs due to the failure of [[Coagulation|secondary hemostasis]].<ref name="Bolton-MaggsPasi2003">{{cite journal|last1=Bolton-Maggs|first1=Paula HB|last2=Pasi|first2=K John|title=Haemophilias A and B|journal=The Lancet|volume=361|issue=9371|year=2003|pages=1801–1809|issn=01406736|doi=10.1016/S0140-6736(03)13405-8}}</ref>
*[[Coagulation|Primary hemostasis]] and the formation of [[platelet]] plug occurs normally but stabilization of the plug by [[fibrin]] is [[Defect|defective]] because of the [[generation]] of inadequate amounts of [[thrombin]].<ref name="Bolton-MaggsPasi2003">{{cite journal|last1=Bolton-Maggs|first1=Paula HB|last2=Pasi|first2=K John|title=Haemophilias A and B|journal=The Lancet|volume=361|issue=9371|year=2003|pages=1801–1809|issn=01406736|doi=10.1016/S0140-6736(03)13405-8}}</ref>
*[[Coagulation|Primary hemostasis]] and the formation of [[platelet]] plug occurs normally but stabilization of the plug by [[fibrin]] is [[Defect|defective]] because of the [[generation]] of inadequate amounts of [[thrombin]].<ref name="Bolton-MaggsPasi2003">{{cite journal|last1=Bolton-Maggs|first1=Paula HB|last2=Pasi|first2=K John|title=Haemophilias A and B|journal=The Lancet|volume=361|issue=9371|year=2003|pages=1801–1809|issn=01406736|doi=10.1016/S0140-6736(03)13405-8}}</ref>
*Clinical expression of hemophilia usually correlates with the activity of the [[coagulation]] factor and the [[disease]] can be classified as:
*[[Clinical]] expression of hemophilia usually correlates with the activity of the [[coagulation]] factor and the [[disease]] can be classified as:
:*Mild (factor level > 0.05–0.40 IU/mL)
:*Mild (factor level > 0.05–0.40 IU/mL)
:*Moderate (factor level = 0.01–0.05 IU/mL)
:*Moderate (factor level = 0.01–0.05 IU/mL)
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====Hemophilia A====
====Hemophilia A====
*Hemophilia A can be characterized by the detection of inversions of [[intron]] 22 (reported in 40–45% of severe [[Patient|patients]]) and [[intron]] 1 (reported in 1–6% of severe [[Patient|patients]]) of ''F8'' [[gene]] (which encodes [[factor VIII]]).<ref name="LakichKazazian1993">{{cite journal|last1=Lakich|first1=Delia|last2=Kazazian|first2=Haig H.|last3=Antonarakis|first3=Stylianos E.|last4=Gitschier|first4=Jane|title=Inversions disrupting the factor VIII gene are a common cause of severe haemophilia A|journal=Nature Genetics|volume=5|issue=3|year=1993|pages=236–241|issn=1061-4036|doi=10.1038/ng1193-236}}</ref><ref name="Bagnall2002">{{cite journal|last1=Bagnall|first1=R. D.|title=Recurrent inversion breaking intron 1 of the factor VIII gene is a frequent cause of severe hemophilia A|journal=Blood|volume=99|issue=1|year=2002|pages=168–174|issn=00064971|doi=10.1182/blood.V99.1.168}}</ref>
*Hemophilia A can be characterized by the detection of inversions of [[intron]] 22 (reported in 40–45% of severe [[Patient|patients]]) and [[intron]] 1 (reported in 1–6% of severe [[Patient|patients]]) of ''F8'' [[gene]] (which encodes [[factor VIII]]).<ref name="LakichKazazian1993">{{cite journal|last1=Lakich|first1=Delia|last2=Kazazian|first2=Haig H.|last3=Antonarakis|first3=Stylianos E.|last4=Gitschier|first4=Jane|title=Inversions disrupting the factor VIII gene are a common cause of severe haemophilia A|journal=Nature Genetics|volume=5|issue=3|year=1993|pages=236–241|issn=1061-4036|doi=10.1038/ng1193-236}}</ref><ref name="Bagnall2002">{{cite journal|last1=Bagnall|first1=R. D.|title=Recurrent inversion breaking intron 1 of the factor VIII gene is a frequent cause of severe hemophilia A|journal=Blood|volume=99|issue=1|year=2002|pages=168–174|issn=00064971|doi=10.1182/blood.V99.1.168}}</ref>
*The ''F8'' [[gene]] is located on the X chromosome.<ref name="pmid6438525">{{cite journal |vauthors=Gitschier J, Wood WI, Goralka TM, Wion KL, Chen EY, Eaton DH, Vehar GA, Capon DJ, Lawn RM |title=Characterization of the human factor VIII gene |journal=Nature |volume=312 |issue=5992 |pages=326–30 |date=1984 |pmid=6438525 |doi= |url=}}</ref>
*The ''F8'' [[gene]] is located on the X [[Chromosome (genetic algorithm)|chromosome]].<ref name="pmid6438525">{{cite journal |vauthors=Gitschier J, Wood WI, Goralka TM, Wion KL, Chen EY, Eaton DH, Vehar GA, Capon DJ, Lawn RM |title=Characterization of the human factor VIII gene |journal=Nature |volume=312 |issue=5992 |pages=326–30 |date=1984 |pmid=6438525 |doi= |url=}}</ref>
*[[Point mutation|Point mutations]] ([[Missense mutation|missense]], [[Nonsense mutation|nonsense]], and [[Splice site mutation|splice site mutations]]) account for 67% of [[Molecule|molecular]] [[Defect|defects]] described.
*[[Point mutation|Point mutations]] ([[Missense mutation|missense]], [[Nonsense mutation|nonsense]], and [[Splice site mutation|splice site mutations]]) account for 67% of [[Molecule|molecular]] [[Defect|defects]] described.
*Small insertions and deletions represent 25% of such [[Defect|defects]].<ref name="LannoyAbinet2009">{{cite journal|last1=Lannoy|first1=N.|last2=Abinet|first2=I.|last3=Dahan|first3=K.|last4=Hermans|first4=C.|title=Identification ofde novodeletion in the factor VIII gene by MLPA technique in two girls with isolated factor VIII deficiency|journal=Haemophilia|volume=15|issue=3|year=2009|pages=797–801|issn=13518216|doi=10.1111/j.1365-2516.2008.01974.x}}</ref>  
*Small insertions and deletions represent 25% of such [[Defect|defects]].<ref name="LannoyAbinet2009">{{cite journal|last1=Lannoy|first1=N.|last2=Abinet|first2=I.|last3=Dahan|first3=K.|last4=Hermans|first4=C.|title=Identification ofde novodeletion in the factor VIII gene by MLPA technique in two girls with isolated factor VIII deficiency|journal=Haemophilia|volume=15|issue=3|year=2009|pages=797–801|issn=13518216|doi=10.1111/j.1365-2516.2008.01974.x}}</ref>  
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====Hemophilia B====
====Hemophilia B====
*[[Missense mutation|Missense]], [[Nonsense mutation|nonsense]], and [[Splice site mutation|splice site mutations]] in the ''F9'' [[gene]] (which is located on the X chromosome and encodes [[factor XI]]) are the most common, accounting for around 70% of [[Mutation|mutations]].<ref name="PeyvandiGaragiola2016">{{cite journal|last1=Peyvandi|first1=Flora|last2=Garagiola|first2=Isabella|last3=Young|first3=Guy|title=The past and future of haemophilia: diagnosis, treatments, and its complications|journal=The Lancet|volume=388|issue=10040|year=2016|pages=187–197|issn=01406736|doi=10.1016/S0140-6736(15)01123-X}}</ref><ref name="pmid237463">{{cite journal |vauthors=Davie EW, Fujikawa K |title=Basic mechanisms in blood coagulation |journal=Annu. Rev. Biochem. |volume=44 |issue= |pages=799–829 |date=1975 |pmid=237463 |doi=10.1146/annurev.bi.44.070175.004055 |url=}}</ref><ref name="pmid2994716">{{cite journal |vauthors=Yoshitake S, Schach BG, Foster DC, Davie EW, Kurachi K |title=Nucleotide sequence of the gene for human factor IX (antihemophilic factor B) |journal=Biochemistry |volume=24 |issue=14 |pages=3736–50 |date=July 1985 |pmid=2994716 |doi= |url=}}</ref>
*[[Missense mutation|Missense]], [[Nonsense mutation|nonsense]], and [[Splice site mutation|splice site mutations]] in the ''F9'' [[gene]] (which is located on the X chromosome and encodes [[factor XI]]) are the most common, accounting for around 70% of [[Mutation|mutations]].<ref name="PeyvandiGaragiola2016">{{cite journal|last1=Peyvandi|first1=Flora|last2=Garagiola|first2=Isabella|last3=Young|first3=Guy|title=The past and future of haemophilia: diagnosis, treatments, and its complications|journal=The Lancet|volume=388|issue=10040|year=2016|pages=187–197|issn=01406736|doi=10.1016/S0140-6736(15)01123-X}}</ref><ref name="pmid237463">{{cite journal |vauthors=Davie EW, Fujikawa K |title=Basic mechanisms in blood coagulation |journal=Annu. Rev. Biochem. |volume=44 |issue= |pages=799–829 |date=1975 |pmid=237463 |doi=10.1146/annurev.bi.44.070175.004055 |url=}}</ref><ref name="pmid2994716">{{cite journal |vauthors=Yoshitake S, Schach BG, Foster DC, Davie EW, Kurachi K |title=Nucleotide sequence of the gene for human factor IX (antihemophilic factor B) |journal=Biochemistry |volume=24 |issue=14 |pages=3736–50 |date=July 1985 |pmid=2994716 |doi= |url=}}</ref>
*[[Frameshift mutation|Frameshift mutations]] in the ''F9'' [[gene]] account for approximately 17%.<ref name="PeyvandiGaragiola2016">{{cite journal|last1=Peyvandi|first1=Flora|last2=Garagiola|first2=Isabella|last3=Young|first3=Guy|title=The past and future of haemophilia: diagnosis, treatments, and its complications|journal=The Lancet|volume=388|issue=10040|year=2016|pages=187–197|issn=01406736|doi=10.1016/S0140-6736(15)01123-X}}</ref>
*[[Frameshift mutation|Frameshift mutations]] in the F9 [[gene]] account for approximately 17%.<ref name="PeyvandiGaragiola2016">{{cite journal|last1=Peyvandi|first1=Flora|last2=Garagiola|first2=Isabella|last3=Young|first3=Guy|title=The past and future of haemophilia: diagnosis, treatments, and its complications|journal=The Lancet|volume=388|issue=10040|year=2016|pages=187–197|issn=01406736|doi=10.1016/S0140-6736(15)01123-X}}</ref>
*Large deletions and promoter region [[Mutation|mutations]] are relatively rare, accounting for 3% and 2% respectively.<ref name="PeyvandiGaragiola2016">{{cite journal|last1=Peyvandi|first1=Flora|last2=Garagiola|first2=Isabella|last3=Young|first3=Guy|title=The past and future of haemophilia: diagnosis, treatments, and its complications|journal=The Lancet|volume=388|issue=10040|year=2016|pages=187–197|issn=01406736|doi=10.1016/S0140-6736(15)01123-X}}</ref>
*Large [[Deletion (genetics)|deletions]] and [[promoter region]] [[Mutation|mutations]] are relatively rare, accounting for 3% and 2% respectively.<ref name="PeyvandiGaragiola2016">{{cite journal|last1=Peyvandi|first1=Flora|last2=Garagiola|first2=Isabella|last3=Young|first3=Guy|title=The past and future of haemophilia: diagnosis, treatments, and its complications|journal=The Lancet|volume=388|issue=10040|year=2016|pages=187–197|issn=01406736|doi=10.1016/S0140-6736(15)01123-X}}</ref>


====Hemophilia C====
====Hemophilia C====
*Hemophilia C, characterized by a [[deficiency]] of [[factor XI]], results from [[Mutation|mutations]] ([[Splice site mutation|splice site]], [[Nonsense mutation|nonsense]], or [[missense mutation]]) in the ''F11'' [[gene]].<ref name="pmid2813350">{{cite journal |vauthors=Asakai R, Chung DW, Ratnoff OD, Davie EW |title=Factor XI (plasma thromboplastin antecedent) deficiency in Ashkenazi Jews is a bleeding disorder that can result from three types of point mutations |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=86 |issue=20 |pages=7667–71 |date=October 1989 |pmid=2813350 |pmc=298131 |doi= |url=}}</ref>
*Hemophilia C, characterized by a [[deficiency]] of [[factor XI]], results from [[Mutation|mutations]] ([[Splice site mutation|splice site]], [[Nonsense mutation|nonsense]], or [[missense mutation]]) in the F11 [[gene]].<ref name="pmid2813350">{{cite journal |vauthors=Asakai R, Chung DW, Ratnoff OD, Davie EW |title=Factor XI (plasma thromboplastin antecedent) deficiency in Ashkenazi Jews is a bleeding disorder that can result from three types of point mutations |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=86 |issue=20 |pages=7667–71 |date=October 1989 |pmid=2813350 |pmc=298131 |doi= |url=}}</ref>
*[[Zygosity|Homozygous]] or [[Zygosity|compound heterozygous]] [[deficiency]] of [[factor XI]] results in a variable [[bleeding]] [[phenotype]] but the clinical presentation in [[Zygosity|heterozygotes]] is less predictable.<ref name="pmid25817556">{{cite journal |vauthors=Bauduer F, de Raucourt E, Boyer-Neumann C, Trossaert M, Beurrier P, Faradji A, Peynet J, Borg JY, Chamouni P, Chatelanaz C, Henriet C, Bridey F, Goudemand J |title=Factor XI replacement for inherited factor XI deficiency in routine clinical practice: results of the HEMOLEVEN prospective 3-year postmarketing study |journal=Haemophilia |volume=21 |issue=4 |pages=481–9 |date=July 2015 |pmid=25817556 |pmc=4657494 |doi=10.1111/hae.12655 |url=}}</ref>
*[[Zygosity|Homozygous]] or [[Zygosity|compound heterozygous]] [[deficiency]] of [[factor XI]] results in a variable [[bleeding]] [[phenotype]] but the clinical presentation in [[Zygosity|heterozygotes]] is less predictable.<ref name="pmid25817556">{{cite journal |vauthors=Bauduer F, de Raucourt E, Boyer-Neumann C, Trossaert M, Beurrier P, Faradji A, Peynet J, Borg JY, Chamouni P, Chatelanaz C, Henriet C, Bridey F, Goudemand J |title=Factor XI replacement for inherited factor XI deficiency in routine clinical practice: results of the HEMOLEVEN prospective 3-year postmarketing study |journal=Haemophilia |volume=21 |issue=4 |pages=481–9 |date=July 2015 |pmid=25817556 |pmc=4657494 |doi=10.1111/hae.12655 |url=}}</ref>



Revision as of 23:20, 28 May 2019


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

Hemophilia is a genetic bleeding disorder resulting from the insufficient levels of clotting factors in the body. The clotting factors irregularity causes a lack of clumping of blood required to form a clot to plug a site of a wound. The genes involved in the pathogenesis of hemophilia include the F8 gene in hemophilia A, F9 gene in hemophilia B, and F11 gene in C. Hemophilia predominantly affects the male population but the sub-type hemophilia C, with an autosomal inheritance pattern, can affect the males as well as females.

Pathophysiology

Physiology

The normal physiology of hemostasis can be summarized as follows:

1. Primary hemostasis

2. Secondary hemostasis

3. Fibrinolysis

Cell-Based Model of Coagulation

a. Initiation

b. Amplification

c. Propagation

Pathogenesis

  • Mild (factor level > 0.05–0.40 IU/mL)
  • Moderate (factor level = 0.01–0.05 IU/mL)
  • Severe (factor level < 0.01 IU/mL)

Hemophilia A

  1. Classic mutations in the F8 gene that cause structural changes in the FVIII molecule or even produce a truncated protein lacking essential functional domains.[18][19]
  2. Mutations in proteins that interact intracellularly in the correct folding and trafficking of the FVIII protein or mutations in extracellular plasma proteins such as von Willebrand factor (VWF).[20][21][22][23]
  3. The third category encompasses patients who have the clinical disease but have no mutations in the F8 gene or in any of the known interacting partners.[16]

Hemophilia B

Hemophilia C

Genetics

Hemophilia A

Hemophilia B

Hemophilia C

Associated Conditions

  • Hemophilia can be associated with the following conditions:

Gross Pathology

On gross pathology, hemophilia is characterized by the following findings:

Microscopic Pathology

On microscopic histopathological analysis, hemophilia can be characterized by the following findings:

References

  1. Lippi G, Favaloro EJ, Franchini M, Guidi GC (February 2009). "Milestones and perspectives in coagulation and hemostasis". Semin. Thromb. Hemost. 35 (1): 9–22. doi:10.1055/s-0029-1214144. PMID 19308889.
  2. Lippi G, Franchini M, Guidi GC (2007). "Diagnostic approach to inherited bleeding disorders". Clin. Chem. Lab. Med. 45 (1): 2–12. doi:10.1515/CCLM.2007.006. PMID 17243907.
  3. Favaloro, Emmanuel (2017). Hemostasis and thrombosis : methods and protocols. New York: Humana Press Springer. ISBN 9781493971961.
  4. Sadler JE, Budde U, Eikenboom JC, Favaloro EJ, Hill FG, Holmberg L, Ingerslev J, Lee CA, Lillicrap D, Mannucci PM, Mazurier C, Meyer D, Nichols WL, Nishino M, Peake IR, Rodeghiero F, Schneppenheim R, Ruggeri ZM, Srivastava A, Montgomery RR, Federici AB (October 2006). "Update on the pathophysiology and classification of von Willebrand disease: a report of the Subcommittee on von Willebrand Factor". J. Thromb. Haemost. 4 (10): 2103–14. doi:10.1111/j.1538-7836.2006.02146.x. PMID 16889557.
  5. Yee A, Kretz CA (February 2014). "Von Willebrand factor: form for function". Semin. Thromb. Hemost. 40 (1): 17–27. doi:10.1055/s-0033-1363155. PMID 24338608.
  6. Favaloro, Emmanuel (2017). Hemostasis and thrombosis : methods and protocols. New York: Humana Press Springer. ISBN 9781493971961.
  7. Favaloro, Emmanuel (2017). Hemostasis and thrombosis : methods and protocols. New York: Humana Press Springer. ISBN 9781493971961.
  8. Kwaan H, Lisman T, Medcalf RL (March 2017). "Fibrinolysis: Biochemistry, Clinical Aspects, and Therapeutic Potential". Semin. Thromb. Hemost. 43 (2): 113–114. doi:10.1055/s-0036-1598000. PMID 28253534.
  9. 9.0 9.1 Hoffman, Maureane (2003). "A cell-based model of coagulation and the role of factor VIIa". Blood Reviews. 17: S1–S5. doi:10.1016/S0268-960X(03)90000-2. ISSN 0268-960X.
  10. Favaloro, Emmanuel (2017). Hemostasis and thrombosis : methods and protocols. New York: Humana Press Springer. ISBN 9781493971961.
  11. Favaloro, Emmanuel (2017). Hemostasis and thrombosis : methods and protocols. New York: Humana Press Springer. ISBN 9781493971961.
  12. Bonar RA, Lippi G, Favaloro EJ (2017). "Overview of Hemostasis and Thrombosis and Contribution of Laboratory Testing to Diagnosis and Management of Hemostasis and Thrombosis Disorders". Methods Mol. Biol. 1646: 3–27. doi:10.1007/978-1-4939-7196-1_1. PMID 28804815.
  13. 13.0 13.1 13.2 13.3 13.4 13.5 13.6 Mannucci PM, Tuddenham EG (June 2001). "The hemophilias--from royal genes to gene therapy". N. Engl. J. Med. 344 (23): 1773–9. doi:10.1056/NEJM200106073442307. PMID 11396445.
  14. 14.0 14.1 14.2 Bolton-Maggs, Paula HB; Pasi, K John (2003). "Haemophilias A and B". The Lancet. 361 (9371): 1801–1809. doi:10.1016/S0140-6736(03)13405-8. ISSN 0140-6736.
  15. 15.0 15.1 Berntorp E, Shapiro AD (April 2012). "Modern haemophilia care". Lancet. 379 (9824): 1447–56. doi:10.1016/S0140-6736(11)61139-2. PMID 22456059.
  16. 16.0 16.1 16.2 Oldenburg, Johannes; El-Maarri, Osman (2006). "New Insight into the Molecular Basis of Hemophilia A". International Journal of Hematology. 83 (2): 96–102. doi:10.1532/IJH97.06012. ISSN 0925-5710.
  17. Roosendaal G, Lafeber FP (July 2006). "Pathogenesis of haemophilic arthropathy". Haemophilia. 12 Suppl 3: 117–21. doi:10.1111/j.1365-2516.2006.01268.x. PMID 16684006.
  18. Morris JA, Dorner AJ, Edwards CA, Hendershot LM, Kaufman RJ (February 1997). "Immunoglobulin binding protein (BiP) function is required to protect cells from endoplasmic reticulum stress but is not required for the secretion of selective proteins". J. Biol. Chem. 272 (7): 4327–34. PMID 9020152.
  19. Pipe SW, Morris JA, Shah J, Kaufman RJ (April 1998). "Differential interaction of coagulation factor VIII and factor V with protein chaperones calnexin and calreticulin". J. Biol. Chem. 273 (14): 8537–44. PMID 9525969.
  20. Nichols WC, Seligsohn U, Zivelin A, Terry VH, Hertel CE, Wheatley MA, Moussalli MJ, Hauri HP, Ciavarella N, Kaufman RJ, Ginsburg D (April 1998). "Mutations in the ER-Golgi intermediate compartment protein ERGIC-53 cause combined deficiency of coagulation factors V and VIII". Cell. 93 (1): 61–70. PMID 9546392.
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