Can Haemophilia Genes Cause Serious Bleeding After Delivery?

Expecting mums who carry the Haemophilia gene are at an increased risk of severe bleeding after delivery. This is because, the high levels of factor VIII (an essential blood-clotting protein, also known as anti-hemophilic factor) during pregnancy fall back to lower levels after childbirth. If an expecting mum has low levels of factor IX (a protein produced naturally in the body that helps the blood form clots to stop bleeding) she can bleed heavily after delivery.

On the other hand, some new mums also suffer from Postpartum Haemorrhage (PPH), wherein bleeding from the birth canal can last for a few months post delivery. Typically, this condition requires a treatment.

Thus, women with symptoms of Haemophilia or those who carry the Hemophilia gene should be checked by a doctor. Let’s dive deep to know more about ead on to know about Haemophilia, its different types, causes, symptoms and treatments.

Types Of Haemophilia

Haemophilia genes can cause severe bleeding after delivery, because this rare inherited bleeding disorder doesn’t allow blood to clot normally due to lack of blood-clotting proteins or clotting factors. In fact, those who have this gene might bleed for a longer time after an injury as well.

Now, there are three typs of haemophilia, identification of which can help zero in on its treatment.

• Haemophilia A. Type A is the most common type of Haemophilia and a deficiency in factor VIII causes this form of Haemophilia.
• Haemophilia B. This type of Haemophilia occurs due to the deficiency of clotting factor IX.
• Haemophilia C. It is also known as “factor XI deficiency” and is a rare form of Haemophilia. It was first discovered in 1953 in people with severe bleeding after dental extractions.

Haemophilia is an inherited genetic condition and isn’t curable. But it can be treated to minimise symptoms and prevent future health complications.

Causes of Haemophilia

The primary cause of Haemophilia is a mutation in the genes that control and regulate the development of clotting factors. The clotting factors help the blood to form clots that seal up the wounds.

For both Haemophilia A and B, about two-thirds of the mutations come from a parent. The remaining can occur as a spontaneous mutation even in people who do not have a family history of Haemophilia.

Symptoms of Haemophilia

The major symptom of Haemophilia is bleeding, either prolonged external bleeding or bruising after minor trauma or for no apparent reason. However, symptoms might vary depending on whether the patient has a mild, moderate, or severe form of the disorder.

In severe cases of Haemophilia, unprovoked or spontaneous bleeding episodes occur often. Prolonged bleeding tends to occur after a more significant injury in case of moderate Haemophilia and in mild Haemophilia, a patient might have unusual bleeding only after a major injury, surgery, or trauma.

How Does Haemophilia Affect Pregnancy And Childbirth?

During pregnancy, the body enters a pro-coagulation or pro-clotting state in preparation for the bleeding that occurs during childbirth. During this state, there is an increase in the production of clotting factors that promote blood clotting and a decrease in the production of anticoagulant factors which prevent such clotting.

In Haemophilia carriers, clotting factor levels do rise during pregnancy. But these levels are still generally much lower than the non-carriers. As such, women who are Haemophilia carriers might be at an increased risk of postpartum haemorrhage (heavy bleeding following childbirth).

An expecting mum who is a carrier of the Haemophilia gene can have low factor VIII (8) or factor IX (9) levels and have symptoms of Haemophilia. 

Mums who are Haemophilia carriers (women who have a gene mutation in one of their X chromosomes), might have mild bleeding symptoms due to reduced clotting factor levels in their blood. It is important to determine a woman’s carrier status for planning a safe pregnancy and childbirth.

If the mother is a Haemophilia carrier, there are chances that the baby will be born with Haemophilia. In families with a known history of Haemophilia, or in those with a prenatal genetic diagnosis of Haemophilia, it is advisable to plan special testing for Haemophilia before the delivery.

Instead of a venipuncture, a sample of blood can be drawn from the umbilical cord that connects the mother and baby in the womb and tested for clotting factor levels.

In normal newborns, factor VIII levels are similar to normal adult values. Low levels indicate Haemophilia. However, levels of factor IX, a vitamin K dependent factor, might be low at birth and reach adult values by six months of age.

It is important to know as soon as possible after birth if a baby has Haemophilia. This is so because special steps can be taken to prevent bleeding complications for the baby.

Before becoming pregnant, women who are carriers need clear and accurate information about:

• The chances of the child having Haemophilia (carrier women have a 50% chance of passing the disorder to their children).

• Consequences of inheriting Haemophilia for both male and female children.

• How is haemophilia treated and what care is available?

• How pregnancy, labour and delivery should be managed to reduce risks to both the mum and the infant?

• The available options for conception, prenatal diagnosis and fetal sex determination.

Testing of Babies for Haemophilia

Some babies should be tested for Haemophilia right after birth, including:

• Babies born to families having a history of Haemophilia.

• Babies whose mums are carriers of Haemophilia.

• Babies having bleeding symptoms at birth.

Cord blood can be used to test them for clotting proteins. However, this should be repeated when the baby is six months of age to confirm the diagnosis of Haemophilia.

Circumcision

Sometimes, parents choose to have their baby boys circumcised. This means that the foreskin from the penis is removed. Bleeding from circumcision is a common cause of bleeding among babies with Haemophilia.

Bleeding of the Head

The head is the second most common place of bleeding amongst babies affected by Haemophilia. Since the head is squeezed when the baby goes through the birth canal, bleeding of the head can be a possibility.

The baby’s head might also bleed when forceps or vacuum extractor is applied to the baby’s head to assist with the delivery and help pull the baby out. Head bleeding can be in the scalp or into the brain and can be serious. 

The signs and symptoms of bleeding into the brain in the newborn baby are very nonspecific and can be difficult to diagnose Haemophilia. Once diagnosed, bleeding in the head needs to be treated immediately with clotting factor concentrates. Without treatment to stop it, the bleeding can be life-threatening and can lead to long-term brain damage.

The treatment for Haemophilia depends on the type and severity of the disorder. The treatment includes replacement therapy in which human plasma concentrates or recombinant forms (produced from DNA) of the clotting factors VIII or IX are given to replace the blood clotting factors that are deficient.

During the replacement therapy, the clotting factors are injected or infused into a patient’s vein in the arm or a port in the chest. Usually, people with mild or moderate Haemophilia do not need replacement therapy until they are going to have surgery.

DISCLAIMER: We have taken steps to check the accuracy of information & practices shared above; however, it is not a replacement for a doctor’s opinion. Please check with either your doctor, or an expert, before trying any suggestion, practice, or medication mentioned here.