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Hemophilia C (Factor XI Deficiency): An Overview

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Being safe should be your first priority if you have hemophilia C. It is erratic and frequently goes undetected until an injury or surgery is performed.

Written byDr. Lochana .k

Medically reviewed byDr. Nagaraj Patil

Published At November 16, 2020
Reviewed AtFebruary 14, 2025
Hemophilia C (Factor XI Deficiency): An Overview

What Is Hemophilia C?

Imagine undergoing surgery, expecting a smooth recovery, only to find that your blood refuses to clot, leaving you vulnerable to prolonged bleeding. This is a terrifying reality for a person with hemophilia C (factor XI deficiency).

Now, what is hemophilia C? Hemophilia C is a rare, usually genetic condition that makes it harder for blood to clot, causing longer bleeding even from small cuts or injuries.

Hemophilia C stands out because it affects both males and females equally. Although rare, understanding this condition is key to managing its symptoms effectively. With the right care and treatment, people with hemophilia C can lead full, active lives—showing that even uncommon conditions deserve attention. Keep reading to learn more!

Why Is Hemophilia C Called Factor XI Deficiency?

Hemophilia C is also known as "Factor XI deficiency" because it is caused by a shortage or absence of clotting factor XI, a protein essential for blood clotting. Picture blood clotting as a construction crew rushing to repair a broken dam. In hemophilia C, also called "Factor XI deficiency," an essential worker—clotting factor XI—is missing from the team. Without it, the repairs are slow, leading to excessive bleeding even from small injuries. The name itself highlights the missing factor, helping doctors diagnose and manage the condition effectively.

How Rare Is Hemophilia C?

Hemophilia C is a rare disorder, affecting approximately one in 100,000 people worldwide. However, its prevalence can vary among various populations, with a higher occurrence in individuals of Ashkenazi Jewish descent (Jewish descent), where the carrier rate is around 8 percent.

Causes and Risk Factors

The cause? A shortage or complete absence of clotting factor XI, a vital protein responsible for helping blood clot. Hemophilia C is inherited when both parents pass on a faulty gene to their child. This is called an autosomal recessive pattern, unlike Hemophilia A and B, which mainly affect males because they are linked to the X chromosome.

  • Genetic Causes of Hemophilia C - Think of hemophilia C as a small glitch in the body's blueprint. It happens due to a mutation in the gene responsible for clotting factor XI, found on chromosome 4. Unlike hemophilia A and B, which mainly affect males, hemophilia C affects both males and females equally.

This glitch results in the body not producing adequate clotting factor XI. There is, therefore, a potential for bleeding. For a child to have hemophilia C, both parents must give the child the faulty gene; this is akin to acquiring two mismatched pieces of a puzzle. If only one parent carries the gene, the child is a carrier-they hold onto the mutation without exhibiting symptoms.

Who Is Most at Risk?

Curious about why some people are more prone to this disease? Let us take a closer look:

  • Family History: Hemophilia C runs in families. It is an autosomal recessive disorder, which means a child must inherit the faulty gene from both parents to have the condition. If only one parent passes it down, the child becomes a carrier but has no symptoms.

  • Ashkenazi Jewish Descent: Individuals of Ashkenazi Jewish heritage have a higher prevalence of hemophilia C, with approximately 8 percent being carriers of the factor XI deficiency gene.

Hemophilia C and Ashkenazi Jewish Descent

Ashkenazi Jews are people whose ancestors came from Central and Eastern Europe. Because this group was somewhat isolated for centuries, certain inherited conditions are more common (Tay-Sachs disease, Gaucher disease, and hemophilia C).

Hemophilia C inheritance is more common in individuals of Ashkenazi Jewish descent than in the general population. This is because genetic factors have been passed down through generations due to historical population isolation and intermarriage. About 1 in 100 people in this group are carriers, and 1 in 450 have the condition. If you have Ashkenazi Jewish ancestry, genetic screening and medical advice can help assess your risk and guide proper care.

Symptoms of Hemophilia C

The symptoms of hemophilia C can appear in different ways. Some people might only have mild signs, while others could experience more frequent and serious bleeding episodes. It all depends on how much factor XI is missing from the body.

Common Symptoms in Adults

Symptoms of hemophilia C in adults:

  • Unusual bruising.

  • Prolonged bleeding after cuts or injuries.

  • Spontaneous bleeding into muscles or joints causes swelling, pain, and stiffness.

  • Long-term damage to joints and muscles if bleeding episodes are not treated.

  • Frequent nosebleeds in severe cases.

  • Excessive bleeding after dental procedures.

Symptoms in Children and Newborns

Hemophilia C can be a quiet challenge to detect in newborns and young children. Parents may notice strange bruising, swelling, or bleeding from even the tiniest of tumbles. In more serious cases, internal bleeding can sneak into the joints, causing discomfort and pain. Keeping a close watch for any signs of unusual bleeding is key—early action can help prevent bigger issues down the road.

Differences Between Hemophilia A, B, and C

What sets hemophilia C apart from its more well-known cousins, hemophilia A and B, is that it is caused by a deficiency in clotting factor XI, not the typical factors seen in A and B. Hemophilia A and B, which predominantly affect males.

Hemophilia A, B, and C all involve problems with blood clotting, but they are caused by missing different clotting factors. Hemophilia A is due to a lack of factor VIII, Hemophilia B is due to a lack of factor IX, and hemophilia C is caused by a lack of factor XI. Hemophilia A and B are linked to the X chromosome, so they mostly affect males, while hemophilia C is passed down in a way that can affect both males and females equally. This basic difference between hemophilia A, B, and C helps in the further diagnosis. Read below to know how it helps in diagnosis.

Diagnosis and Testing

Finding hemophilia C early gives a head start in preventing problems. Early diagnosis helps doctors manage the condition and keep it under control. To confirm hemophilia C, your doctor can use a mix of family history, physical examinations, and laboratory tests like assembling clues to solve a mystery and get the right treatment in place.

How Is Hemophilia C Diagnosed?

To diagnose hemophilia C, doctors will start by looking at the patient's symptoms and family history of bleeding problems. If they suspect hemophilia C, they will order blood tests to check the levels of clotting factor XI. A low level of this factor in the blood is the main sign of the condition.

  • Blood Tests and Clotting Factor Tests - Doctors use blood tests, especially a clotting factor assay, to measure factor XI levels. Normal levels range from 70 to 150 percent, but in hemophilia C, they are below 30 percent, confirming the diagnosis.

Other tests include:

  • aPTT (Activated Partial Thromboplastin Time) Test: Checks clotting time, which is usually prolonged in hemophilia C.

  • Genetic Testing: Identifies mutations in the F11 gene to confirm the cause and assess family risk.

  • Challenges in Diagnosing Hemophilia C - Because hemophilia C is rare and its symptoms can mimic other bleeding disorders, it is often misdiagnosed or not considered until more severe bleeding episodes occur. A late diagnosis can cause problems. Doctors should check for hemophilia C if a patient has unexplained bleeding, especially with a family history of clotting disorders.

What Are the Treatment and Management Strategies?

Although there is no cure for hemophilia C, treatment options are available to manage the condition and prevent excessive bleeding. The goal of treatment is to replace the missing clotting factor and minimize the risk of bleeding episodes.

  • Fresh Frozen Plasma Treatment - The main treatment for hemophilia C is fresh frozen plasma or FFP. It contains clotting factors necessary for proper clotting, such as Factor XI. When you have surgery or are injured, FFP prevents you from bleeding too much by helping your body respond appropriately. People with severe hemophilia C benefit from frequent FFP injections because they reduce the risk of spontaneous bleeding and guarantee their safety.

  • Medications for Hemophilia C - In addition to fresh frozen plasma (FFP), other treatments can help manage hemophilia C. One option is Desmopressin (DDAVP), a medication that stimulates the release of certain clotting factors. While it is more effective for hemophilia A, some patients with hemophilia C may benefit from it in certain situations. The story doesn't end there; research is always moving forward, with scientists working on new medications and treatments to improve care. So, who knows? There may be even better options just around the corner.

  • Managing Heavy Bleeding in Women - For women with hemophilia C, dealing with heavy menstrual bleeding can be a bit more challenging. But there are solutions! Hormonal therapies, like birth control pills or hormone replacement therapy, can help regulate periods and ease the risk of excessive bleeding. In some cases, a boost of clotting factors might be needed to keep things in check, ensuring that every month runs more smoothly.

Living With Hemophilia C

Living with hemophilia C requires a little extra planning and care, but it doesn’t mean slowing down. By adjusting your lifestyle and staying on top of treatment, you can reduce bleeding risks and continue living a full, active life, showing that with the right support, nothing is out of reach.

  • Lifestyle and Precautions - People with hemophilia C should be careful to avoid injuries. This means wearing protective gear during physical activities and being cautious with daily tasks to prevent falls. Regular check-ups with a doctor are important to manage the condition and catch any problems early.

  • Surgery and Dental Procedures With Hemophilia C- Unlike hemophilia A and B, hemophilia C does not cause spontaneous bleeding but can lead to significant blood loss after medical procedures. To prevent complications, doctors use fresh frozen plasma (FFP) before and after surgery to replace missing factor XI and may prescribe Tranexamic acid for dental work. Before undergoing any procedure, keep your doctor in the loop about your health!

When to See a Doctor?

If you or your child notice unexplained bruises, joint pain, or bleeding that will not stop, do not wait! Getting checked early can help prevent bigger issues and improve quality of life. A quick visit to the doctor can make all the difference. You can also consult experienced doctors online at iCliniq for expert advice and guidance from the comfort of your home!

Conclusion:

Hemophilia C, also known as Factor XI deficiency. A rare condition caused by a deficiency in an important clotting protein called Factor XI, it is good that, in comparison to other types of hemophilia, hemophilia C most commonly presents with minimal symptoms, thus managing better and having a good quality of life.

Note From iCliniq:

Hemophilia C, or Factor XI deficiency, is a rare bleeding disorder because of the deficiency of Factor XI, a protein required for blood clotting. Unlike Hemophilia A and B, it presents with mild or unpredictable bleeding tendencies in the majority of cases after surgery or trauma and not spontaneously. It occurs more frequently in individuals with Ashkenazi Jewish heritage. It is managed according to the severity and sometimes with fresh frozen plasma or Factor XI concentrates.

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Frequently Asked Questions

Hemophilia C occurs due to a mutation in gene F11. This gene carries the instructions for creating factor XI. Hence, this gene may not make enough factor XI or may not make it at all. Both males and females may get hemophilia C by inheriting the mutated genes from both parents.
Hemophilia patients' life expectancy varies depending on whether the patient got the treatment on time. However, hemophilia patients have been found to have ten years less life expectancy than healthy men. Many patients die before adulthood if adequate treatment is not provided.
Hemophilia C occurs due to a mutation in gene F11, which is present on chromosome 4. The mutated copy of F11 is inherited in two copies by everyone without any gender predilection affecting both males and females equally. However, it is less common than hemophilia A and B.
Hemophilia C is a rare condition. It affects 1 in 100000 men and women in the United States, making hemophilia A ten times more common than hemophilia C. It affects males and females equally, and people of any age group can get affected by this.
Hemophilia is a hereditary bleeding disorder in which a blood clot does not happen properly. This condition involves spontaneous bleeding following minor injuries or surgical procedures. Hemophilia generally affects the proteins present in blood that helps in blood clotting.
Hemophilia A and B occur by inheriting a mutated gene from one of the parents. In hemophilia C, both biological parents may inherit the mutated genes. People with hemophilia C do not have bleeding issues, and it occurs due to problems in factor XI.
Hemophilia C is an autosomal recessive disorder. It is caused by a lack of factor XI, causing problems in blood clotting. In a recessive pattern, the child can get defective genes from each parent, and the parents usually do not have any symptoms of this condition.
A hemophilia patient should avoid playing contact sports with high chances of injury, such as football, hockey, or wrestling. They must also avoid certain medications, such as aspirin and ibuprofen, which can worsen the bleeding. In addition, maintaining good dental hygiene and getting vaccinations at an appropriate age is necessary.
There is no cure for hemophilia. However, the condition can be managed to lead a good and healthy life. As it affects blood clotting factors, medicines can be given to prevent and treat prolonged bleeding.
Hemophilia includes various complications that can get worsen with age which include the following:
  - Intracranial hemorrhage (bleeding between brain tissues).
- Joint disease.
- Inhibitor development (an immune system response to infused clotting factors in the body).
 
Living with these complications can be challenging, but these can be managed with medications.
The best method to treat hemophilia or prevent bleeding is to replace the missing blood clotting factor [in hemophilia A, the missing clotting factor is Factor VIII (8) and in Hemophilia B, the missing clotting factor is Factor IX (9)] so that the blood can clot properly. This can be done by injecting the deficient blood clotting factor directly into the patient’s vein.
The immune system starts to react negatively in people with severe hemophilia. This affects the clotting factors [in hemophilia A, the missing clotting factor is Factor VIII (8) and in hemophilia B, the missing clotting factor is Factor IX (9)] used to treat bleeding. As this happens, the immune system develops the proteins that prevent the clotting factors from functioning properly, making the treatment less effective.
Hemophilia is an inherited genetic condition passed down from parent to child through their genes. The gene for hemophilia is found on the X chromosome, which is usually passed from mother to son. If a woman is a carrier of the gene, she has a 50% chance of passing the gene on to each of her children. However, Hemophilia can also occur as a spontaneous genetic mutation, which means it occurs in a person with no family history of the condition. In such cases, the risk of passing the condition on to future generations is low.

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