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1. Pedigree + Pathogenesis of Hemophilia
2. Types of bleeding disorder ( inherited )
- focus more on Hemophilia A ( clinical features ,
3. Complications of hemophilia
4. Pathophysiology of hemarthrosis
5. Interpret Laboratory investigations
- explain coagulation cascade
- list examples of disease for other factor deficiency
6. Hemophilia vs von Willebrand disease
7. Ethical concerns
- Exceptions for having circumcision due to diseases
- MERCI
- Treatment
8. Symptoms of bleeding disorder correlate with ddx

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Medical
- prolonged bleeding
- Risk factor of circumcision : bleeding & injury
- suggested to done circumcision early ( easy to take care )
- advice patient to take care of hygiene
- circumcision get risky when you get older - pain , infection

Empathy
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- inherited bleeding disorder in which the blood does not clot properly
- decrease in activity of coagulating factor (reduce or dysfunction )
- why A? - due to reduce in factor VIII
- B - reduce in factor XI
- determine by specific factor assay
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PT ( Prothrombin Time ): Normal
- extrinsic pathway & common pathway

APTT ( Activated Partial Thromboplastin time ) : Prolonged
- problem with intrinsic pathway
- effect coagulation cascade

Platelet : Normal

Factor VIII : Low

* List Examples of disease for other factors deficiency

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Laboratory investigation results were as follows:
PT :14 seconds (Normal Range: 12.6-15.7 seconds)
APTT : 60 seconds (Normal Range: 30.0-45.8 seconds)
Platelet : 200 x109/L
Factor VIII level : 5% (Normal Range: 50-150%)

He was diagnosed with Haemophilia A and managed accordingly after discussion with the parents

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5. Bleeding disorder
- rare disorders affecting the way the body controls blood clotting
- inherited : platelet dysfunction , thrombocytopathy , hemophilia , von Willebrand disease

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4. Maternal uncle - frequent hospitalization due to recurrent bleeding in knee joint

- uncle from mother side
- mother is asymptomatic
- disease carried by chromosome X
- to know the disease carried by which chromosome is through pedigree

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2. Prolonged bleeding for 2 days ( CC )
- impaired of haemostasis ( def : keep the blood in fluid form in circulation to arrest bleeding following injury to blood vessel )
- impaired to 5 major component ( blood vessel , platelet , vwf, coagulation factor , coagulation inhibitir , fibrinolytic system )

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1. Adam , 7 year old boy
- minor
-presence of  congenital or inherited disease
- gender : pattern of inheritance
- age for circumcision : Malaysia ( 7 -12 yrs )

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Myth of getting circumcised at the young age.

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Myth of getting circumcised at the young age.

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- whats the exact age to perform circumcision
- share awareness
- Risk factor : aging
- circumcised at early age : easy to take care
- Decision made by Adam's parents as he is just 7 years old
- Educate the parents about the risk factors , complications
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Adam, a 7-year-old boy presented with prolonged bleeding for 2 days duration following circumcision. His grandmother was blaming Adam’s father on his decision in doing circumcision at the early years. His maternal uncle had history of frequent hospitalizations due to recurrent bleeding in the knee joint. Bleeding disorder was suspected and investigated