Q&A: Symptoms and Combat Implications of Hemophilia

I’m writing a character that has to engage in hand-to-hand combat but she has haemophilia. So, fighting face to face would be the last thing she’d want to do. Is there any fighting styles/techniques that she would learn that would decrease her chance of getting a wound?

For those unfamiliar, Hemophilia is a genetic mutation that impairs clotting. Specifically, the mutation prevents the production of specific proteins responsible for coagulation of blood. This usually gets presented as the patient having difficulty managing injuries suffered, and that part is true; a hemophilic needs to be careful of any injury (including bruising) as it can potentially become life threatening.) However, it goes beyond that.

The reduced clotting factors do mean that injuries, particularly severe ones, will result in difficult to control bleeding. This is also an issue with post-surgery. Spontaneous bleeding can also result in joint stiffness or pain (from internal hemorrhaging around the joints), bleeding into the soft tissue, (which can manifest as bruising or hematomas), chronic, and persistent nosebleeds. A bleed, including a spontaneous one, in a vital organ can kill you.

The defect that produces hemophilia is carried on the X chromosome. This means that, while women can be hemophilic it’s quite rare. Their father would need to be hemophilic, and their mother would either need to hemophilic or a carrier (meaning one of their chromosomes had the mutation, and as a result were not symptomatic.) If their mother was non-symptomatic, there’d still only be 50% chance of their daughters being hemophilic.

Because it’s extremely unlikely to occur in girls, it’s rarely tested for unless symptoms have been identified. (With boys, it’s common to test for hemophilia at birth if there’s any family history of it.) In particular, two major symptoms for women that are tracked are extremely heavy menstrual bleeding, and menorrhagia (where mensuration lasts for more than 7 days.) As a result, it’s uncommon for (mild cases of) hemophilia to be diagnosed in girls before puberty.

Treatment is usually handled by administering concentrated clotting factor proteins to the patient. Keep in mind, this is, “treatment,” not a cure. With sufficient technology, it may be possible to use an implant to administer clotting factor proteins on a regular basis. Of course, it might also be possible to use a retrovirus (such as crisper) to modify and remove the genetic defect. If you’re in a less technologically advanced setting (alternately a disaster scenario that extends over multiple months, or a post-apocalyptic setting), prepackaged protein infusions probably aren’t an option.

When it comes to violence, hemophiliacs really can’t afford to get into a fight. Under normal circumstances, you’re going to end up with minor bruising from hand to hand combat. Add in hemophilia, and that bruising is going to be significantly more dangerous. You’re looking at an internal hemorrhaging risk that someone without the mutation wouldn’t need to worry about. At the upper end of the spectrum, this includes a real risk of seizure from blows to the head, even with a relatively mild cases of hemophilia. Relatively minor trauma can be life threatening for a hemophiliac.

Here’s a problem, martial arts training will include a lot of, “relatively minor trauma.” You’re going to end up with bruises on your arms, on your thighs, on your hands. You’re going to end up with bruises in places you can explain, and bruises in places you can’t. You’re going to get banged up. That’s normal. That’s not accidents. That’s not sparring. That comes from the training itself. You will do it to yourself, and not even be aware of it at the time. Accidents, when they happen, are much worse, and you can easily see broken bones or soft tissue injuries. For a hemophiliac, the normal wear and tear of marital arts training comes with a very real risk of death. This doesn’t mean a hemophiliac can’t train in martial arts (many do), but, it does preclude combat training (and full contact training of any kind.) Hemophilia even precludes joint manipulation, both applying and receiving. It’s stereotyped as the “gentle” form of martial arts, but the strain it puts on your body is actively hazardous to someone with hemophilia. It’s the kind of physical disability a dojo needs to know about, and needs to plan around.

To put this in context, I’m currently looking at a case where a middle aged man fell 3 meters (roughly 10 feet), and was hospitalized from hemorrhagic shock. Meaning, a relatively mild accident, which you or I would probably just complain about, but go on with our day, nearly killed him from blood loss, due to his body’s inability to clot. He was in the hospital for 10 days and had to undergo surgery to survive.

So, while someone with hemophilia can live a full life, mild trauma is life threatening to them. Engaging in violence will kill them. Barring significant medical treatment, they need to live carefully. Additionally, hemophilia among women is real, but is also quite rare, because the mutation needs to occur on both of their X chromosomes.

I’m inclined to say, “no,” there really isn’t this character could be getting into fights (and surviving), unless their clotting factors have been brought up to line with non-hemophiliac blood levels.


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