In this issue of The Journal, an article by Scranton et al (p 2028) refers to several cases of hemophilia with inhibitors (anti-factor VIII antibodies) and describes some displeasing neuromuscular complications. These grizzly events are most commonly seen in those major hemophilia treatment centers that tend to attract this type of patient. Yet, the experience described by Scranton et al shows how problems of this sort can also be seen in private medical practice.
Hemophiliacs represent perhaps one per 10,000 to 20,000 of the total population. Thus, each million people will include 50 to 100 such patients, of whom perhaps five will have inhibitors. Clearly, few physicians will have the opportunity to gain more than passing experience of this disorder. Yet, the clinical complexity of hemophilia demands specialized expertise. The combination of orthopedic sensitivity and hematologic sophistication exhibited in this article can only be expected in institutions accustomed to hemophilia.