Small wounds and punctures are usually not a problem for hemophiliacs and can be treated as in a nonhemophiliac. Uncontrolled internal bleeding, however, can result in pain and swelling and permanent damage, especially to joints and muscles. The symptoms often first appear in toddlers as their joints begin to bear weight.
There is no cure for hemophilia, but treatment has been refined in recent years. In the 1960s, infusion of concentrated clotting factors replaced the whole-blood or plasma transfusions previously necessary, allowing most to administer preventive treatment at home. In the 1980s, however, many hemophiliacs became infected with hepatitis or HIV (the AIDS virus) that was present in contaminated concentrated clotting factor. Blood donors are now screened, and commercial products are now heat-treated to kill the viruses. Genetic screening can identify carriers of hemophilia, and the status of fetuses can be now be ascertained early in pregnancy. Treatments under study include gene therapy by insertion of healthy factor VIII or IX genes and fetal tissue implants.
Examples of the transmission of hemophilia have been found in several royal families. The family of Queen Victoria of England and, later, that of her granddaughter the Czarina Alexandra Feodorovna were affected. The apparent ability of Rasputin to check the hemophilia of the czarina's son was the basis of his hold over her and the czar. The family of Alfonso XIII of Spain, who married another granddaughter of Victoria, was also affected.