Doug, 12, experiences frequent nosebleeds, easy bruising, and blood in the urine; his parents discourage him from contact sports due to his condition. Which disorder best explains his symptoms?

• A. Lymphoma
• B. Hemophilia
• C. Neoplasm
• D. Leukemia

Answer: (B)

Bleeding that occurs easily—especially frequent nosebleeds and bruising—along with blood in the urine in a young boy points to a inherited defect in the clotting cascade rather than a problem with blood cells. Hemophilia is a deficiency of a coagulation factor (most often factor VIII or IX) that impairs the body's ability to form a stable fibrin clot. Because the clotting process is defective, bleeding after minor injuries can be prolonged and mucosal sites like the nose or urinary tract can ooze. The male patient fits the X-linked pattern of Hemophilia, which is why this tends to present in boys. In contrast, lymphomas or leukemias involve abnormal cell growth and typically present with systemic symptoms and abnormal blood counts rather than a primary problem with clotting factors, making them less likely explanations for this specific bleeding pattern.