Gastrointestinal Bleed in the Context of Hemophilia A in an Incarcerated Patient in the Rio Grande Valley

Background: Hemophilia A, the most common X-linked hereditary hemostasis disorder, has an incidence of approximately 1 in 5600 male live births worldwide. It results from a deficiency of clotting factor VIII, crucial for fibrin generation in the coagulation cascade, leading to inadequate fibrin generation and defective secondary hemostasis. Hemophilia can cause life-threatening bleeding, characterized as severe (<1% factor VIII activity), moderate (2-5%), or mild (6-40%). Social determinants of health pose significant challenges in managing hemophilia in underserved populations. This case presents gastrointestinal bleeding in a mild hemophilia A patient in the Rio Grande Valley. Case Presentation: A 24-year-old Hispanic male with mild hemophilia A presented with a three-day history of melena, headaches, dizziness, and mild abdominal discomfort. Despite recent normal colonoscopy and EGD results, he had a history of intermittent black stool episodes. On admission, he was hypotensive and bradycardic with significant anemia and severe iron deficiency. Endoscopy revealed a small hiatal hernia and mild gastric erosions. He received two units of pRBCs, oral ferrous sulfate, pantoprazole, and recombinant Factor VIII. Hematology recommended follow-up and continued treatment. Conclusions: This case highlights the importance of recognizing social determinants of health in managing mild hemophilia A, emphasizing the need for education, access to care, and regular follow-up. The patient's incarceration and limited access to factor replacement underscore the risk of life-threatening emergencies. Addressing barriers to accessing necessary interventions is crucial for improving outcomes in hemophilia patients.