Delayed Diagnosis of Hemophilia B Presenting with Hematemesis

A 36-year-old nonalcoholic gentleman presented with history of moderate-amount hematemesis. He received multiple blood transfusions. upper gastrointestinal endoscopy was done which showed no evidence of varices, but a tiny bleeding ulcer was seen in lower end of esophagus; sclerosing agent was injected at the base of ulcer. All the blood investigations were normal. A diagnosis of Dieulafoy’s lesion was made. After two months, he developed hemarthrosis after sustaining injury in right knee. Again investigations were done and coagulation profile revealed raised activated partial thromboplastin time and normal prothrombin time. Factor VIII and IX assay were sent in view of raised aPTT. Factor VIII and IX was 120% and 4% of normal respectively. Von Willebrand factor levels were within normal limits. Revised diagnosis of moderate hemophilia B was made.