CASE REPORT article
Front. Pediatr.
Sec. Neonatology
Monochorionic diamniotic twin brothers with severe hemophilia A: a case report
Provisionally accepted
- Neonatal Unit, Department of Public Health and Pediatric Sciences, Turin, Italy, Turin, Italy
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Background: Congenital hemophilia A is a recessive inherited hemorrhagic disorder caused by deficiency of factor VIII (FVIII). According to the activity of functional coagulation FVIII, the severity of hemophilia A is divided into three levels: mild, moderate and severe. The characteristic phenotype in hemophilia is the bleeding tendency. Clinical severity depends on the extent of the FVIII deficiency and the first bleeding episode in severe and moderate congenital hemophilia A occurs mostly in early childhood. At present, there are limited reports on symptomatic severe congenital hemophilia A in neonatal period. Case presentation: We describe a pair of monozygotic twin brothers with severe hemophilia A. Patient-related factors were birth weights discrepancy of 10 %, the need for non-invasive respiratory support due to mild respiratory distress, duration of breastfeeding and vaccinations were similar in both twins. Anti-hemorrhagic prophylaxis was carried out after birth with IM Vitamin K. Due to the presence of prolonged bleeding at the sampling site after performing EGA/ neonatal screening, coagulation assay was carried out and coagulation factor assay was performed accordingly: activated partial thromboplastin time (APTT) was prolonged without extended prothrombin time (PT). The activity of factors VIII in both twins was completely absent (0.7%). Hematological consultancy was requested and the diagnosis of severe congenital hemophilia A was established. The drug Emicizumab was started as primary anti-hemorrhagic prophylaxis with good response without any major bleeding events in the first year of therapy. Conclusions: Coagulation system is not fully developed at birth, complicating clinical decision making and correct interpretation of coagulation testing. Targeted coagulation profiling and factor assays are mission-critical for newborns from twin pregnancies when a hematologic disorder is suspected. Coagulation factor assays are essential to confirm the diagnosis of hemophilia A. Early diagnosis of hemophilia is essential to drive timely initiation of an appropriate management plan. Specific studies are needed to understand if diagnosis of congenital hemophilia A in monochorionic twins may influence the occurrence of bleeding tendency and brain damage in the affected fetuses.
Keywords: case report4, congenital hemophilia A1, factor VIII2, neonate3, Twins
Received: 18 Dec 2025; Accepted: 30 Jan 2026.
Copyright: © 2026 Riboldi, Coscia and Peila. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lorenzo Riboldi
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