DOI: 10.4103/jpdtsm.jpdtsm_72_26 ISSN: 2949-6594

Clinical and Epidemiological Characteristics of Inherited Bleeding Disorders: A 13-year Retrospective Study from a Tertiary Referral Center in Karbala, Iraq

Ashwaq Ali Hussein
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Abstract

BACKGROUND:

Inherited bleeding disorders (IBDs) comprise a heterogeneous group of genetic conditions caused by deficiencies of coagulation factors or platelet function, resulting in impaired hemostasis and an increased risk of spontaneous or trauma-related bleeding. Despite the clinical importance of IBDs, epidemiological data from regional centers in Iraq remain limited, particularly regarding disease spectrum, associated demographic factors, and clinical presentation. This study aimed to describe the epidemiological profile, clinical characteristics, disease distribution, and selected sociodemographic factors among patients with IBDs in Karbala, Iraq.

METHODS:

A retrospective analysis was conducted at the main hereditary blood disease referral center serving Karbala Governorate (Hereditary Blood Diseases Center, Karbala Teaching Hospital for Children, Iraq). Medical records of patients diagnosed with IBDs between January 2011 and December 2024 were reviewed, with data extraction performed in January 2025. A total of 263 eligible patients were included. Demographic characteristics, disease type, ABO/Rhesus blood group, parental consanguinity, place of residence, age at diagnosis, and clinical manifestations were extracted using a standardized data collection form. Statistical analyses were performed using SPSS version 28. Associations between categorical variables were evaluated using appropriate statistical tests, and a two-sided P < 0.05 was considered statistically significant.

RESULTS:

A total of 263 patients with IBDs were included in the study. The majority of patients (62.7%, n = 165) were diagnosed before 5 years of age, with 47.1% ( n = 124) diagnosed during the 1 st year of life. Males represented 79.1% ( n = 208) of the study population, and 57.0% ( n = 150) of patients were residents of central Karbala. The most frequently observed ABO blood group was O-positive (39.9%, n = 105). Hemophilia A was the most prevalent IBD, accounting for 40.3% ( n = 106) of all cases. Among patients with von Willebrand disease (VWD), type 3 was the predominant subtype (42.0%, n = 21). The most common clinical manifestations were skin bleeding (63.1%, n = 166), bleeding following trauma (60.5%, n = 159), and epistaxis (41.1%, n = 108). Joint bleeding showed a significant association with younger age at diagnosis, particularly among patients diagnosed before 5 years of age. Significant associations were also observed between IBD type and place of residence, parental consanguinity, and O-positive blood group (all P < 0.05).

CONCLUSIONS:

IBDs in Karbala predominantly affected males and were frequently diagnosed during early childhood, particularly before 5 years of age, emphasizing the need for timely recognition and early referral. Hemophilia A represented the most prevalent disorder, while type 3 VWD was the predominant subtype among patients with VWD. Skin bleeding, posttraumatic bleeding, and epistaxis were the leading clinical manifestations. The significant associations between disease type and residence, parental consanguinity, and O-positive blood group indicate the contribution of demographic and genetic factors to the local epidemiological pattern. These findings highlight the importance of establishing systematic screening strategies, genetic counseling programs, and specialized referral pathways to improve early diagnosis, prevent complications, and optimize long-term management of IBDs in Iraq.

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