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Severe female hemophilia A patient caused by a nonsense mutation (p.Gln1686X) of F8 gene combined with skewed X-chromosome inactivation.

Hemophilia A is a congenital coagulation disorder with a worldwide prevalence of approximately 1 in 5000 males, which results from a deficiency or dysfunction of coagulation factor VIII (FVIII, F8) [1]. Clinical severity is inversely related to residual factor VIII activity (FVIII:C), and hemophilia A is classified as severe, moderate, or mild, depending on patients with FVIII:C less than 1%, 1–5%, and 5–30%, respectively. The gene encoding F8 is located on the long arm of chromosome X (Xq28) and consists of 26 exons [2]; thus it is an X-chromosomelinked recessive bleeding disorder. It typically occurs in male individuals, and female patients with hemophilia A have rarely been reported [3].