Hemophilia A and its Prevalence in the Indian Sub-continent

Hemophilia A : a genetic disorder characterised by a deficiency in the protein Factor VIII, a clotting protein, which leads to profuse bleeding resulting from minor injuries, or in some cases: spontaneous bleeding. The disorder itself is an X-linked recessive condition arising from a mutation in F8 gene, and hence passed on by females.

It is assumed that there are 100,000 people living with the condition in India, a notable case when discussing genetic disorders due to the sheer size of the population: a sprawling canvas magnifying the population of those suffering from such disorders. In India specifically, the prevalence of the disease is regionally dependent, notably more prevalent of in the Northeastern part of India, as opposed to a lower density of population in the Southern part. This article will make an ill-advised attempt to answer this difference, utilising a combination of biology and Indian history. Please note that the subject of ancient Indian History is not something I can attest to having a firm grasp of, yet I am aware that it is a greatly controversial subject streaked with clashing views. Therefore, the following views are merely a product of the consumed information, and so do not reflect educated views that should be given precedence over more scholarly works.

A map of the recorded cases of Hemophilia A in the Indian Sub-continent

This article shall commence with a summary of the original inhabitants of India and their origins: the Dravidian people and the Indo-Aryan people. The Dravidians were the primary inhabitants of the Southern regions of India, potentially of an Austro-Asian heritage. The Indo-Aryans on the other hand, were of a potential Indo-European heritage and settled in India after the establishment of the Dravidian people, primarily in the North of India. It has been hypothesised that the Indo-Aryans arrived in the Indian subcontinent with a small female population, presumably hailing from Southern Russia.

This small female population is the key to the proposed reason for the difference in population density for people with Hemophilia A, as it is a genetic disorder passed on by females via the X-chromosome. Therefore, a small female population with even a few carriers combined with a noted prevalence in the practice of polygamy would have led to the conception of a generation with a significant increase in the generality of the condition. It must also be noted that Hemophilia A was notably prevalent in Europe, to the degree that it was called the royal disease. Notable figures afflicted by it include Queen Victoria, although it must be noted that this was the result of a mutation, not a linear pattern of inheritance. The above point is thus best considered an aside.

To recapitulate, the Indo-Aryans likely had a smaller female population with potentially few carriers. Their practice of polygamy would have lead to the conception of a generation with a greater prevalence of Haemophilia A, and so forms its own cycle that continued on, bearing the impact that it does on such a large population. The lower case numbers in South India coupled with the knowledge that the two factions may have intermingled seems to indicate that a lowered concentration of the condition would be in order. Despite this, the lack of cass in Central India seems to remain open to speculation, although the upcoming updates to the IGDD may provide further insight.

Despite the lack of real connection that the Southern Russian origin of the Indo Aryans may have had little in common with the royal disease that ravaged the royal flanks, it may very well be that Europeans may have a genetic predisposition to such conditions, and so rages on the debate regarding race and medicine. Though race is, and should be, the furthest thing from a factor in societal treatment, ethnic history does bear a significant impact on one’s genetic makeup, which thusly determines an individual’s future. For instance, people of Mediterranean origin are more likely to develop sickle-cell anemia. These are of undeniable importance when making a diagnosis and prognosis, especially regarding gynecology, and the advice given to potential parents considering the repercussions of the union of their genetic makeup.

Race has had an admittedly tenuous relationship with science and continues to haunt the very reaches of this otherwise noble domain with outdated stereotypes. Even today, a quarter of all medical students are under the erroneous impression that people of African descent have thicker skin. Admittedly, there are physical differences between races, yet considering our racially charged culture, greater levels of caution should be exercised. There are no heroes in a narrative where powerful information is carelessly thrown about, and those who receive it are too lazy to check such dangerous concepts.

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