Hi Michelle,
You ask good questions, so please don't feel uncomfortanble about asking them.
Persons affected with Hemophilia have the condition for life. Today it is managed thru intravenous infusion of Factor VIII concentrate and other means. Today life expectancy can be normalized by reducing chronic joint disease (a complication of this condition).
As a young child grows and becomes more active, the frequency of spontaneous bleeding into the joints may increase as a consequence. However the frequency of bleeding can decrease with age. This could be explained by the active youthfulness of children, where the risk of trauma resulting from play from falls and bumps is far greater. By this analogy, the frequency of spontaneous bleeding episodes will vary each month, it can even only occur every few years. Much depends on the type of Hemophilia present, because there are a few forms described which relate to the severity of sypmtoms and the time they are diagnosed. This means there were relatively 'healthy' periods which Alexei would have enjoyed. He swam, rowed boats and did what young lads would do, despite the constant adult supervision.
Joints are the most common sites of spontaneous bleeding, left untreated the condition will cause prolonged bleeding and is often accompanied by excessive pain and swelling. Fevers may be present. Hemophilia is usually diagnosed in the first year of life.
Historic documents tell us that Alexei appeared healthy with normal pink skin. It was not until several weeks had elapsed that he was observed to bleed spontaneously from his umbilicus.
Such descriptions would preclude that Alexei's condition could be diagnosed today as Congenital Thrombocytopenia.
Neonates with such a condition will present symptoms at birth or within 2 - 3 days post partum - showing severe, generalised petechiae (small crimson spots on the skin) caused by subcutaneous hemorrhaging. Nose bleeds and bleeding of the gums are common features, with eventual loss of eyesight (due to retinal bleeding) will also occur. The cause of death is usually intracranial hemorrhaging. Left untreated it can prove fatal. This condition can be readily excluded in the case of Alexei. Remember that Alexei was an active young lad.
The acquired form of Thrombocytopenia is excluded because this condition is not inheritable. It can develop after longterm administration of certain medications, chemotherapy, severe meningitis and complications in pregnancy and yes also viral infections.
The acquired form of Thrombocytopenia must be excluded because we know that Alexei was suffering from his blood disorder before his first birthday, it was episodic throughout his short life, which is characteristic for the diagnosis of Hemophilia. Importantly, there was no documented evidence that he was ill in Spala except from the episode which resulted from a fall in the bathtub if I remember correctly.
It would be fanciful to suggest that the Royal Disease was anything but Hemophilia. Agreeably both Hemophilia and the more recently understood mechanisms of Thrombocytopenia do have some commonalities, however the well documented descriptions of all Alexei's episodes all point to his condition as being Hemophilia.
Finally, we are aware that the Royal Disease affected some males in the Royal House. If Kendrick's hypothesis has any credibility, then how would he be able to explain how so many 'affected' male relatives developed acquired Thrombocytopenia if the condition was not Hemophilia.
