To make a valid argument that he may not have had hemophilia if one lacks sound DNA evidence that he did not, one needs to consider not only the most spectacular incidents of his suffering but the aggregate of those episodes that happened far more often. Remember, Alexei was not a normal child when it came to boyhood bumps and bruises...... Try as one might, one cannot dismiss what the majority of Alexei's episodes point to -- a coagulation disorder.
Alexei Nikolaevich's actual medical records have probably been misfiled somewhere in the State Archives of the Russian Federation. According to Pierre Gilliard, Dr. Derevenko told him confidentially soon after he became Alexei's tutor that what he had was hemophilia. It is unwise to dismiss 99 per cent of Alexei's episodes just because the one we do have the most documentation of (including the one extant medical record and the attempt by Count Fredericks to obfuscate a leak of the doctors' diagnosis) brought on secondary symptoms over and above the primary one of massive hemorrhage.
Thrombocytopenia per se is not a disease in itself but a symptom of disease, and manifests itself in superficial bleeding into the skin. Alexei bled into his joints quite often and developed problems with his joints, as is typical of a hemophiliac. Hemolytic anemia leads to leg ulcers, which Alexei never had. That disease does not present itself until later in life than young childhood, when as is typical of a child suffering from a moderate to severe case of hemophilia, Alexei bruised as he learned to walk. It sounds like someone else altogether developed end-stage leukemia later in a much longer life than fourteen years, doesn't it??? The Tsarevich's recoveries from hemophilic episodes were NEVER spontaneous, by the way: it took the boy months to get his strength back, to straighten out his leg and to get to the point when he could spend an afternoon with his father on an outing.
'Alexei's recovery will be slow,' the Emperor wrote to his mother after his fever had broken and the threat to his life had passed. The breaking of the boy's fever was not a complete recovery but the turning point that began it. The exhausted Alexei still needed to regain his appetite and his strength. The blood that had pooled in his hip joint and upper leg still had to be reabsorbed -- part of the normal recovery process N., A., and their son expected thanks to their experience with the many other episodes that had preceded this particular one at Spala. According to the specialist literature available to the Imperial doctors at the time Count Fredericks wrote his bulletin, those episodes were typical not of the spectacular one-time scenario theory being presented as if to eclipse everything else the boy suffered, but of a bleeding disease that doctors of the 19th century had only recently begun to codify shortly before the birth of the Tsarevich.
