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Joey is a 13-year-old African American boy who presents to the emergency department (ED) with a severe nosebleed and bruises on both legs. The ED physician asked Joey’s parents’ how the incident occurred. They replied, “He was just picking his nose and he started bleeding!” They are unsure how Joey got the bruises. ED physician further asked about their family medical history. Joey is adopted, and his Caucasian parents do not know anything about Joey’s biological parents except that they are in prison serving a life sentence. A hematologist was consulted and orders a factor analysis. Lab results came back as the following: WBC- 7,000/ Hgb 13.6/ Hct 36%/ Platelets 80,000/ PTT 65/ PT 14/ INR 1.0 ED physician orders fresh frozen plasma (FFP) and platelet transfusions. Joey’s parents are Jehovah Witnesses, and they refused the transfusion. Joey is not stable for discharge home and was admitted to the pediatric unit. Factor analysis results came back, and the hematologist diagnosed Joey with Hemophilia A. Joey’s parents still refuse the transfusion. 
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