Our data shows that there are differences in the clinical manifestations of patients in India compared to those described in the only other large series reported so far in the literature from Iran. The clinical manifestations in our patients have been compared with that of other large series in Table I . Epistaxis (77% and 48%) was the most common symptom among patients from Iran [7, 9] . However, this occurred much less frequently (epistaxis, 19%) in our patients. Epistaxis was also significantly less in our patients when compared to that from Israel [11] ; (57% vs. 19%). Hemarthrosis was observed in 13% of our patients though this has not been reported from the other small series reported from India [10] . Though hemarthrosis has been reported from the series published from Iran [7, 9] , it has not been reported from that reported from Israel [11] . Bleeding following circumcision was a major feature in patient from Iran [7, 9] . But since this is not a common practice in this part of the world, only one of our patients had presented with this symptom. Gum bleeding, which occurred in almost half of our patients was not documented in the Iranian series but was shown to be present in a smaller group of patients from India [10] and from Israel [11] . Prolonged bleeding post trauma/surgical procedure was the most frequent (62%) symptom in our patients. Our data shows that the pattern of bleeding among patients with combined FV and FVIII deficiency in India is different from that reported from Iran and Israel, even though the mean factor levels are similar. At present, we are not able to explain the difference in clinical behavior in our patients but the change in the life style may be a factor because similar observation has also been documented from other small series India [10] .