In his 1967 book about Russia's last Imperial family titled "Nicholas and Alexandra" author Robert K. Massie concluded with these words: "Why Lenin triumphed, why Nicholas failed, why Alexandra placed the fate of her son, her husband and his empire in the hands of a wandering holy man, why Alexis suffered from hemophilia - these are the true riddles of this historical tale.  All of them have answers except, perhaps, the last."

If the riddle of the blood disorder that helped bring down Russia's Imperial Empire is to be solved, we must first find the truth about a holy man's influence on the lives of an Empress and her son.  History has recorded that Grigory Efimovich Novykh, known to the world as Rasputin, possessed mysterious powers of healing that could stop the bleeding episodes of Alexei, the only son and heir of Tsar Nicholas II.

The entire story of Tsar Nicholas II and his Empress Alexandra centres on the Spala episode of October 1912 when their son Alexei appeared to be on the brink of death.  For a week and a half the boy displayed symptoms of pallor, internal haemorrhaging, abdominal swelling, pain and bleeding in the joints, delirium, and dangerously high fever, but he suddenly began to recover after the arrival of a telegram sent by Rasputin to the Empress Alexandra.

All sorts of theories, from a reduction of stress and blood pressure to claims of hypnosis, have been used in attempts to explain how the words of a simple telegram could cure an eight year old boy believed to have been dying from haemophilia.  Take Rasputin and his telegram out of the picture and the sudden recovery of the Tsarevich Alexei becomes just another symptom to be considered when making the diagnosis of the boy's disease.. instead of being a mystery that has become the stuff of legend.

Fever, delirium, and spontaneous remission are not generally found in cases of haemophilia and are inconsistent with such a diagnosis.  Since medical science was not as advanced in 1912 as it is at the present time, it would be wise to look to our current knowledge of haematology for a better explanation.  That explanation can be found in a bleeding disorder first identified 35 years after the Spala episode in 1947. 

All of the symptoms seen in the Spala case of the Tsarevich Alexei.. the pallor, internal haemorrhaging, high fevers and delirium.. match with the description of what medical science now knows as Aplastic Crisis.  The abdominal swelling is called splenomegaly, a severe swelling of the spleen that is a major clue to the real cause of the episode.  In ninety percent of cases the onset of aplastic crisis takes place before the age of fifteen. Alexei's episode occurred seven weeks after his eighth birthday. The median age of onset is seven.

The most important evidence to support a diagnosis of aplastic crisis in the Spala episode is the spontaneous remission.  Aplastic crisis is a self-limiting disorder.  It will last six, and possibly as many as ten days, and then subside all on its own.  Rasputin was quite right when he advised the Empress that her son would get better if the doctors were not allowed to bother him too much.  The recommended treatment is to give the patient only comfort and supportive measures until the bone marrow's ability to produce healthy red blood cells is able to recover.

There is nothing mysterious about how Alexei's health had improved after the arrival of Rasputin's telegram.  The haemorrhaging that was the result of aplastic crisis had simply run its course.  While that makes it clear Rasputin had done nothing magical or fantastic to cure the young Tsarevich, it in no way minimizes what he had done for the Empress.  Surrounded by doctors and advisors all predicting the worst, only Rasputin gave her hope and reason to believe things could get better.  He did not heal Alexei's disease as historians have suggested, but Rasputin did heal Alexandra's faith and her belief that there could be a brighter future for her son.

Most history books attribute the cause of Alexei's 1912 haemorrhaging episode to an injury he received a month earlier while he was climbing into a boat.  Some others claim it was the result of a fall in the bath.  The problem with either notion is that haemorrhaging in a haemophiliac, as Alexei was alleged to have been, happens immediately following the injury.  It does not wait for three or four weeks to develop as it did in the Spala episode, so a much better explanation of the cause must be found.

Aplastic crisis is caused by the disruption of erythropoiesis, the creation new red blood cells in the bone marrow.  In the majority of cases, it is the result of infection by a childhood virus most commonly known as "Slapped Cheek" or Fifth Disease.  The single stranded DNA Human Parvovirus B19 was first discovered in 1975 and its association with aplastic crisis was not uncovered until six years later in 1981.

Parvovirus B19 is transmitted person to person by respiratory secretions, most commonly in community outbreaks passed among school children.  Seventy percent of cases occur in youngsters between the ages of five and fifteen.  With an incubation period of four days to three weeks, most patients suffer only mild symptoms of headache, low grade fever, and an itchy red rash.

For patients with a chronic blood disorder the Parvovirus B19 poses a far greater threat.  It goes straight to the bone marrow where it is highly toxic to the developing red blood cells and is responsible for 90 percent of aplastic crises.  Parvovirus B19 can also be responsible for swelling in the joints which may persist for months afterwards in some patients.  In children it most commonly affects the knees.  For much of the following year of 1913 the Tsar's son was made to wear a leg brace because he had difficulty walking for several months after the Spala episode.  Parvovirus B19 can also cause severe arthritis in adults, especially women.

The inherited chronic blood disorders that can make a patient vulnerable to aplastic crises caused by Parvovirus B19 were not identified or understood until more than thirty years after the Spala crisis of 1912.  They can be x-linked and passed from the mothers who are the carriers to the sons who are the victims in exactly the same manner that haemophilia is passed from mothers to their sons.  They can produce the same kind of symptoms of bruising, bleeding, nosebleed, and pallor, but they do not fit within the current medical definition of haemophilia.

The haemophilia claim has never been supported by any doctors' reports or medical test results.  It is supported only by assumptions based on the hearsay of history that allege the bleeding disease had been passed down the family line from Queen Victoria.  That too has never been substantiated by the publication of any actual medical evidence.  There may well have been a blood disorder passed from mothers to sons in the Royal family line, but the identity of that disorder has never been determined with the knowledge of late twentieth century haematology.  It has only been assumed on the basis of nineteenth century guesswork. 

Despite the claims of history, no haemophiliacs currently exist among the living direct descendants of Queen Victoria.  Modern medicine knows of several inherited blood disorders other than haemophilia that will also fit the historical accounts.  The differences between them exist at the cellular level and modern testing methods are required to tell these blood disorders apart.

The doctors of Russia's Imperial court came straight out and identified Alexei's problem barely two weeks after the Spala episode and the world ignored what was said in their public statement.  In the October 21, 1912 announcement made by the Minister of the Imperial Court Baron Fredericks, four Imperial court physicians said: "..such haematomas, that is blood swellings, can be accompanied by a very high temperature, which is what was observed in the case of His Highness.  The results of such a wide spread haemorrhaging are a significant anaemia.."

Although the Tsar's physicians never used the word haemophilia, people chose to believe the speculation first made the following year in a 1913 book titled "Behind the Veil at the Russian Court." When the first of the private letters from Empress Alexandra to her husband Nicholas were published ten years later in 1923, five years after the Imperial couple had been murdered by Bolshevik Cheka guards, historians began sifting through her private correspondence for anything that would support the haemophilia claim.

Selecting only those diary entries that supported their conclusions, historians quickly seized upon the entries of September 8^th and 9^th of 1904 (old Julian calendar) that told of the newborn Alexei's bleeding navel.  They assumed this to be the first evidence of haemophilia. That speculation soon became accepted as fact, but it is a seriously mistaken assumption. 

Those diary entries indicate that the bleeding had started on the afternoon of September 8^th and had stopped late the following morning, lasting less than a day. The incident occurred in the fifth week after Alexei's entry into the world and bleeding such as this is now considered to be nothing unusual within six to eight weeks after the birth of any newborn. Any parent or paediatrician is familiar with bleeding of this nature.  The navels of some newborn children simply take longer to heal than others.  It is no more complicated than that. 

In order to confirm the true identity of the blood disorder that led to Tsarevich Alexei's haemorrhaging crisis in October of 1912 and acted as a catalyst in Russia's headlong rush toward revolution, we must do more than explain Rasputin's alleged healing ability.  We must also find Alexei.

Historians allege that Alexei met his death with the rest of his family when they were murdered by Lenin's Bolshevik Cheka guards at the Ipatiev House in Ekaterinburg during the early morning hours of July 17, 1918.  However, that claim has never been proved and Alexei has yet to be officially found.

When the grave that had hidden the remains of the murdered Tsar and his family for more than seven decades was opened the day after Russian President Boris Yeltsin's 1991 inauguration it was discovered that Alexei and one of his sisters were both missing.  He was still missing when the remains of his parents and three of his four sisters were formally buried at the Cathedral of St. Peter and St. Paul in St. Petersburg on July 17, 1998, the eightieth anniversary of their murders.

Rumours of a survivor have swirled around the story of Russia's Imperial murders ever since it happened on that Siberian summer morning.  As many as eighty people are said to have claimed to be either Alexei or a child of Alexei.  There are now twelve stories of claimants being discussed in books, by the media, and on the Internet.  There can be only one Tsarevich Alexei.

There are many strange explanations made by claimants who said they were cured of the disease but only one of those claimants exhibited all of the symptoms that appear in the historical record of Alexei's blood disorder.  During the two years leading up to his death just moments before midnight of June 26, 1977, Alexei Heino Tammet-Romanov had lived on transfusions of whole blood for as many as six weeks at a time.  Months before his disease became acute and claimed his life, Alexei Tammet-Romanov had been diagnosed with Chronic Myelomonocytic Leukaemia.

Called CMML for short, haematologists currently place chronic myelomonocytic leukemia in a group called Myelodysplastic Syndromes or MDS.  The disorders in this group are known as "preleukaemias" or "smouldering" leukaemias and only one or two cases per million people are reported each year.  In twenty percent of cases the leukaemia results from some other underlying cause, from chemotherapy, exposure to chemicals, or constitutional disorders of childhood.  Tracing Alexei Tammet-Romanov's death following a diagnosis of CMML back through the preleukaemic phase points to an inherited cause of childhood anaemia.

Two x-linked causes of anaemia present the possibility of eventual myelodysplasia followed by leukaemia.  Sideroblastic anaemia affects the way new cells developing in the bone marrow handle iron in the blood.  The other x-linked recessive blood disorder is called G6PD glucose-6-phosphate dehydrogenase deficiency.  The ultimate effect of G6PD deficiency in red blood cells is to produce a haemolytic/aplastic anaemia.

Symptoms in the haemolytic anaemias include easy bruising and bleeding similar to that found in haemophilia, but they are caused by a low platelet count called thrombocytopenia rather than by a lack of blood clotting Factor VIII or IX . One of the interesting traits of the haemolytic group is that the bone marrow's ability to compensate for red blood cell destruction can improve as the patient grows.  The closer the patient gets to adulthood, the better that patient's ability to deal with the blood disorder can be.

G6PD deficiency is passed from mothers to their sons and results in a haemolytic/aplastic anaemia.  Such an anemia can produce symptoms similar to haemophilia and make the patient vulnerable to an aplastic crisis that can subside after a week or so without medical intervention.  Thirty-five percent of aplastic patients will go on to develop a Myelodysplastic (MDS) syndrome.

One of the five diseases in the MDS group is Chronic Myelomonocytic Leukaemia.  This is the same disease that led to the death of Alexei Tammet-Romanov.  Exactly a month after his death from leukaemia in June of 1977, the Ipatiev House where the murder of Tsar Nicholas II took place was demolished on July 27^th of that year on orders from Moscow and the KGB.

The same DNA scientists who identified the remains of Tsar Nicholas have had DNA teeth samples from Alexei Tammet-Romanov in their possession since April of 1993.  One of those scientists, Dr. Pavel Ivanov, admitted in a letter written in 1995 that a DNA test was started on one of those samples two years earlier in the Spring of 1993.  Since that time the authorities who are aware of the case of Alexei Tammet-Romanov have chosen to remain silent.  The Russian, British, and American scientists who still hold the samples, and the authorities in Moscow they were doing the work for, must be brought to task and called upon to tell what they know about this case.

There may be a complication to using DNA to test the remains for confirmation.  The blood disorders that led to Alexei Tammet-Romanov's death are mitochondrial diseases caused by deletions, duplications, or mutations in mitochondrial DNA.  These deformities take place in the same type of DNA that has been used to identify the remains of Tsar Nicholas and his wife Alexandra. 

DNA or not, there can be no doubt of the answer.  The evidence of the 1912 Spala episode supports the conclusion of aplastic crisis resulting from an inherited cause of anaemia.. and the death of Alexei Tammet-Romanov following a diagnosis of Chronic Myelomonocytic Leukaemia supports the same conclusion.  The evidence of each proves the other.

Haematologists place this kind of leukaemia case at a ratio of 0.5 to 1.0 in 1,000,000... one or two out of every two million people.  That suggests that there is, quite literally, a one in a million chance that after dying of a leukaemia that resulted from an inherited blood disorder that Alexei Tammet-Romanov could have been anyone other than the missing Tsarevich. In his report on the DNA identification of the remains of Tsar Nicholas II, England's Dr. Peter Gill placed the odds of an unrelated person having the same DNA at a "likelihood ratio" of 8 x 10⁴ or one in eighty thousand.  The evidence of the disease can therefore be considered to be equal to, and probably stronger than, the evidence of DNA.

Alexei Heino Tammet-Romanov was telling the truth when he lay dying on a Vancouver hospital bed in June of 1977.  He really was the missing Alexei Nicolaievich, Sovereign Heir, Tsarevich, and Grand Duke of Russia.

Before Alexei had landed in the hands of the foster family that cared for him after the murders, the Tsar's executioners had stripped him of his clothes and destroyed all of the easily recognizable evidence of his Imperial past. When Alexei crossed the frontier into Estonia with his foster family three years later he carried with him the only evidence of his survival that could not be eliminated by the men who had assassinated his parents and sisters.

The blood disorder that made Alexei so famous was the only piece of evidence that would stay with him for the rest of his life.  It is the one piece of evidence that could never be hidden.  As it turned out, Alexei finally had to die from the disease that was in his blood in order to prove his identity and point an inquiring world in the direction of the truth.

A discussion of Alexei Tammet-Romanov's survival of the 1918 murders of his family can be
found on the website "Tsarevich Alexei: Lenin's Greatest Secret" posted on July 16, 1997 on
the World Wide Web.

John M.L. Kendrick, September 16, 1998.
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