Abstract
One who manage dental patient who has a bleeding disorder should have knowledge about the coagulation system and the patient's specific coagulation defect. Such patient can receive quality comprehensive dental care, provided appropriate preoperative planning and evaluation with the patient's physician or hematologist is accomplished. Patient should be provided appropriate replacement therapy before the dental procedure, selection of conservative treatment approaches, and use of local hemostatic measures to facilitate hemostasis.
Highlights
A deficiency of either clotting factor VIII or IX leads to the disorder called haemophilia which is a hereditary X-linked recessive disorder.[1,2] The prevalence of haemophilia A is estimated at 1 in 6000 men while that of haemophilia B has a prevalence of 1 in 30000 men.[7]
The clinical features of both types of haemophilia are same: spontaneous or traumatic haemorrhages; muscle haematomas; haemophilic arthropathy caused by recurrent bleeding into target joints; and bleeding into the CNS
Without suitable exogenous clotting factor replacement therapy these manifestations of the disease could result in deadly sequelae, which negatively impact patient’s quality of life and decreases their life expectancy.[4]
Summary
A deficiency of either clotting factor VIII (haemophilia A) or IX (haemophilia B) leads to the disorder called haemophilia which is a hereditary X-linked recessive disorder.[1,2] The prevalence of haemophilia A (classic haemophilia) is estimated at 1 in 6000 men while that of haemophilia B (or Christmas disease) has a prevalence of 1 in 30000 men.[7]. In 1803, the Philadelphia physician Dr John Conrad Otto documented that a bleeding condition was hereditary and mainly affected males. He drew the disease back through three generations to a woman who had settled near Plymouth, New Hampshire in 1720. A Factor VIII level above 25% causes very mild disease; the patient can generally lead a relatively normal life and may remain undiagnosed, but there can be prolonged bleeding following trauma or surgery. Absence of bleeding from socket cannot always rule out hemophilia.[9] An interesting fact is the clotting time is within normal limits even at 1-2% of Factor VIII.[10]. The tests done to evaluate the status of primary haemostasis include: 1. Complete blood count/ platelet count
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