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Bleeding Disorders - Oral Health Care Considerations

Platelet disorders#

  • >50,000 cells/mm³ – routine dental procedures, including simple extractions
  • 20,000-50,000 cells/mm³ – platelet transfusions may be indicated for surgical procedures
  • <20,000 cells/mm³ – ⚠️ no elective dental care

Hemophilia A and B#

  • Severe hemophilia (factor activity <1%) is associated with severe spontaneous bleeding into major joints (elbows, knees and ankles) leading to hemarthroses, intramuscular bleeding, and retroperitoneal bleeding.

  • Moderate hemophilia (factor activity 1% – 5%) is associated with less significant bleeding.

  • Mild hemophilia (factor activity >5% – <40%) usually only manifests as impaired hemostasis after severe trauma or surgical procedures.

  • Surgical procedures - 50%-100% of factors needed.

  • Routine dental care - >50% of factors needed.

  • Mandibular blocks - >30% of factors needed.

  • For mild cases, consider desmopressin acetate (DDAVP).

  • The American Dental Association (ADA) 2014 guidelines do not have a provision for antibiotic prophylaxis for patients with hemophilia and joint replacement. Instead, clinicians are encouraged to use their clinical judgement.

  • Factor replacement is calculated based on severity of disease and patient’s weight:

    Hemophilia A - Factor Replacement
    1 unit of factor VIII (F VIII)/kilogram of body weight raises the F VIII level by 2%.
    (Example – A 70 kg person with hemophilia A needs 3,500 unit to raise a factor level from <1 to 100.)
    Hemophilia B - Factor Replacement
    1 unit of factor IX (F IX)/kilogram of body weight raises the F IX level by 1%.
    (Example – A 70 kg person with hemophilia B needs 7,000 unit to raise a factor level from <1 to 100.)

von Willenbrand Disease#

Consider adding desmopressin acetate (DDAVP) for surgical procedures.

Medical Complexity Status - Bleeding Disorders#

 Drugs/ drug

See Medical Complexity Status for more information.

Related Pages#