- Consult with the patient’s hematologist.
- Always use local hemostatic agents and techniques to minimize bleeding.
- Use antifibrinolytic mouthrinses.
- Be aware of critical values to assess bleeding tendencies.
- Consider systemic replacement therapy when indicated.
- Patients may develop intraoral petechiae .
- >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
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.)
Consider adding desmopressin acetate (DDAVP) for surgical procedures.
| Drugs/ drug|
See Medical Complexity Status for more information.
- Medical Disorders
- Laboratory Values
- Boender J, et al. A diagnostic approach to mild bleeding disorders. J Thromb Haemost. 2016 Aug;14(8):1507-16.
- Halpern LR, et al. Treatment of the Dental Patient with Bleeding Dyscrasias: Etiologies and Management Options for Surgical Success in Practice. Dent Clin North Am. 2020;64(2):411-434.
- Kizilocak H, et al. Diagnosis and treatment of hemophilia. Clin Adv Hematol Oncol. 2019 Jun;17(6):344-351.
- Pelland-Marcotte M-C, et al. Hemophilia in a Changing Treatment Landscape. Hematol Oncol Clin North Am. 2019 Jun;33(3):409-423.