WITH ADVANCES in the understanding of true hemophilia and the availability of concentrated clotting factor extracts, the hazards of surgery in patients with this bleeding disorder have been significantly reduced. Surgical experiences with seven hemophiliacs are presented illustrating the clinical course, vicissitudes of management, and modes of treatment.
Report of Cases
—A 5-year-old severely affected hemophiliac boy was admitted with bleeding from two carious teeth which had been drilled by his dentist 20 hours previously.There were 250 cc of fresh blood and 100 cc of fresh frozen plasma given initially followed by 250 cc fresh or lyophilized plasma daily for four days. The bleeding did not recur.
The problem of dental caries is ever present in the hemophiliac. The situation presents the opportunity for a unique method of coagulation control. Since a hematoma cannot form, replacement therapy need only be titered against the presence of bleeding.