“Antihemophilic factor is not the only answer for all factor VIII deficiencies.” Case report of odontogenic infection in a patient with hemophilia A, complicated by factor VIII inhibitors, and managed by transfusion of antihemophilic factor and factor VIII inhibitor bypass activity

Abstract

Dental extraction in hemophiliacs with acquired inhibitors is always a risky procedure, which often presents a lot of problems associated with bleeding. A known case of hemophilia A complicated with factor VIII inhibitors and having odontogenic infection was successfully managed by transfusion of factor VIII inhibitor bypass activity (FEIBA) and antihemophilic factor. Past medical history was significant for multiple factor VIII transfusions. Bethesda assay done to identify inhibitors revealed low titer factor VIII inhibitors. Extraction of the involved tooth was done after transfusion of FEIBA with low-dose protocols. Minimal bleeding was noted after extraction which was controlled by local measures. FEIBA was proven to be highly effective, and no side effects of the product were observed.

Management of Odontogenic Fascial Space Infection in Hemophilia Patients: A Proposed Protocol

“…The literature is scarce when it comes to the management of odontogenic fascial space infection in patients with hemophilia. Some clinicians preferred conservative management in the form of removal of focus/foci only [5]. Those who have performed incision and drainage have not discussed the details and alteration needed in doing I&D in such patients [9].…”

“…However, the available literature is sparse which is specific to the management of odontogenic fascial space infection in hemophilia patients. Some clinicians recommend extraction of offending tooth/teeth without incision and drainage in order to avoid bleeding as a complication [5]. This approach may further complicate the case, causing progression of disease to involve the other spaces if incision and drainage is not performed timely.…”