haemophilia july 2010

7/28/2019 Haemophilia July 2010

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OralSurgerywithminimalfactorsupportOralSurgerywithminimalfactorsupport

ininHaemophiliaHaemophiliaandvWDandvWDpatientsastudypatientsastudy

AlfredHos italAlfredHos ital

DrIan

Hewson

DirectorDentalServices

AlfredHospital

MelbourneAustralia


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AlfredHaemophiliapatientsAlfredHaemophiliapatients

PreviousprotocolatAlfred:

Factorsto

70%

100%

before

oral

sur er

ost

o erative

dosesdependingoncomplexityofprocedure.

rotoco

wou

vary

w t

egree

o

ora

surgery

an

pat ents

oralhealth

Factorsforfivedayspostopwithremovaloffourwisdom

teeth


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Previousfactoradministration:

Forfourwisdomteeth:Daily4550U/kgPreoperativeandfor

fivedayspostoperative.

Lessextensiveoralsurgery:Initial30U/kgwithafollowupof

Wisdomteeth

=$ 17,000

$19,000

Simpleextractions=$ 5,000 $5,500


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Protocolnow:

Noadditionalfactorsprescribedpreoralsurgery,regardless

ofde ree

of

difficult

of

oral

sur er

and

atients

factor

%

LAviaInferiorDentalNerveblockifrequired

Nopost

op

AB

cover

(peri

operative

if

required)

ranexam cac mou was m ree mesa ay

provided

for

7

daysGeneralanaestheticpatientsarekeptinhospitalovernight.


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Protocolnow:

Patientsonregularprophylacticprogram,maintainthis

re ime

factorlevels

at

o eration

now

bein

measured .

UseLaryngealmaskforGApatients

Marcain*.5%1:200,000

adrenaline

to

16ml

oa ona ac orsprescr e un esspos op ee nga

problem.Localhaemostaticmeasuresonly

*BupivacineHCLAstraZeneca


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POST DENTAL EXTRACTION CHART

FOR HAEMOPHILIA PATIENTS

Please fill out the following chart for any bleeding associated with the

extraction(s) that you have had today, tick the relevant box. Thank You.

BLEEDING FROM SOCKET(S)

1

2

3

INJECTION

SITE

5

6

7

8

MILD = some blood in saliva

MODERATE = need to apply pressure to socket to stop ooze or bleeding

SEVERE = need to attend Hospital for management

Injection Site: Did you have any: Swelling Significant bruising at the

site of the injection for a lower jaw tooth extraction. Please tick which

problem(s) and tick days in box on right

Post: Dental Unit, The Alfred PO Box 315 Prahran 3181

Fax: 9276 6938Or bring in when attending for your next appointment


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50ConsecutivePatients(Noinhibitors)

All atienthave ivenwritten&oralconsent


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Patientpopulation

13

14

10

11

12

8

9

atients

HaemA

5

6

7

Numberof aem

VWD

2

3

4

0

1

Severe


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30

25

20

s

15

Noofpa

tien HaemA

HaemB

VWB

10

HAEMB vWD

5


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Number and Type of Extraction

100

82

80

90

60

70

SIMPLE

31

40

50Total urgca

Simple

20

SURGICAL

0

1


13/26

60

Infiltration, 4850

,

40

IDNBLOCKS

INFILTRATIONS

30IDN

Infiltration

10

0

Type of LA Injection


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Total Number of patients and degree of Post-Op bleeding

45

35

40

25

30

atients

Nil

15

20

Number

ofP

Moderate

Severe

10

0

5

1 2 3 4 5 6 7 8

AtDayeight:Nil=41(82%),Mild=6(12%),Moderate=3(6%)

Days


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30

25

20

nts

Nil

Mild

10

P

atie

Moderate

Severe

5

0

1 2 3 4 5 6 7 8

AtDay

eight:

Nil

=25

(83%),

Mild

=4(13%),

Moderate

=1(4%)

ays


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25

20

15

atients

Nil

Mild

10Numberof

Moderate

Severe

5

0

1 2 3 4 5 6 7 8


Days


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12

10

8

patient

Nil

Mild

4

Numberof

Moderate

Severe

2

0

1 2 3 4 5 6 7 8


ays


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14

10

12

8

patient

Nil

Mild

6

Numberof

Moderate

Severe

2

4

0

1 2 3 4 5 6 7 8

AtDay

eight:

Nil

=12

(92%),

Mild

=1(8%),

Moderate

=0(0%)

ays


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100

80

90

60

70

Nil

Mild

Moderate

Severe

40

50%Nil

Mild

Moderate

Severe

20

0

1 2 3 4 5 6 7 8


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RESULTSRESULTSExtraction Type& No

Total cases Nildays (%)

Milddays (%)

Moderatedays (%)

Severe days(%)

Simple x 2 11 66 (75%) 20 (23%) 2 (2%) 0

Simple x 5 2 15 (94%) 1 (6%) 0 0

Simple x 7 1 1 (12%) 7 (88%) 0 0

Simple x 9 1 5 (63%) 2 (25%) 0 1 (12%)

Surgical x 1 3 16 (67%) 6 (25%) 2 (8%) 0

Surgical x 2 2 16 (100%) 0 0 0

Surgical x 3 1 3 (37.5%) 2 (25%) 3 (37.5%) 0

Surg 1 Simp 1 3 16 (67%) 5 (21%) 3 (12%) 0

Surg 1 Simp 2 1 5 (63%) 0 1 (12%) 2 (25%)

Surg 2 Simp 1 3 17 (71%) 2 (8%) 3 (13%) 2 (8%)

Surg 2 Simp 2 4 17 (53%) 9 (28%) 3 (9%) 3 (9%)

Surg 3 Simp 1 1 8 (100%) 0 0 0


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RESULTSRESULTS

Severe1% 5%,8patients

(16%)andMild6% 35%30patients(60%)

Atotalof113extractionperformed:

31Surgical,82Simple.

Bydayeight94%ofallpatientshadNilormildbleedingbut

6%stillhadmoderatebleeding(Requiredtoapplypressureto

socket

to

stop

ooze/bleed)

Fourpatientsrequiredpostoperativetreatmentathospital


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RESULTSRESULTS

41INDblocksadministeredwith27gaugelongneedlesNo

,

dayeight71%hadnilbleedingand18%hadmildbleeding

9%hadmildbleeding(97%)

Nopatienthashaddrysocket


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RESULTSRESULTS

1. HaemophiliaA

0%

2Surgical

2Simple

Day

3 1750

U

FactorVIII Day5 redresssocket

.

FactorVIII

Day

7 gauze

pressure

&

tranexamic acid

3. HaemophiliaA 3% 9xsimpleDayI&32000UDay2

1500UFactor

VIII

4. HaemophiliaA


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RESULTSRESULTS

protocol


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haemophilia july 2010

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