Fast Five Quiz: Hemophilia

Emmanuel C. Besa, MD


September 21, 2021

The treatment of hemophilia may involve management of hemostasis, management of bleeding episodes, use of factor replacement products and medications, treatment of patients with factor inhibitors, and treatment and rehabilitation of patients with hemophilia synovitis.

Oral bleeding from the frenulum and bleeding after tooth extractions are not uncommon in patients with hemophilia. Bleeding is aggravated by the increased fibrinolytic activity of saliva. If not treated appropriately, dental bleeding can persist and expand to sublingual, pharyngeal, facial, or dissecting neck hematomas or other serious bleeding. Combine adequate factor replacement therapy with an antifibrinolytic agent (epsilon-aminocaproic acid or tranexamic acid) to neutralize the fibrinolytic activity in the oral cavity. Topical agents, such as fibrin sealant, bovine thrombin, and human recombinant thrombin, can also be used. 

Fresh frozen plasma and cryoprecipitate are no longer used in hemophilia because of the lack of safe viral elimination and concerns regarding volume overload. Cryoprecipitate contains no factor IX and is not appropriate for factor IX therapy.

Although joint aspiration may be indicated in some situations, such as lack of response to factor replacement after 48-72 hours, it is generally not recommended in patients with hemophilia.

Desmopressin is considered the treatment of choice for mild and moderate hemophilia A. It is not effective in the treatment of severe hemophilia and is not used in hemophilia B because it does not affect factor IX levels.

Read more about the treatment of hemophilia.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Hemophilia A, Hemophilia B, Hemophilia C, and Acquired Hemophilia.

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