Haemophilia A — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementHaemophilia AORE Part 1

A patient with haemophilia A requires extraction of a lower molar. Their baseline factor VIII level, inhibitor status and previous response to desmopressin are not available. What is the essential pre-operative step?

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Correct answer: D — Agree an individual haemostatic plan with the haemophilia team

**A is correct.** A single-tooth extraction is a higher-bleeding-risk procedure in haemophilia, so the dentist must liaise in advance with the haemophilia team to agree an individualised haemostatic plan. The plan may require factor VIII concentrate, or in selected mild haemophilia A a previously demonstrated response to desmopressin; it may also include tranexamic acid and local haemostasis. **B** is wrong because tranexamic acid is an adjunct and cannot be assumed adequate as sole cover. **C** is wrong because local measures do not correct the systemic coagulation defect. **D** is not routine management for haemophilia A; specific factor therapy is preferred when indicated. **E** is unsafe as a universal approach: DDAVP is only suitable for selected patients with known responsiveness and appropriate clinical circumstances.

Reference: Oxford University Hospitals NHS Foundation Trust. Dental care - Clinical Haematology: Dental surgery section (reviewed 18 April 2024). https://www.ouh.nhs.uk/haematology/services/haemophilia/bleeding-disorders/dental-care/