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IANB Haemophilia Risk — ORE Part 1 MCQ

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HardPharmacology & TherapeuticsIANB Haemophilia RiskORE Part 1

A patient with haemophilia B (factor IX deficiency) requires local anaesthesia for restorative treatment. Following liaison with the haemophilia team, which anaesthetic technique requires factor replacement before it is given?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: DInferior alveolar nerve block

An inferior alveolar nerve block is a deep regional injection and, in a person with haemophilia B, requires haemostatic cover arranged with the haemophilia team. Bleeding in the deep pterygomandibular region may be difficult to compress and can have serious consequences. UK haemophilia dental guidance places procedures requiring an inferior dental block in a higher bleeding-risk category. Buccal infiltration is the key distractor: it is a superficial technique and evidence in people with haemophilia found no adverse bleeding events when it was given without additional factor replacement. Intraligamentary and intrapulpal injections are local supplementary techniques rather than deep regional blocks. Topical anaesthesia does not involve needle penetration and therefore does not create an injection-related bleeding risk.

Reference: Oxford University Hospitals NHS Foundation Trust. Dental care - Clinical Haematology: Bleeding risk for dental procedures, reviewed 18 April 2024. https://www.ouh.nhs.uk/haematology/services/haemophilia/bleeding-disorders/dental-care/