Inherited bleeding disorders and surgery, Queensland Haemophilia Centre
All persons with Haemophilia if untreated will experience excessive bleeding following surgery. The severity of Haemophilia, the factor level and the type of surgery will determine the extent of bleeding. Even if mild haemophilia is present, excessive bleeding can occur that may affect the success of the surgery, lead to complications or result in the need for a blood transfusion.
In severe Haemophilia, any surgery needs to be covered with Factor replacement shortly before surgery and then up to 14 days depending on the type of surgery. Your Haemophilia Specialist will decide how much treatment you will need. Factor replacement is usually continued until healing is complete.
In mild Haemophilia, (factor levels greater than 5 per cent) minor skin surgery may be undertaken without factor prophylaxis but there is a risk of re-bleeding after several days. Otherwise other types of surgery - dental extractions or general surgery need to have treatment prior to surgery and for a few days following. In Haemophilia A, treatment can be with a medication- DDAVP- that can be repeated or Recombinant Factor VIII concentrates. In Haemophilia B, only Recombinant Factor IX concentrates can be used.
If you are affected by von Willebrand's disorder, the risk of bleeding is dependent on the severity of the vWD and the surgery planned. Most cases of von Willebrand's are mild and minor surgery, for example skin surgery, can be undertaken without prior treatment, but in most situations an assessment by a Haematologist or Haemophilia specialist is appropriate to guide treatment. In most minor surgery and dental extractions a medication - DDAVP -can be used to minimise blood loss. In major surgery, either DDAVP or in most cases, von Willebrand Factor containing concentrates (usually plasma derived Factor VIII concentrates) should be used.
It is very important prior to any surgery that you inform the doctor that you have Haemophilia or von Willebrand's Disorder. If there are doubts as to the appropriate management you should be referred for assessment with blood tests and advice from a Haematologist or Haemophilia specialist. Major surgery should be performed under the supervision of a Haemophilia Centre.