Presentations 2020: OMFS

345 - Acquired Haemophilia A presenting as airway emergencies with intra-oral swelling- A Case Series

BV Griffiths SD Jones L Duff
Presented by: Bridie Griffiths
Royal Gwent Hospital

Background Acquired Haemophilia A (AHA) is a very rare autoimmune bleeding disorder with a high mortality rate, presenting largely within the ageing population. Patients are often diagnosed during, or after, an attendance to A&E with symptoms of uncontrollable bleeding. Literature states that AHA should be suspected in patients elderly patients with sudden onset or abnormal bleeding and highlights the importance of prompt diagnosis. However, there is lack of awareness of this rare condition and other compounding factors, such as comorbidities and polypharmacy (including multiple anti-platelets or anticoagulants). In addition, diagnosis of AHA involves identification of an elongated APTT (activated partial thromboplastin time), not attributable to an anticoagulant, in contrast to a normal PT (Prothrombin time), followed by an assessment of FVIII and anti-human Factor VIII levels. These tests cannot be completed in all hospitals. Though intraoral bleeding is an infrequent site of presentation, these tissues can be traumatised almost daily to some extent by teeth, foods or foreign bodies. Due to its rarity AHA does not feature in Undergraduate dental training, nor in any National guidelines for dentistry, yet this cohort frequently carry out procedures with high and low bleeding risk and treat post operative bleeding in emergency settings. Discussion This case series discusses two sequential cases of presentation of a progressively swollen and blood filled tongue referred to the OMFS team at the same district general hospital. Both male patients fitted into the described 65+ category and were referred with a description of possible dental trauma. Both patients were diagnosed with, and the presentation attributed to AHA, though one pre surgical intervention, and one post. The case looks at how acutely increased awareness of the condition and multidisciplinary care across two sites altered the delivered treatment and subsequent patient outcomes.
Consent Statement: Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian. A copy of the consent form is available for review by the the meeting organisers..

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