PB1395 - Successful management of multiple tooth extraction in a patient with Glanzmann Thrombasthenia with platelet antibodies

Background: Glanzmann's thrombasthenia(GT) is a rare autosomal recessive disease characterized by quantitative or qualitative defects in integrins αIIb and β3. These integrins are encoded by the ITGA2B and ITGB3 genes and form platelet glycoprotein (GP)IIb/IIIa, which acts as the principal platelet receptor for fibrinogen. As a consequence no bridging of platelet to other platelets can occur and this results in bleeding.
We report a case of multiple tooth extraction in a patient with severe periodontal disease with underlying Glanzmann thrombasthenia. This 34 year old gentleman required 8 teeth to be extracted due to underlying severe chronic periodontitis and early abscess formation. He also had developed platelet alloantibodies due to platelet transfusion in the past. The oro-maxillo-facial surgery(OMFS) team was notified of his condition. The procedure was planned and closely co-managed by both the teams. Recombinant Factor VIIa was given just prior to procedure .Post extraction , the patient developed gum bleeding which was able to be controlled with the use antifibrinolytic agent( tranexamic acid) ,recombinant factor VIIa(rFVIIa) and local hemostatic measures like tranexamic paste application and occlusal dental splint.Hemostasis was well secured with these measures.

Aims: To demonstrate that the use of local hemostatic measures and the use rFVIIa is sufficient to secure bleeding in a patient with multiple tooth extraction.

Methods: Review of case record and lab investigations.

Results: -

Conclusion(s): Securing hemostasis in a patient with bleeding disorder remains a challenge. However with a multidisciplinary team approach using both local and systemic agents we managed to stop the bleeding in this gentleman.