Diagnosis of Bleeding Disorders

In the United States, most people with hemophilia are diagnosed at a very young age. Based on data from the Centers for Disease Control and Prevention, the median age at diagnosis is 36 months for people with mild hemophilia, 8 months for those with moderate hemophilia, and 1 month for those with severe hemophilia. In about two thirds of cases, there is a family history of hemophilia. Sometimes prenatal genetic testing is done to diagnose hemophilia before birth. The remaining cases result from spontaneous mutations, or unrecognized hemophilia carriers in women. A bleeding disorder is suspected if a newborn exhibits prolonged bleeding after circumcision, heel sticks for routine newborn screening tests, or head bleeding after difficult delivery. Bleeding disorders may also manifest themselves as unusually frequent or large bruising when the infant learns to roll over or crawl. Bleeding disorders are typically diagnosed through a combination of complete blood counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen tests and factor studies.¹⁶

While severe genetic bleeding disorders are typically diagnosed shortly after birth, dental providers may be the first to recognize mild or moderate bleeding disorders as these usually escape early diagnosis. Due to intraoral bleeding being a common symptom of bleeding disorders, many patients may seek dental care in the event of an oral bleed. This places the dental provider in a unique position to be the first to recognize the signs and symptoms of an underlying bleeding disorder, especially due to the propensity of oral trauma that commonly occurs when young children are learning to crawl and walk. In addition, if prolonged bleeding is observed following dental treatment, oral trauma, tooth eruption and exfoliation, this increases the likelihood that the patient has a bleeding disorder. If this occurs, the dental provider must refer the patients to their primary care provider or a hematologist for the proper diagnostic tests.¹⁷

In the United States, bleeding disorders in children are managed by pediatric hematologists who typically are associated with a HTC that is part of a combined hematology/oncology department of a children’s hospital. Bleeding disorders in adults are managed by an adult hematologist associated with a HTC that is a part of a combined hematology/oncology departments of cancer centers and clinics.