Pseudopathologies of hemostasis and dental surgery

Values of hemostasis tests are grossly abnormal in persons with factor XII deficiency, dysfibrinogenemia, the lupuslike anticoagulant, and pseudothrombocytopenia, yet these persons do not usually bleed spontaneously or even after surgery. We reviewed the records of 66 patients with laboratory diagnosis of one of the aforementioned abnormalities to determine whether they bled excessively after challenges to hemostasis such as dental extractions. Only three of them bled excessively, but two of these had other concomitant causes that could explain bleeding. Hence the dentist should not give up dental extractions or other surgical procedures when results of hemostasis tests are grossly abnormal, because these are not necessarily associated with abnormal hemostasis. Obviously, the correct interpretation of abnormal hemostasis values warrants close collaboration and reciprocal consultation between the dentist and the hematologist.