Conservative local measures (pressure packs, figure-of-eight sutures, electrosurgery) managed the bleeding temporarily, but recurring episodes necessitated an in-depth investigation.
Diagnostic Pathway
With conventional tests unremarkable, the clinicians suspected a rare coagulation/fibrinolysis defect, especially focusing on Factor XIII deficiency—a disorder not detected by standard assays.
The diagnostic approach relied on clinical history (noting vague maternal bleeding during delivery and consanguinity), consistent delayed bleeding timing, and targeted coagulation factor assays, particularly for FXIII.
Instead of thromboelastography (TEG), the team opted for a streamlined algorithm involving coagulation factor quantification, confirming congenital FXIII deficiency.
Clinical Significance & Management Strategies
Factor XIII deficiency often presents with delayed bleeding, poor wound healing, and normal routine coagulation tests—making it a “hidden” bleeding disorder in oral surgical contexts.
The case highlights the critical role of history-taking, bleeding timing patterns, and the selective use of global hemostasis assays and specific factor assays (FXIII) in reaching a diagnosis.
Management of FXIII deficiency includes targeted replacement therapy, use of antifibrinolytic agents like tranexamic acid, local hemostatic measures (e.g. oxidized cellulose, acrylic splints), and interdisciplinary coordination for surgical planning.
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Broader Implications for Dental Specialists
The article underscores that rare coagulopathies—such as FXIII deficiency—should be considered when patients exhibit excessive or delayed bleeding after dental extractions, despite normal screening labs.
Employing a structured diagnostic algorithm—clinical history, advanced assays, and appropriate referral—can lead to accurate diagnosis and tailored management, minimizing complications.
Key Take‑Home
✔ Normal screening tests (CBC, PT, aPTT, fibrinogen) do not rule out rare but clinically significant disorders like FXIII deficiency.
✔ Secondary bleeding—typically appearing 7–10 days post‑extraction—is a red flag indicating possible fibrin-stabilizing pathway defects.
✔ A systematic diagnostic workflow including detailed bleeding history, assessment of family and obstetric background, and specific factor testing is essential.
✔ Management combines local hemostasis (e.g., Sutures, oxidative cellulose, acrylic splints) with systemic therapies (factor replacement, antifibrinolytics), coordinated with hematology.
* This case offers a powerful reminder: in dental settings, persistent or delayed post-extraction bleeding—even when routine labs appear normal—can unmask rare coagulation disorders that demand attention.
I encourage all colleagues to read the full article for a thorough understanding of the diagnostic algorithm, case figures (including healing images and flow‑chart), and nuanced treatment details.
👉 Dive into the full article here: “Post‑dental extraction bleeding: Emphasis on the diagnosis of rare coagulation disorders” (PMC8405522) and enrich your practice with this vital knowledge.
