The role of transfusion therapy and alternative methods in surgical oral sanitation in patients with thrombocytopenia

Introduction. In patients with oncological and hematological diseases, thrombocytopenia significantly complicates surgical oral sanitation required for the timely initiation and continuation of antitumor therapy. The lack of uniform criteria for transfusion support and the risk of post-extraction bleeding determine the need to assess the safety of tooth extraction in this patient population.

The objective was to assess the incidence of socket bleeding after tooth extraction in patients with thrombocytopenia and its surgical treatment.

Methods and materials. We performed a retrospective analysis of the medical records of 84 patients treated at the R. M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, who underwent 106 tooth extractions in 2019–2023. Platelet counts before and after the intervention, transfusion support, and the incidence of postoperative bleeding were assessed.

Results. At platelet counts <100×10⁹/L, extractions were performed in 57 episodes; moderate socket bleeding was observed in 14 % of cases (n=8), at PLT levels of 6–34×10⁹/L. In 21 episodes, patients received prophylactic platelet concentrate transfusions before extraction (PLT 7–39×10⁹/L); moderate post-extraction bleeding was observed in 19 % (n=4) of these cases. In another 3 cases, transfusions were performed after extraction; nevertheless, in 1 of these episodes, the patient developed moderate socket bleeding during the first 24 hours. All bleeding episodes were controlled conservatively and did not require surgical hemostasis. No bleeding was recorded at PLT ≥100×10⁹/L. In the group without transfusion support, moderate socket bleeding was observed during the first 24 hours after extraction in 3 episodes (PLT 25–30–34×10⁹/L) and resolved spontaneously.

Conclusions. The risk of post-extraction bleeding in patients with thrombocytopenia requires surgical oral sanitation to be performed in an inpatient setting. Consequently, the time required to prepare the patient for treatment of the underlying disease increases. The use of donor blood components may prevent post-extraction bleeding but does not eliminate its risk. The use of allogeneic biological products derived from donor blood components, as an adjunct to existing methods or as a standalone approach to improve local hemostasis and accelerate healing, appears to be a promising direction.

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