103 Chapter 5 Discussion Bleeding problems are often reported by patients with OI and in case reports, but large cohort studies reporting on bleeding tendency of adult patients are not performed. Clinical appreciation of the presence and severity of bleeding symptoms is a fundamental step in the evaluation of a possible bleeding disorder in OI and therefore this study investigated bleeding tendency in a large cohort of adult OI patients using a structured BAT. In 42% of the included OI patients the Self-BAT score was increased compared to the normal range 20. Bleeding after surgery Surgery is frequently needed in our population. In this cohort 91% of all patients underwent surgery. Because 17% of all included patients with OI reported that they required blood transfusion after surgery, awareness of this bleeding risk is of critical importance. Identification of risk factors in OI patients before surgery can result in less bleeding incidents and reduce the need for transfusion because attention to mild bleeding symptoms can ameliorate bleeding diathesis when drugs, such as desmopressin and antifibrinolytics, are used when necessary 14,21–23. There are several studies describing excessive bleeding due to surgery in OI patients, despite normal pre-operative haematological assessment. Wong et al. reported bleeding complications despite normal preoperative Menorrhagia Hemarthrosis CNS bleeding Other Epistaxis GI-bleeding Dental extraction Surgery Postpartum haemorrhage 1 1 4 2 5 2 1 5 34 Figure 2 Distribution of bleeding symptoms needing extensive medical intervention
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