## 4 Discussion
### Considerations for Dental Treatment  
#### 4.9.1 Laboratory Tests  
American Board of Internal Medicine laboratory test reference ranges [59] are shown in Table 3.  
* Platelet count: Used to quantify the number of platelets [59; 60; 61; 62; 63]
* Platelet aggregation: Evaluates the adequacy of platelet reactivity to physiological stimuli that activate platelets. It is used to identify abnormal pictures in functional, hereditary, and acquired platelet disorders [59; 60; 61; 62; 63]
* VWF Antigen: Measures the total plasma VWF concentration [59; 60; 61; 62; 63]
* Ristocetin Agglutination: Detects the presence of large VWF multimers. It is a routine test in the diagnostics of VWD [59; 60; 61; 62; 63] \begin{table}
\begin{tabular}{c c c} \hline \hline
**Authors and Year of** & **Haemostasis** & **Operational Suggestions in Oral Surgery** \\
**Publication** & **Pathologies** & **-** \\ \hline  & & - & In patients with mild or moderate haemophilia, non-invasive dental treatments can be performed under antifibrinolytic treatment, while the ablation of calculus and some forms of minor surgery can be performed with the combined administration of antifibrinolvtics and desmopressin. In severe haemophilia, replacement of the deficient coagulation factor is necessary, with consideration of hospitalization. \\  & & - & Local anaesthesia must be carefully administrated due to the risk of haematomas. \\  & & - & A combination of tranexamic acid (20 mg/kg) and a single infusion of factor VIII or IX to achieve a peak level of about 30\% of factor VIII or IX in vivo can be used prior to dental extraction. \\ \hline  & & - & desmopressin is usually effective in preventing or treating abnormal bleeding in type 1 VWD, but in patients with type 2 disease, replacement therapy with purified VWF is often required since the response to desmopressin is variable. On the other hand, desmopressin is not effective in the treatment of patients with type 3 VWD, who therefore necessitate replacement therapy with purified human VWF associated with FVIII at least on the first administration \\  & & - & Prolonged bleeding is frequently observed following tooth extractions or associated with professional oral hygiene procedures. Treatments should be carefully considered in relation to the patient’s state of health and the severity of the disease, in coordination with the haematologist. \\ \hline \hline \end{tabular}
\end{table} 
Table 2: _Cont._ \begin{table}
\begin{tabular}{c c} \hline \hline
**Laboratory Tests** & **Reference Ranges** \\ \hline Factor I & 200–400 mg/dL \\ \hline Factor II & 60–130\% of normal \\ \hline Factor IX & 60–130\% of normal \\ \hline Factor XII & 60–130\% of normal \\ \hline  & & Therapeutic range: 2.0–3.0 \\ INR (International Normalized Ratio) & Therapeutic range in high-risk patients: 2.5–3.5 \\  & Therapeutic range in patients with lupus \\  & anticoagulant: 3.0–3.5 \\ \hline Platelet count & 150–450 \(\times\) 10\({}^{3}\)/mCL \\ \hline Protein S Plasma Activity & 57–131\% \\ \hline Plasma thrombin time & 17–23 s \\ \hline \hline \end{tabular}
\end{table} 
Table 3: American Board of Internal Medicine—Laboratory test reference ranges January 2023 [59]. * Prothrombin Time (PT): evaluates the factors of the extrinsic and common coagulation pathways (VII, X, V, Prothrombin II, and fibrinogen) [59; 60; 61; 62; 63]
* Partial thromboplastin time (PTT): Evaluates the factors of the intrinsic and common coagulation pathways (Precallicrein, high molecular weight kininogen, factors XII, XI, IX, VIII, X and V, prothrombin II and fibrinogen) [59; 60; 61; 62; 63]
* Thrombin time: Evaluates the last stage of coagulation. It is prolonged if there is antithrombin activation caused by heparin or by qualitative changes in fibrinogen or hypofibrinogenemia [59; 60; 61; 62; 63]
* Fibrinogen dosage: The fibrinogen dosage allows for the measurement of the concentration of circulating fibrinogen.