Screening for hemophilia before surgery is of great importance to reduce the risk of bleeding, as shown by a case published in BMC Surgery

“For patients with recurrent bleeding after hemorrhoid surgery, hemophilia should be further excluded,” wrote the authors of the study. Since wound bleeding may recur in patients with hemophilia following suture hemostasis, prompt supplementation with coagulation factors is necessary to stop the bleeding.

The case presented here is that of a man, aged 21 years who was admitted to the hospital because of repeated bleeding following hemorrhoid surgery. Suture hemostasis procedures did not resolve the problem. 

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Following the examination of his coagulation indexes, the patient was diagnosed with mild hemophilia B, a disease characterized by the deficiency of coagulation factor IX. He had no family history of hemophilia or tendency for bleeding.

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He was treated with frozen plasma and coagulation factor complex, which stopped his bleeding. The patient was finally discharged from the hospital after spending 23 days there. His levels of coagulation factor were still low at follow-up, but no bleeding occurred again.

The researchers concluded that patients with hemophilia who may not be diagnosed because their disease is mild may be at a high risk of bleeding surgery, highlighting the importance of hemophilia screening before the operation.

The authors also mentioned the importance of psychological support following surgery as patients usually tend to avoid physical activity due to repeated bleeding, even though they receive adequate treatment. “After the bleeding is stopped, some patients still prefer to stay in bed for a long time without any movement,” they wrote. However, this may increase the risk of deep vein thrombosis and “is not conducive to the recovery.”

Replacement therapy is a type of treatment for patients with hemophilia where the body is supplemented with the coagulation factor that is deficient.


Jiang X, Xu M, Ding Y, Cao Y, Pan Y. Recurrent bleeding after rubber band ligation diagnosed as mild hemophilia B: a case report and literature review. BMC Surg. 2022;22(1):124. doi:10.1186/s12893-022-01553-8