Malignancy and Hemostasis

  • Matthew Idle
  • Scott Claiborne
  • Ketan Patel
  • Deepak KademaniEmail author


The presence of cancer may predispose the patient to a hypercoagulable state. Approximately 15% of all patients with a malignancy may be affected by some form of thromboembolic disease. Trousseau’s syndrome relates to this predisposition to both arterial and venous coagulation in this cohort of patients. This well-documented state affects the local tumor site as well as causes these systemic effects. The additional burden on the patient of potential immobility, chemotherapy, surgery, indwelling lines, and nutritional deficit make thromboembolic disease more prevalent. It must also be borne in mind that malignant disease may also result in a greater bleeding tendency due to dysfunction with components of the coagulation cascade. Additionally, many patients may be on anticoagulant therapy, and bone marrow disorders such as leukemia may cause thrombo-hemorrhagic complications.

The oral surgical management of cancer patients in regard to hemostasis is a complex interplay of history, physical findings, laboratory values, and provider preference. There is limited high-quality information available regarding the specific oral surgery population, and therefore the best recommendations are extrapolated from available studies and guidelines in the medical and surgical literature. The ultimate decision is at the discretion of the treating provider to ensure procedures are executed appropriately, and there is a plan for monitoring in the postoperative period. Certainly the patient and treatment factors which place patients at greater risk for bleeding should be evaluated together in consultation with the patient’s oncologist prior to surgery. Once the risk of bleeding is established, laboratory testing guides consideration of preoperative transfusion, further medical management, or alteration of the surgical plan to reduce risk of bleeding intraoperatively. Scheduling surgery to accommodate for the expected bone marrow recovery following the drop in the patient’s blood counts is also a helpful measure. Reducing the extent of surgery and dividing treatment into multiple visits can decrease the stress on the patient’s hemostatic mechanisms. Careful attention to surgical technique to minimize tissue trauma and blood loss is essential, and local hemostatic measures discussed elsewhere are helpful adjuncts.


Thromboembolism Oral surgery Malignancy Tumor Tissue factor Thrombocytopenia Coagulopathy 


  1. 1.
    Letai A, Kuter DJ. Cancer, coagulation and anticoagulation. Oncologist. 1999;4:443–9.PubMedGoogle Scholar
  2. 2.
    Varki A. Trousseau’s syndrome: multiple definitions and multiple mechanisms. Blood. 2007;110(6):1723–9.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Nagy JA, Brown LF, Senger DR, et al. Pathogenesis of tumor stroma generation: a critical role for leaky blood vessels and fibrin deposition. Biochim Biophys Acta. 1989;948(3):305–26.PubMedGoogle Scholar
  4. 4.
    Khorana AA, Connolly GC. Assessing risk of venous thromboembolism in the patient with cancer. J Clin Oncol. 2009;27(29):4839–47.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Jain A, Gupta N, Singh T, et al. A study of haemostatic parameters in patients of chronic myeloid leukaemia. J Clin Diagn Res. 2016;10(7):OC19–23.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Zhu YW, Feng TB, Zhou XJ, et al. Routine hemostasis and hemogram parameters: valuable assessments for coagulation disorder and chemotherapy in cancer patients. Chin Med J. 2016;129(15):1772–7.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Langer F, Bokemeyer C. Crosstalk between cancer and haemostasis. Hamostaseologie. 2012;32:95–104.PubMedCrossRefGoogle Scholar
  8. 8.
    Lip GY, Chin BS, Blann AD. Cancer and the prothrombotic state. Lancet Oncol. 2002;3:27–34.PubMedCrossRefGoogle Scholar
  9. 9.
    Falanga A, Marchetti M, Vignoli A. Coagulation and cancer: biological and clinical aspects. J Thromb Haemost. 2013;11(2):223–33.PubMedCrossRefGoogle Scholar
  10. 10.
    Falanga A, Marchetti M, Vignoli A, et al. Clotting mechanisms and cancer: implications in thrombus formation and tumor progression. Clin Adv Hematol Oncol. 2003;1:673–8.PubMedGoogle Scholar
  11. 11.
    Riedl J, Pabinger I, Ay C. Platelets in cancer and thrombosis. Hamostaseologie. 2015;34:54–62.CrossRefGoogle Scholar
  12. 12.
    Tafur AJ, Dale G, Cherry M, et al. Prospective evaluation of protein C and factor VIII in prediction of cancer-associated thrombosis. Thromb Res. 2015;136(6):1120–5.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Alberio L, Safa O, Clemetson KJ, et al. Surface expression and functional characterization of alpha-granule factor V in human platelets: effects of ionophore A23187, thrombin, collagen, and convulxin. Blood. 2000;95:1694–702.PubMedGoogle Scholar
  14. 14.
    Vormittag R, Simanek R, Ay C, et al. High factor VIII levels independently predict venous thromboembolism in cancer patients: the cancer and thrombosis study. Arterioscler Thromb Vasc Biol. 2009;29:2176–81.PubMedCrossRefGoogle Scholar
  15. 15.
    Donati MB. Cancer and thrombosis: from phlegmasia alba dolens to transgenic mice. Thromb Haemost. 1995;74:278–81.PubMedGoogle Scholar
  16. 16.
    Ruf W, Mueller BM. Thrombin generation and the pathogenesis of cancer. Semin Thromb Hemost. 2006;32(Suppl 1):61–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Palumbo JS. Mechanisms linking tumor cell-associated procoagulant function to tumor dissemination. Semin Thromb Hemost. 2008;34:154–60.PubMedCrossRefGoogle Scholar
  18. 18.
    Falanga A. Biological and clinical aspects of anticancer effects of antithrombotics. Pathophysiol Haemost Thromb. 2003/2004;33:389–92.PubMedCrossRefGoogle Scholar
  19. 19.
    Mackman N. The role of tissue factor and factor VIIa in haemostasis. Anesth Analg. 2009;108(5):1447–52.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Ohta S, Wada H, Nakazaki T, et al. Expression of tissue factor is associated with clinical features and angiogenesis in prostate cancer. Anticancer Res. 2002;22:2991–6.PubMedGoogle Scholar
  21. 21.
    Garnier D, Milsom C, Magnus N, et al. Role of the tissue factor pathway in the biology of tumor initiating cells. Thromb Res. 2010;125(Suppl 2):S44–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Rong Y, Durden DL, Van Meir EG, et al. ‘Pseudopalisading’ necrosis in glioblastoma: a familiar morphologic feature that links vascular pathology, hypoxia, and angiogenesis. J Neuropathol Exp Neurol. 2006;65:529–39.PubMedCrossRefGoogle Scholar
  23. 23.
    Khorana AA, Ahrendt SA, Ryan CK, et al. Tissue factor expression, angiogenesis, and thrombosis in pancreatic cancer. Clin Cancer Res. 2007;13:2870–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Yu JL, May L, Lhotak V, et al. Oncogenic events regulate tissue factor expression in colorectal cancer cells: implications for tumor progression and angiogenesis. Blood. 2005;105:1734–41.PubMedCrossRefGoogle Scholar
  25. 25.
    Abe K, Shoji M, Chen J, et al. Regulation of vascular endothelial growth factor production and angiogenesis by the cytoplasmic tail of tissue factor. Proc Natl Acad Sci USA. 1999;96:8663–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Zwicker JI, Liebman HA, Neuberg D, et al. Tumor derived tissue factor-bearing microparticles are associated with venous thromboembolic events in malignancy. Clin Cancer Res. 2009;15:6830–40.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Del Conde I, Bharwani LD, Dietzen DJ, et al. Microvesicle-associated tissue factor and Trousseau’s syndrome. J Thromb Haemost. 2007;5:70–4.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Im JH, Fu W, Wang H, et al. Coagulation facilitates tumor cell spreading in the pulmonary vasculature during early metastatic colony formation. Cancer Res. 2004;64:8613–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Amirkhosravi A, Mousa SA, Amaya M, et al. Assessment of anti-metastatic effects of anticoagulant and antiplatelet agents using animal models of experimental lung metastasis. Methods Mol Biol. 2010;663:241–59.PubMedCrossRefGoogle Scholar
  30. 30.
    Caine GJ, Stonelake PS, Lip GYH, et al. The hypercoagulable state of malignancy: pathogenesis and current debate. Neoplasia. 2002;4(6):465–73.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Nemerson Y. The tissue factor pathway of blood coagulation. Semin Hematol. 1992;29(3):170–6.PubMedGoogle Scholar
  32. 32.
    Semeraro N, Colucci M. Tissue factor in health and disease. Thromb Haemost. 1997;78(1):759–64.PubMedCrossRefGoogle Scholar
  33. 33.
    Gordon SG, Mourad AM. The site of activation of factor X by cancer procoagulant. Blood Coagul Fibrinolysis. 1991;2(6):735–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Mielicki WP, Gordon SG. Three-stage chromogenic assay for the analysis of activation properties of factor X by cancer procoagulant. Blood Coagul Fibrinolysis. 1993;4(3):441–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Falanga A, Gordon SG. Isolation and characterization of cancer procoagulant: a cysteine proteinase from malignant tissue. Biochemistry. 1985;24(20):5558–67.PubMedCrossRefGoogle Scholar
  36. 36.
    Donati MB, Gambacorti-Passerini C, Casali B, et al. Cancer procoagulant in human tumor cells: evidence from melanoma patients. Cancer Res. 1986;46(12 Pt 1):6471–4.PubMedGoogle Scholar
  37. 37.
    Gordon SG, Cross BA. An enzyme-linked immunosorbent assay for cancer procoagulant and its potential as a new tumor marker. Cancer Res. 1990;50(19):6229–34.PubMedGoogle Scholar
  38. 38.
    Nieswandt B, Hafner M, Echtenacher B, et al. Lysis of tumor cells by natural killer cells in mice is impeded by platelets. Cancer Res. 1999;59(6):1295–300.PubMedGoogle Scholar
  39. 39.
    Palumbo JS, Talmage KE, Massari JV, et al. Platelets and fibrin(ogen) increase metastatic potential by impeding natural killer cell-mediated elimination of tumor cells. Blood. 2005;105(1):178–85.PubMedCrossRefGoogle Scholar
  40. 40.
    Placke T, Örgel M, Schaller M, et al. Platelet-derived MHC class I confers a pseudonormal phenotype to cancer cells that subverts the antitumor reactivity of natural killer immune cells. Cancer Res. 2012;72(2):440–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Placke T, Salih HR, Kopp HG. GITR ligand provided by thrombopoietic cells inhibits NK cell antitumor activity. J Immunol. 2012;189(1):154–60.PubMedCrossRefGoogle Scholar
  42. 42.
    Mehta P, Lawson D, Ward MB, et al. Effect of human tumor cells on platelet aggregation: potential relevance to pattern of metastasis. Cancer Res. 1986;46(10):5061–3.PubMedGoogle Scholar
  43. 43.
    Fäldt R, Ankerst J, Zoucas E. Inhibition of platelet aggregation by myeloid leukaemic cells demonstrated in vitro. Br J Haematol. 1987;66(4):529–34.PubMedCrossRefGoogle Scholar
  44. 44.
    Pulte D, Furman RR, Broekman MJ, et al. CD39 expression on T lymphocytes correlates with severity of disease in patients with chronic lymphocytic leukemia. Clin Lymphoma Myeloma Leuk. 2011;11(4):367–72.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Jaime-Pérez JC, Cantú-Rodríguez OG, Herrera-Garza JL, et al. Platelet aggregation in children with acute lymphoblastic leukemia during induction of remission therapy. Arch Med Res. 2004;35(2):141–4.PubMedCrossRefGoogle Scholar
  46. 46.
    Nouh MA, Inui M, Kakehi Y. Renal cell carcinoma with IVC thrombi; current concepts and future perspectives. Clin Med Oncol. 2008;2:247–56.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Mootha RK, Butler R, Laucirica R, et al. Renal cell carcinoma with infra renal vena caval tumor thrombus. Urology. 1999;54:561–5.PubMedCrossRefGoogle Scholar
  48. 48.
    Heit JA, Silverstein MD, Mohr DN, et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;160:809–15.PubMedCrossRefGoogle Scholar
  49. 49.
    Blom JW, Vanderschoot JP, Oostindier MJ, et al. Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost. 2006;4:529–35.PubMedCrossRefGoogle Scholar
  50. 50.
    Khorana AA. Cancer and coagulation. Am J Hematol. 2012;87:S82–7.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Fisher B, Constantino J, Redmond C, et al. A randomized clinical trial evaluating tamoxifen in the treatment of patients with node negative breast cancer who have estrogen-receptor positive tumors. N Engl J Med. 1989;320:479–84.PubMedCrossRefGoogle Scholar
  52. 52.
    Pritchard KI, Paterson AHG, Paul NA, et al. Increased thromboembolic complications with concurrent tamoxifen and chemotherapy in a randomised trial of adjuvant therapy for women with breast cancer. J Clin Oncol. 1996;14:2731–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Moore RA, Adel N, Riedel E, et al. High incidence of thromboembolic events in patients treated with Cisplatin-based chemotherapy: a large retrospective analysis. J Clin Oncol. 2011;29(25):3466–73.PubMedCrossRefGoogle Scholar
  54. 54.
    Otten H-MMB, Mathijssen J, ten Cate H, et al. Symptomatic venous thromboembolism in cancer patients treated with chemotherapy: an underestimated phenomenon. Arch Intern Med. 2004;164(2):190–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Dursun B, He Z, Somerset H, et al. Caspases and calpain are independent mediators of Cisplatin-induced endothelial cell necrosis. Am J Physiol Renal Physiol. 2006;291(3):F578–87.PubMedCrossRefGoogle Scholar
  56. 56.
    Togna GI, Togna AR, Franconi M, et al. Cisplatin triggers platelet activation. Thromb Res. 2000;99(5):503–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Bona R. Thrombotic complications of central venous catheters in cancer patients. Semin Thromb Haemost. 1999;25:147–55.CrossRefGoogle Scholar
  58. 58.
    Falanga A, Marchetti M. Anticancer treatment and thrombosis. Thromb Res. 2012;129(3):353–9.PubMedCrossRefGoogle Scholar
  59. 59.
    DeCicco M, Matovic M, Balesterri L, et al. Central venous thrombosis: an early and frequent complication in cancer patients bearing long-term silastic catheter. A prospective study. Thromb Res. 1997;86:101–13.CrossRefGoogle Scholar
  60. 60.
    Koksoy C, Kuzu A, Erden I, et al. The risk factors in central venous catheter-related thrombosis. Aust N Z J Surg. 1995;65:796–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Monreal M, Raventos A, Lerma R, et al. Pulmonary embolism in patients with upper extremity DVT associated to venous central lines—a prospective study. Thromb Haemost. 1994;72:548–50.PubMedGoogle Scholar
  62. 62.
    Houry S, Georgeac C, Hay JM, et al. A prospective multicenter evaluation of preoperative hemostatic screening tests. Am J Surg. 1995;170:19–23.PubMedCrossRefGoogle Scholar
  63. 63.
    Sun NC, McAfee WM, Hum GJ, et al. Haemostatic abnormalities in malignancy: a prospective study in one hundred eight patients. Am J Clin Pathol. 1979;71:10–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Mohammed M, Mansoor M, Taher M. Hemostatic derangements in patients with solid malignant tumors. J Pak Med Stud. 2013;3(1):1–9.Google Scholar
  65. 65.
    Agarwal AM, Prchal JT. Anemia associated with marrow infiltration (chapter 44). In: Lichtman MA, Kipps TJ, Seligsohn U, editors. Williams hematology. 8th ed. New York, NY: McGraw-Hill; 2010.Google Scholar
  66. 66.
    Kuter DJ. Managing thrombocytopenia associated with cancer chemotherapy. Oncology. 2015;29(4):282–94.PubMedGoogle Scholar
  67. 67.
    Pedersen-Bjergaard J. Radiotherapy and chemotherapy-induced myelodysplasia and acute myeloid leukemia: a review. Leuk Res. 1992;16:61.PubMedCrossRefGoogle Scholar
  68. 68.
    Glassman AB. Hemostatic abnormalities associated with cancer and its therapy. Ann Clin Lab Sci. 1997;27(6):391–5.PubMedGoogle Scholar
  69. 69.
    Shimazaki C, Inabi T, Uchiyama H, et al. Serum thrombopoietin levels in patients undergoing autologous peripheral blood stem cell transplantation. Bone Marrow Transplant. 1997;19:771–5.PubMedCrossRefGoogle Scholar
  70. 70.
    Manzullo EF, Sahai SK, Weed HG. Preoperative evaluation and management of patients with cancer. In: Post TW, editor. UpToDate. Waltham, MA: UpToDate; 2014.Google Scholar
  71. 71.
    Thatishetty AV, Agresti N, O’Brien CB. Chemotherapy-induced hepatotoxicity. Clin Liver Dis. 2013;17(4):671–86.PubMedCrossRefGoogle Scholar
  72. 72.
    Glaspy JA. Disturbances in hemostasis in patients with B-cell malignancies. Semin Thromb Hemostat. 1992;18:440–8.CrossRefGoogle Scholar
  73. 73.
    Fellin F. Perioperative evaluation of patients with hematologic disorders (chapter 6). In: Merli GJ, Weitz HH, editors. Medical management of the surgical patient. 3rd ed. Philadelphia, PA: Elsevier; 2008.Google Scholar
  74. 74.
    Wu Y, Aravind S, Ranganathan G, et al. Anemia and thrombocytopenia in patients undergoing chemotherapy for solid tumors: a description study of a large outpatient oncology practice database, 2000–2007. Clin Ther. 2009;31(Pt 2):2416–32.PubMedCrossRefGoogle Scholar
  75. 75.
    Cairo MS. Dose reductions and delays: limitations of myelosuppressive chemotherapy. Oncology. 2000;9(Suppl 8):21–31.Google Scholar
  76. 76.
    Dutcher JP, Schiffer CA, Aisner J, et al. Incidence of thrombocytopenia and serious hemorrhage among patients with solid tumors. Cancer. 1984;53:557–62.PubMedCrossRefGoogle Scholar
  77. 77.
    Elting L, Rubenstein E, Loewy J, et al. Incidence and outcomes of chemotherapy-induced thrombocytopenia in patients with solid tumors. Support Care Cancer. 1996;4:238.Google Scholar
  78. 78.
    Piatek C, Akhtari M. Thrombocytopenia: optimizing approaches in cancer patients. Oncology. 2015;29(4):297–8.PubMedGoogle Scholar
  79. 79.
    Gaydos LA, Freireich EJ, Mantel N. The quantitative relation between platelet count and hemorrhage in patients with acute leukemia. N Engl J Med. 1962;266:905–9.PubMedCrossRefGoogle Scholar
  80. 80.
    Pisciotto PT, Benson K, Hume H, et al. Prophylactic versus therapeutic platelet transfusion practices in hematology and/or oncology patients. Transfusion. 1995;35:498–502.PubMedCrossRefGoogle Scholar
  81. 81.
    Friedmann AM, Sengul H, Lehmann H, et al. Do basic laboratory tests or clinical observations predict bleeding in thrombocytopenic oncology patients? A reevaluation of prophylactic platelet transfusions. Transfus Med Rev. 2002;16(1):34–45.PubMedCrossRefGoogle Scholar
  82. 82.
    Slichter SJ. Relationship between platelet count and bleeding risk in thrombocytopenic patients. Transfus Med Rev. 2004 Jul;18(3):153–67.PubMedCrossRefGoogle Scholar
  83. 83.
    Elting L, Martin C, Cantor S, et al. A clinical prediction rule to guide the use of prophylactic platelet growth factors and platelet transfusions. Proc Am Soc Clin Oncol. 1998;421a:17.Google Scholar
  84. 84.
    MacManus M, Lamborn K, Khan W, et al. Radiotherapy-associated neutropenia and thrombocytopenia: analysis of risk factors and development of a predictive model. Blood. 1997;89:2303–10.Google Scholar
  85. 85.
    Elting L, Martin C, Kurtin D, et al. The bleeding risk index: a clinical prediction rule to guide the prophylactic use of platelet transfusions in patients with lymphoma or solid tumors. Cancer. 2002;94:3252–62.PubMedCrossRefGoogle Scholar
  86. 86.
    Kaufman RM, Djulbegovic B, Gernsheimer T, et al. Platelet transfusion: a clinical practice guideline from the American Association of Blood Banks. Ann Intern Med. 2015;162(3):205–13.PubMedCrossRefGoogle Scholar
  87. 87.
    Padhi S, Kemmis-Betty S, Rajesh S, et al. Blood transfusion: summary of NICE guidance. BMJ. 2015;351:h5832.PubMedCrossRefGoogle Scholar
  88. 88.
    Lin Y, Foltz LM. Proposed guidelines for platelet transfusion. BCMJ. 2005;47(5):245–8.Google Scholar
  89. 89.
    Fillmore WJ, Leavitt BD, Arce K. Dental extraction in the thrombocytopenic patient is safe and complications are easily managed. J Oral Maxillofac Surg. 2013;71(10):1647–52.PubMedCrossRefGoogle Scholar
  90. 90.
    Napolitano L. Perioperative anemia. Surg Clin North Am. 2005;85:1215–27.PubMedCrossRefGoogle Scholar
  91. 91.
    Rodgers GM, Becker PS, Bennett CL, et al. Cancer and chemotherapy induced anemia. J Natl Compr Canc Netw. 2008;6:536.PubMedCrossRefGoogle Scholar
  92. 92.
    Maccio A, Madeddu C, Gramignano G, et al. The role of inflammation, iron, and nutritional status in cancer-related anemia: results of a large, prospective, observational study. Haematologica. 2015;100:124.PubMedPubMedCentralCrossRefGoogle Scholar
  93. 93.
    Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352:1011–23.PubMedCrossRefGoogle Scholar
  94. 94.
    Engelfriet CP, Overbeeke MA, von dem Borne AE. Autoimmune hemolytic anemia. Semin Hematol. 1992;29:3.PubMedGoogle Scholar
  95. 95.
    Neoh K, Stanworth S, Pasricha SR, et al. Estimating prevalence of functional iron deficiency anaemia in advanced cancer. Support Care Cancer. 2017;25(4):1209–14.PubMedCrossRefGoogle Scholar
  96. 96.
    Gilreath JA, Stenehjem DD, Rodgers GM. Diagnosis and treatment of cancer related anemia. Am J Hematol. 2014;89:203–12.PubMedCrossRefGoogle Scholar
  97. 97.
    Cascinu S, Fedeli A, Del Ferro E, et al. Recombinant human erythropoietin treatment in cisplatin associated anemia: a randomized, double blind trial with placebo. J Clin Oncol. 1994;12:1058.PubMedCrossRefGoogle Scholar
  98. 98.
    Abels R. Erythropoietin for anemia in cancer patients. Eur J Cancer. 1993;29A(Suppl 2):S2.PubMedCrossRefGoogle Scholar
  99. 99.
    Hébert PC, Wells G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med. 1999;340(6):409–17. Erratum in: N Engl J Med. 1999;340(13):1056.Google Scholar
  100. 100.
    Henderson JM, Bergman S, Salama A, et al. Management of the oral and maxillofacial surgery patient with thrombocytopenia. J Oral Maxillofac Surg. 2001;59(4):421–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Matthew Idle
    • 1
  • Scott Claiborne
    • 1
  • Ketan Patel
    • 2
  • Deepak Kademani
    • 1
    • 2
    • 3
    Email author
  1. 1.Oral/Head and Neck Oncologic and Reconstructive SurgeryNorth Memorial Health HospitalMinneapolisUSA
  2. 2.Department of Oral and Maxillofacial SurgeryNorth Memorial Health HospitalMinneapolisUSA
  3. 3.Department of SurgeryNorth Memorial Health HospitalMinneapolisUSA

Personalised recommendations