Surgery in People With Mild Haemophilia

BACKGROUND: People with mild haemophilia (PMH) may require surgical treatment. PURPOSE: To analyse the literature related to surgery in PMH. METHODS: An English-language literature search in PubMed (MEDLINE) for articles published between the start of the search engine until 2 March 2026 was carried out using "mild haemophilia surgery" as keywords. RESULTS: A total of 445 publications were encountered, of which only 64 were analysed because they were strictly connected to the title of this article (inclusion criterion). The remaining 381 were excluded because they were not strictly connected to the title of this article. It was found that PMH have undergone pseudotumour, urological and dental surgery, and a wide variety of other surgical procedures with satisfactory results. However, in comparison with severe and moderate haemophilia patients, PMH have a higher risk of postoperative bleeding, death, and redo surgery. Besides, dosing above factor (F) VIII target ranges with FVIII concentrates was frequent during peri-operative management of PMH. The Arg593Cys genotype and intense peri-operative utilization of FVIII, particularly when given by continuous infusion, have been connected to a high risk for inhibitor appearance in PMH A. CONCLUSIONS: To reduce the risk of developing inhibitors, treatment with desmopressin should be used whenever possible in PMH. In PMH with high-risk mutations who require major surgery, the combined use of desmopressin and FVIII concentrates should be considered.