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Human Disease Y3 > Bleeding and Leukaemia > Flashcards

Bleeding and Leukaemia Flashcards

1
Q

what is the process of haemostasis ?

A 
injury and tissue damage,
vascular response,
platelet adhesion and aggregation,
unstable platelet clot,
coagulation factor cascade,
fibrin,
stable clot
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2
Q

what is the vascular response in haemostasis ?

A

vasoconstriction

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3
Q

what is the platelet response in haemostasis ?

A

VWF, platelet and fibrinogen —-> unstable platelet clot

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4
Q

what is the function of fibrin in clotting ?

A

give stability to the clot

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5
Q

what are the genetic coagulation defects ?

A

haemophila A,B,C, Von Willebrands

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6
Q

what are the acquired coagulation defects ?

A

drugs, liver disease, vitamin K deficiency, disseminated intravascular coagulation, massive blood transfusion

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7
Q

what clotting factor is deficient in haemophilia A ?

A

VIII

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8
Q

what clotting factor deficient in haemophilia B ?

A

IX

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9
Q

what clotting factor is deficient in haemophilia C ?

A

XI

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10
Q

when can haemophiliac A’s have dental treatment ?

A

straight after administration of factor VIII

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11
Q

when can haemophiliac B’s have dental treatment ?

A

factor IX has longer half life so can be given daily so treatment could be done at end of day

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12
Q

what is the treatment for haemophilia C ?

A

FFP, factor XI plus transexamic acid

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13
Q

what is Von Willebrands disease ?

A

similar to haemophilia A

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14
Q

how are people with Von Willebrands disease prepared for surgical procedures ?

A

minor - DDAVP and oral traexamic acid

major - factor VIII infusion

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15
Q

what considerations should be made before giving injections to haemophiliacs ?

A

regional blocks in floor of mouth may cause haemorrhage to track through tissue planes causing potential airway obstruction,
avoid intramuscular injections,
infiltrations fine for mild haemophiliacs

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16
Q

which anticoagulants are usually given for DVT’s and PE ?

A

heparin - immediate effect in acute thromboembolism
enoxaparin LMWH - inhibits factor Xa
newer drugs e.g. clexane

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17
Q

what is the mechanism of action of warfarin ?

A

impairs the synthesis of vitamin K dependent coagulase factors II, VII, IX, X in the liver

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18
Q

how long does warfarin take to become effective ?

A

2-4 days

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19
Q

what are the indications for short term oral anticoagulation ?

A 
prevent DVT, 
MI 3 months,
established DVT 3 months,
xenograft cardiac valves 3 months,
pulmonary embolism 3-6 months,
CABG 2 months
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20
Q

what are the indications for long term oral anticoagulation ?

A

recurrent venous thromboembolism,
rheumatic heart disease and atrial fibrillation,
cardiac prosthetic valve replacement and arterial grafts

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21
Q

what is the scale for measuring INR ?

A 
normal - 1
DVT, PE, AF - 2.5,
recurrent DVT - 3.5,
recurrent PE - 3.5,
mechanical heart valves - 3.5
22
Q

when should INR be checked prior to a procedure ?

A

no longer than 24-36 hrs before, preferably on the day

23
Q

which drugs potentiate warfarin ?

A

miconazole oral gel (daktarin)

NSAIDS

24
Q

what are the relevant drug interactions with anticoagulants ?

A

metronidazole - should be avoided or warfarin reduced by half
erythromycin - unpredictable effects in certain patients

25
Q

how can INR be altered for planned surgery ?

A

stop 48 hrs before,
reduce warfarin by half for 48 hrs,
antibiotic or antifungal course

26
Q

what are rivaroxiban and dabigatran ?

A

oral anticoagulants with no requirement for regular blood levels or INR

27
Q

what is the mechanism of action of rivaroxiban ?

A

factor Xa inhibitor

28
Q

what is the mechanism of action of dabigatran ?

A

direct thrombin inhibitor

29
Q

what are rivaroxiban and dabigatran used for ?

A

hip, knee replacement prophylaxis (both)

stroke, AF, valve replacement (dab)

30
Q

what are the anti platelet medications ?

A

low dose aspirin,
clopidogrel,
ticlopidine,
dipyridamole

31
Q

what is low dose aspirin used to treat ?

A

thrombotic cardiovascular or cerebrovascular disease

32
Q

what are clopidogrel and ticlopidine used to treat ?

A

symptomatic ischemic heart disease

33
Q

what is dipyridamole used for ?

A

adjunct to oral anticoagulants with prosthetic heart valves

34
Q

what is the mechanism of action of aspirin, clopidogrel and ticlopidine ?

A

inhibit platelet aggregation to blood vessel walls,

lasts for the life of the platelets 7-10 days

35
Q

what is the mechanism of action of dipyridamole ?

A

reversible effect, acts directly on enzymes in platelets and vessel cell walls

36
Q

which NSAIDs are used as anti platelet medications ?

A

ibuprofen, diclofenac - reversible

37
Q

what causes coagulation defects ?

A

liver disease, hepatocellular failure, vitamin K deficiency, increased fibrinolysis, thrombocytopenia (low platelet count)

38
Q

how is thrombocytopenia treated ?

A

autoimmune - treat with steroids or splenectomy,

leukaemia, aplastic anaemia - treat with platelet transfusion

39
Q

what is leukaemia ?

A

neoplastic proliferation of WBC’s in bone marrow

40
Q

what causes leukaemia ?

A 
genetic - downs syndrome,
ionizing radiation,
chemicals - benzene,
viruses,
lymphoblastic and non lymphoblastic
41
Q

what is acute lymphoblastic leukaemia ?

A

B lymphocyte neoplasm

42
Q

what effect does chemotherapy have on bon marrow ?

A

leukopenia and neutropenia,
thrombocytopenia,
anaemia

43
Q

what effect does chemotherapy have on the oral cavity ?

A

severe mucositis, oral ulceration, pseudomonas, candida albicans, herpes simplex

44
Q

what are the recommendations for dental care prior to cancer therapy ?

A 
comprehensive oral assessment,
detailed OH instruction,
chlorhexidiene,
stabilise caries, 
remove teeth with doubtful prognosis
45
Q

what are the recommendations for dental care during cancer therapy ?

A 
hygienist available,
chlorhexidiene,
fluoride MW,
alleviate xerostomia,
prevent mucositis
46
Q

when is prophylactic antibiotic cover recommended for patients having dental treatment during cancer therapy ?

A

if patient is neutropenic at time of treatment,

if treatment is likely to cause a significant bacteraemia

47
Q

what should be checked before performing and extraction or surgical procedure on a cancer patient ?

A

platelet and white cell count

48
Q

when would platelet cover be required in a cancer patient undergoing an extraction or surgical procedure ?

A

if the count is below 50X10^9 per litre

49
Q

when should dental treatment be carried out on those having chemotherapy ?

A

before chemotherapy or 2-3 days after

50
Q

when should platelets and neutrophils be checked ?

A

for procedures likely to cause bacteraemia

51
Q

what are the risks of dental treatment to a patient undergoing chemotherapy ?

A

dental infections can be fatal on high doses of chemotherapy

Human Disease Y3 (24 decks)

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