Bleeding Dental Patients Flashcards
What is the ISTH bleeding assessment tool?
A series of 14 sites of bleeding questioned and scored depending on the severity of symptoms from the patient
What are some blood panel investigations?
Full blood count- platelet number, not function
Coagulation screen- clotting factor levels
Prothrombin time
What is the extrinsic pathway of the physiological cascade?
Only factor VII
Prolong PT only
Factor VII deficiency- oral warfarin therapy, sepsis, congenital deficiency, early vitamin K deficiency
What is the common pathway of the physiological cascade?
Factor II, V, X
Prolongs both PT and APTT (activated partial thromboplastin time)
Vitamin K deficiency
Oral warfarin therapy
Oral dabigatran therapy
Disseminated intravascular coagulopathy- septicaemia, meningitis, malignancy
What is the intrinsic pathway of the physiological cascade?
Refers to factors VIII, IX, XI, XII DIC (disseminated intravascular coagulopathy) Liver disease Massive transfusion Unfractionated heparin therapy monitoring- prolongs APTT Oral warfarin therapy Lupus anticoagulant Deficiency in VIII, IX, XI, XII
What are some causes of bleeding disorder?
Abnormal vascular endothelium
Deficiency of clotting factors
Platelet abnormalities
What condition might mucocutaneous bleeding and delayed post-surgical bleeding suggest?
Von Willebrands disease, a dysfunctional platelet syndrome and factor XIII deficiency
What are some common hereditary coagulation disorders?
Haemophilia A- deficiency of factor VIII (male patients)
Haemophilia B- deficiency of factor IX (male patients)
Von Willebrand’s disease
Rare- factor X, factor VII, factor V deficiency
What is haemophilia?
An inherited bleeding disorder in which the blood does not clot properly
What are the symptoms of haemophilia?
Major haemorrhage into joints, traumatic soft tissue bleeds, GI haemorrhage, haematuria, haematospermia, severe pain, intramuscular haematoma
How is haemophilia managed?
All patients with severe/moderate deficiency must be reviewed every 6 months in a hospital environment
All patients with mild factor deficiency must be reviewed every 2 years in a hospital environment with 6 monthly check ups in general dental practice
What is the treatment for haemophilia?
Clotting factor replacement therapy
What is Von Willebrand’s disease?
An inherited blood disorder where the blood does not clot properly due to a deficiency in VWF
What does VWF do?
It is a multimeric glycoprotein secreted by endothelium and megakaryocytes
It promotes platelet adhesion to damaged epithelium and other platelets, and also stabilises and transports factor VIII
A deficiency of VWF causes abnormal platelet function and low factor VIII activity
What are the symptoms of VWD?
Epistaxis (nose bleeds)
Menorrhagia (heavy menstrual periods)
Bleeding after surgery
Tends NOT to have joint bleeds, muscle bleeds or spontaneous bleeds
