Bleeding disorder Flashcards
List three acquired hemorrhagic disorders.
Disseminated intravascular coagulation (DIC) and liver disease
Vitamin K deficiency Drug induced (anti-platelet, anti- coagulant)
pdf 150 for more info
List three methods to control epistaxis
Manual haemostasis
Nasal packing
Nasal cauterisation
How does manual haemostasis control epistaxis?
Squeeze nostrils together for 5-10 min, without frequent peeking
Head in neutral/lowered position (NOT hyperextended ∵ risk of aspiration)
± gauze moistened with adrenaline (1 : 10000) / phenylephrine (for vasoconstriction)
How does nasal packing control epistaxis?
Anterior: Vaseline® (petroleum jelly gauze filled with Abio ointment), Merocel® (expandable)
Posterior: rolled gauzes, inflatable balloon devices
All packing should be removed in 3-4 days
How does nasal cauterisation control epistaxis?
Chemical: silver nitrate
Electrocauterisation: requires LA, use rigid endoscopy, reserved for severe/pos bleeding
List two causes of bleeding tendency resulting in epistaxis
Haemophilia A (F8), B (F9), von Willebrand disease
What are the causes of hemorrhagic disorders?
Genetics (haemophilia, vWD), liver disease (liver failure), medications (anticoagulants, antiplatelets)
What are the salient points of a history-taking for a patient with previous post-operative bleeding history?
Time:
How long have you had the bleeding problem? How long have you been on anticoagulants?
Describe:
your bleeding problem
Past:
Have you had problems with previous dental appointments?
Cause:
What is the cause of your bleeding problem/ why are you on anticoagulants?
Lab:
What are your most recent laboratory results relative to your anticoagulation/ bleeding problem status?
What are the types of anticoagulants?
Aspirin, warfarin, heparin
List the laboratory blood tests for a patient with previous post-operative bleeding history.
Activated partial thromboplastin time (aPTT) (intrinsic)
Prothrombin time (PT) (extrinsic)
INR (normal = 1; therapeutic = 2-3; OK for extraction if under 3.5)
Bleeding time (BT) (Simplate)
Platelet count
Thrombin time (TT)
What is the dental management before the appointment? (on warfarin)
Consult patient’s physician
List 4 conditions that may need to consider for post-operative bleeding after extraction (2)
Haemophili A
Haemophilia B
von Willebrand disease
Liver cirrhosis
List two causes of bleeding tendency resulting in epistaxis
Thrombocytopenia
Drug induced such as aspirin
Patient got mitral valve replacement in the past and is on anticoagulant. He is scheduled for extraction.
a. What anticoagulant is he taking? (3)
Wafarin, heparin
Patient got mitral valve replacement in the past and is on anticoagulant. He is scheduled for extraction.
b. What blood test would you perform? (2)
INR, aPTT, PT, platelet count
Patient got mitral valve replacement in the past and is on anticoagulant. He is scheduled for extraction.
c. What are the dental complications of his condition? (2.5)
Infection, bleeding
Patient got mitral valve replacement in the past and is on anticoagulant. He is scheduled for extraction.
d. What is the dental management before the appointment? (2.5)
FROM: BCSH: British committee of standard hematology
Check INR prior 72 hours (<4safe, > 4 send to hospital)
Heparin: significant first pass effect, only iv, latest heparin in capsule can be taken orally
Antibiotic Prophylaxis
Given: the patient has history of atrial fibrillation (2010, 2)
a. Give 2 medications that the patient should take to prevent stroke?
Aspirin, warfarin
Given: the patient has history of atrial fibrillation (2010, 2)
b. Give the laboratory test that test anti-coagulation status.
INR
Given: the patient has history of atrial fibrillation (2010, 2)
c. What are the complications in major oral surgery?
Pacemaker Bleeding Fresh frozen plasma transfusion Give vit K Thromboembolism Infection control Antibiotic Prophy for major surgery: cellulitis, more than 4hours, foreign body like implant, immunocommpromsed like chemotherapy, DM, kidney dialysis, organ transplant (also need prophy in MOS) *in hospital*
