Bleeding disorders Flashcards
types of bleeding disorders
platelet disorders
clotting disorders
platelet disorders
Failed platelet production
Excessive platelet destruction
Abnormal platelet function
what is thrombocytopenia
Thrombocytopenia
Too little
Normal platelet level is 150-300 X10 9/L
Autoimmune
Alcoholism
Bone marrow diseases
Cancer
Infections- e.g. HIV, EBV
Cancer treatments
Liver problems- cirrhosis and hepatitis
Glanzmanns disease
what is Glanzmanns
Autosomal recessive
Affects platelet aggregation
Epistaxis, menorrhagia, gingival
haemorrhage
dental treatment on patient with platelet disorders
Liaise with Haematology/Oncology
FBC prior to procedure
Platelet levels above 50x109/L for
extraction
Platelet levels above 70x109/L for major
surgery
Steroids
Eltrombopag
Tranexamic acid
Platelet transfusion
what is transexamic acid used to treat
prevent excessive blood loss
name 3 clotting disorders
Von Willebrand’s Disease
Haemophilia A (Factor VIII)
Haemophilia B (Factor IX)
Symptoms of VWD
Excessive bleeding from injury, surgery,
dental extraction
Frequent nosebleeds
Heavy periods
Heavy bleeding during labour and delivery
Blood in urine or stool
Easy bruising or lumpy bruises
Treatment for VWD
Tranexamic acid
Desmopressin
Factor VIII- severe
Symptoms of haemophilia
Nosebleeds
Prolonged bleeding from wounds
Bleeding gums
Skin that bruises easily
Pain and stiffness around joints
Internal bleeding
what cases of severe haemophillia should be routinely reffered to the dental hospital for
severe cases of haemophilia
when is haemostatic cover therapy required
Extractions
Oral surgery
Periodontal surgery
Implant surgery
IDBs, lingual infils
when is haemostatic cover therapy not required
Buccal infiltration
Palatal infiltration
Intraligamental injection
Intrapapillary injection
dental extractions for patient with haemophilia
Liase with Haemophilia centre to organise
factor replacement therapy
Use of buccal articaine
Tranexamic acid mouthwash and/or
tablets
Topical haemostatic agents- pressure
packs, sutures, oxidized cellulose
(Surgicel), Fibrin glue
periodontal treatment -gingivitis- on patient with haemophilia
No factor replacement required
TA mouthwash effectively manages post-
op bleeding
Disclosing agents used to demonstrate
plaque to patients
periodontal treatment - periodontitis - on patient with haemophilia
Prolonged bleeding can be encountered
No factor replacement required but pre-
op TA and post op TA mouthwash is
advised
In severe cases factor replacement
therapy may be advised
Challenges with
Haematological cove
Patients develop inhibitors to
replacement clotting factor
Require more expensive drugs
More severe bleeding
Drugs which affect bleeding
Anti-platelet drugs- aspirin, clopidogrel
Anti-coagulants- Warfarin, Heparin
Newer anti-coagulants- Dabigatran,
Apixaban, Rivaroxaban, Edoxaban
Types of blood cancer
Myeloma
Leukaemia
Lymphoma
Myelodyplasia
what is multiple myeloma
Plasma cell neoplasm
Mainly affects people aged over 60.
Many years before symptoms appear
Sometimes related to radiotherapy or
petroleum products
Production of abnormal serum
immunoglobulins
Diagnosing myeloma
Blood tests
CT/MRI scan
Bone marrow biopsy
Dental aspects of myeloma
70% cases skull affected
Root resorption
Loose teeth
Mental anaesthesia
Pathological #
Rare cause of mandibular radiolucencies
Dental aspects of myeloma
Anaemia
Infection
Haemorrhagic tendencies
Renal failure
Chemotherapy
Steroids
Bisphosphonates
Biological therapies
Liase with Haematology
types of leukaemia
Acute- acute lymphoblastic leukaemia
acute myeloid leukaemia
Chronic- chronic lymphocytic leukaemia
chronic myeloid leukaemia
Treatment for leukaemia
Chemotherapy
Radiation therapy
Stem cell transplant
Immunotherapy
Tyrosine kinase inhibitors
Dental aspects of leukaemia
Crowding out of normal blood cells by the
leukaemic cells
Anaemia
Bleeding tendencies
Susceptibility to infections
Septicaemia from oral infections
Mucosal pallor
Ulceration
Gingival swelling
Spontaneous bleeding
what is lymphoma
Cancer of the lymph glands or other
organs of the lymphatic system
types of lymphoma
Hodgkin’s lymphoma
Non Hodgkin’s lymphoma
symptoms of lymphoma
non tender swollen lymph
nodes, fever, night sweats and
unexplained weight loss
Treatment for lymphoma
Depends on type, grade and extent of
lymphoma, age
Low grade- watch and wait
High grade- chemotherapy, radiotherapy,
monoclonal antibody therapy- Rituximab
what is myelodysplasia
Rare type of blood cancer
Don’t have enough healthy blood cells
Most common in adults over the age of 70
Bone marrow makes abnormal cells
instead of healthy blood cells (RBC, WBC,
platelets)
Immature blood cells squeeze out the
healthy ones
Can develop slowly or quickly
Can develop into AML
tx of myelodsyplasia
Injections of growth factor medicines such
as Erythropoietin to increase numbers of
blood cells
Blood transfusion
Antibiotics
Biological therapies- Lenalidomide
Chemotherapy
Immunosuppressants
Stem cell (bone marrow) transplant
Dental treatment on patients
with blood cancers
Dental screening prior to treatment
Make patient dentally fit
Liaise with Haematology consultant
