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Special Care module 7 > Bleeding disorders > Flashcards

Bleeding disorders Flashcards

1
Q

types of bleeding disorders

A

platelet disorders
clotting disorders

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2
Q

platelet disorders

A

 Failed platelet production
 Excessive platelet destruction
 Abnormal platelet function

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3
Q

what is thrombocytopenia

A

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

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4
Q

what is Glanzmanns

A

 Autosomal recessive
 Affects platelet aggregation
 Epistaxis, menorrhagia, gingival
haemorrhage

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5
Q

dental treatment on patient with platelet disorders

A

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

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6
Q

what is transexamic acid used to treat

A

prevent excessive blood loss

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7
Q

name 3 clotting disorders

A

 Von Willebrand’s Disease
 Haemophilia A (Factor VIII)
 Haemophilia B (Factor IX)

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8
Q

Symptoms of VWD

A

 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

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9
Q

Treatment for VWD

A

 Tranexamic acid
 Desmopressin
 Factor VIII- severe

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10
Q

Symptoms of haemophilia

A

 Nosebleeds
 Prolonged bleeding from wounds
 Bleeding gums
 Skin that bruises easily
 Pain and stiffness around joints
 Internal bleeding

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11
Q

what cases of severe haemophillia should be routinely reffered to the dental hospital for

A

severe cases of haemophilia

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12
Q

when is haemostatic cover therapy required

A

 Extractions
 Oral surgery
 Periodontal surgery
 Implant surgery
 IDBs, lingual infils

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13
Q

when is haemostatic cover therapy not required

A

 Buccal infiltration
 Palatal infiltration
 Intraligamental injection
 Intrapapillary injection

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14
Q

dental extractions for patient with haemophilia

A

 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

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15
Q

periodontal treatment -gingivitis- on patient with haemophilia

A

 No factor replacement required
 TA mouthwash effectively manages post-
op bleeding
 Disclosing agents used to demonstrate
plaque to patients

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16
Q

periodontal treatment - periodontitis - on patient with haemophilia

A

 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

17
Q

Challenges with
Haematological cove

A

 Patients develop inhibitors to
replacement clotting factor
 Require more expensive drugs
 More severe bleeding

18
Q

Drugs which affect bleeding

A

 Anti-platelet drugs- aspirin, clopidogrel
 Anti-coagulants- Warfarin, Heparin
 Newer anti-coagulants- Dabigatran,
Apixaban, Rivaroxaban, Edoxaban

19
Q

Types of blood cancer

A

 Myeloma
 Leukaemia
 Lymphoma
 Myelodyplasia

20
Q

what is multiple myeloma

A

 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

21
Q

Diagnosing myeloma

A

 Blood tests
 CT/MRI scan
 Bone marrow biopsy

22
Q

Dental aspects of myeloma

A

 70% cases skull affected
 Root resorption
 Loose teeth
 Mental anaesthesia
 Pathological #
 Rare cause of mandibular radiolucencies

23
Q

Dental aspects of myeloma

A

 Anaemia
 Infection
 Haemorrhagic tendencies
 Renal failure
 Chemotherapy
 Steroids
 Bisphosphonates
 Biological therapies
 Liase with Haematology

24
Q

types of leukaemia

A

 Acute- acute lymphoblastic leukaemia
acute myeloid leukaemia
 Chronic- chronic lymphocytic leukaemia
chronic myeloid leukaemia

25
Q

Treatment for leukaemia

A

 Chemotherapy
 Radiation therapy
 Stem cell transplant
 Immunotherapy
 Tyrosine kinase inhibitors

26
Q

Dental aspects of leukaemia

A

 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

27
Q

what is lymphoma

A

Cancer of the lymph glands or other
organs of the lymphatic system

28
Q

types of lymphoma

A

 Hodgkin’s lymphoma
 Non Hodgkin’s lymphoma

29
Q

symptoms of lymphoma

A

non tender swollen lymph
nodes, fever, night sweats and
unexplained weight loss

30
Q

Treatment for lymphoma

A

 Depends on type, grade and extent of
lymphoma, age
 Low grade- watch and wait
 High grade- chemotherapy, radiotherapy,
monoclonal antibody therapy- Rituximab

31
Q

what is myelodysplasia

A

 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

32
Q

tx of myelodsyplasia

A

 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

33
Q

Dental treatment on patients
with blood cancers

A

 Dental screening prior to treatment
 Make patient dentally fit
 Liaise with Haematology consultant

Special Care module 7 (6 decks)

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