Blood- Inherited disorders Flashcards
What are inherited bleeding disorders?
A defect of
- Coagulation factors
- Platelet (number and function)
- both.
Which affects the coagulation of blood.
What is haemophilia A?
Deficiency in factor 8
How do we treat haemophilia A?
Severe- recombinant factor 8.
Mild-
DDAVP- Releases factor 8 that is stuck on the endothelial cells.
Tranexamic acid- slows down clot breakdown (fibrinolysis)
What is haemophilia B?
Deficiency in factor 9
How do we treat haemophilia B?
Recombinant factor 9
DDAVP doesn’t work (no factor 9 trapped in cells)
What are inhibitors?
Antibodies produced in response to synthetic coagulation factors (8 and 9)
What is Von willebrand’s disease?
A combination of reduced platelet aggregation and deficiency of factor 8.
How do we treat von willebrand’s
DDAVPS - as factor 8 deficient
Tranexamic acid- to stop fibrinolysis.
What should be considered for haemophiliac patients undergoing extractions and oral surgery?
- Atraumatic treatment - caries removal using hand instruments.
- antibiotics if infected
- observe haemostasis (stopping bleeding)
severe patient- overnight
mild- 2-3 hours
Which local anaesthetic procedures are safe for haemophiliac patients?
- Buccal infiltration
- Intraligamentary injections
- Intra-papillary injections
Which LA procedures are more dangerous for haemophiliac patients?
- inferior alveolar nerve block
- Lingual infiltration
- Posterior superior nerve block
Why is an inferior alveolar nerve block more dangerous for Haemophiliac patients?
Because you are puncturing tissue with a needle
Bleeding won’t be obvious and it won’t stop normally.
A severe haemophiliac patient comes into your practice. They are dentate. How are they treated?
Refer to hospital
A severe haemophiliac patient comes into your practice. They are edentulous. How are they treated?
Can be treated in GDP
A mild haemophiliac patient comes into your practice. They require restorative treatment (e.g. pros). How do you treat them?
In GDP
A mild haemophiliac patient comes into your practice. They require Extraction and local anaesthetic. How do you treat them?
Refer to hospital.
What is thrombophilia?
Increased risk of blot clots developing.
What causes thrombophilia?
Increased clot production
Underproduction of fibrinolytic factors.
Compare thrombocytopenia and Thrombocytothemia?
Thrombocytopenia- decreased platelets
Thrombocytothemia- increased platelets.
What are qualitative disorders?
normal number of platelets but abonormal platelet function.
This can be acquired by cirrhosis/ drugs/ high alcohol intake.
What is drug induced coagulopathy?
This is when we use drugs to reduce a patient’s coagulation?
e.g. oral anticoagulation
Injected anticoagulants (e.g.Heparins)
Anti-platelet medication.
Give examples of patients that would have anti-coagulation as part of their treatment:
thrombophillia
atrial fibrillation
Deep vein thrombosis
Heart valve disease.
mechanical heart valves
What type of oral anti-coagulant is warfarin?
coumarin
Some drugs are potentiating to warfarin.
What does this mean?
Give examples?
How do we deal with these drugs?
Potentiating increases the effect of warfarin.
- E.g. alcohol in patients with liver disease.
- NSAIDs
- Antibiotics
Reduce the concentration of warfarin
Give examples of warfarin inhibiting drugs
How do we deal with these drugs?
Alcohol for patients without liver disease
Carbamazepine-Epilepsy
Chloestyramine-High cholesterol
= We increase concentration of warfarin.
Which drugs do you use with warfarin with caution?
Aspirin as an analgesic
Amoxicillin (only if ABSOLUTELY neccessary as an antibiotic)
Antifungal- Fluconazole.
Which treatments do we need to check the patient’s INR before starting?
Minor Oral surgery
extractions
biopsies
Periodontal surgery.
Which treatments do we not need to check the INR for?
Prosthodontic treatment
Conservation
Endodontics
Hygiene phase therapy.
What should you consider when using Local anaesthetic on a patient on warfarin?
- The Local anaesthetic should be a vasoconstrictor.
- Use an infilitration or intraligamentary or mental nerve injection.
- If we cannot do these- the inferior alevolar nerve block should be given slowly using as aspirating technique.
- Haemophilliacs should not be given an inferior alveolar nerve block
What should you consider when treating a patient on warfarin?
- Treat them early in the morning & at the start of the week- so if there are any complications they can return to you.
- Assume that everything will interact.
- have to check their INR <48 hours before treatment.
- Can only treat the patient if INR <4.
- No more than 3 roots should be extracted at once.
A patient is taking a single antiplatelet drug.
How is this relevant to your treatment?
They will stop bleeding but haemostasis will take longer.
The patient is taking a combination of antiplatelet drugs.
How is this relevant to your treatment?
They will need to stop one of the antiplatelet drugs 7 days prior to treatment. Need to speak to doctor.
If patient has a stent you need to speak to the cardiologist.
Compare antiplatelets and anticoagulants
Antiplatelets prevent the clumping of platelets.
Anticoagulants slow down clotting.