Blood- Inherited disorders

Question 1

What are inherited bleeding disorders?

Answer 1

A defect of

• Coagulation factors
• Platelet (number and function)
• both.

Which affects the coagulation of blood.

Question 2

What is haemophilia A?

Answer 2

Deficiency in factor 8

Question 3

How do we treat haemophilia A?

Answer 3

Severe- recombinant factor 8.

Mild-

DDAVP- Releases factor 8 that is stuck on the endothelial cells.

Tranexamic acid- slows down clot breakdown (fibrinolysis)

Question 4

What is haemophilia B?

Answer 4

Deficiency in factor 9

Question 5

How do we treat haemophilia B?

Answer 5

Recombinant factor 9

DDAVP doesn’t work (no factor 9 trapped in cells)

Question 6

What are inhibitors?

Answer 6

Antibodies produced in response to synthetic coagulation factors (8 and 9)

Question 7

What is Von willebrand’s disease?

Answer 7

A combination of reduced platelet aggregation and deficiency of factor 8.

Question 8

How do we treat von willebrand’s

Answer 8

DDAVPS - as factor 8 deficient

Tranexamic acid- to stop fibrinolysis.

Question 9

What should be considered for haemophiliac patients undergoing extractions and oral surgery?

Answer 9

• Atraumatic treatment - caries removal using hand instruments.
• antibiotics if infected
• observe haemostasis (stopping bleeding)

​severe patient- overnight

mild- 2-3 hours

Question 10

Which local anaesthetic procedures are safe for haemophiliac patients?

Answer 10

• Buccal infiltration
• Intraligamentary injections
• Intra-papillary injections

Question 11

Which LA procedures are more dangerous for haemophiliac patients?

Answer 11

• inferior alveolar nerve block
• Lingual infiltration
• Posterior superior nerve block

Question 12

Why is an inferior alveolar nerve block more dangerous for Haemophiliac patients?

Answer 12

Because you are puncturing tissue with a needle

Bleeding won’t be obvious and it won’t stop normally.

Question 13

A severe haemophiliac patient comes into your practice. They are dentate. How are they treated?

Answer 13

Refer to hospital

Question 14

A severe haemophiliac patient comes into your practice. They are edentulous. How are they treated?

Answer 14

Can be treated in GDP

Question 15

A mild haemophiliac patient comes into your practice. They require restorative treatment (e.g. pros). How do you treat them?

Answer 15

In GDP

Question 16

A mild haemophiliac patient comes into your practice. They require Extraction and local anaesthetic. How do you treat them?

Answer 16

Refer to hospital.

Question 17

What is thrombophilia?

Answer 17

Increased risk of blot clots developing.

Question 18

What causes thrombophilia?

Answer 18

Increased clot production

Underproduction of fibrinolytic factors.

Question 19

Compare thrombocytopenia and Thrombocytothemia?

Answer 19

Thrombocytopenia- decreased platelets

Thrombocytothemia- increased platelets.

Question 20

What are qualitative disorders?

Answer 20

normal number of platelets but abonormal platelet function.

This can be acquired by cirrhosis/ drugs/ high alcohol intake.

Question 21

What is drug induced coagulopathy?

Answer 21

This is when we use drugs to reduce a patient’s coagulation?

e.g. oral anticoagulation

Injected anticoagulants (e.g.Heparins)

Anti-platelet medication.

Question 22

Give examples of patients that would have anti-coagulation as part of their treatment:

Answer 22

thrombophillia

atrial fibrillation

Deep vein thrombosis

Heart valve disease.

mechanical heart valves

Question 23

What type of oral anti-coagulant is warfarin?

Answer 23

coumarin

Question 24

Some drugs are potentiating to warfarin.

What does this mean?

Give examples?

How do we deal with these drugs?

Answer 24

Potentiating increases the effect of warfarin.

• E.g. alcohol in patients with liver disease.
• NSAIDs
• Antibiotics

Reduce the concentration of warfarin

Question 25

Give examples of warfarin inhibiting drugs

How do we deal with these drugs?

Answer 25

Alcohol for patients without liver disease

Carbamazepine-Epilepsy

Chloestyramine-High cholesterol

= We increase concentration of warfarin.

Question 26

Which drugs do you use with warfarin with caution?

Answer 26

Aspirin as an analgesic

Amoxicillin (only if ABSOLUTELY neccessary as an antibiotic)

Antifungal- Fluconazole.

Question 27

Which treatments do we need to check the patient’s INR before starting?

Answer 27

Minor Oral surgery

extractions

biopsies

Periodontal surgery.

Question 28

Which treatments do we not need to check the INR for?

Answer 28

Prosthodontic treatment

Conservation

Endodontics

Hygiene phase therapy.

Question 29

What should you consider when using Local anaesthetic on a patient on warfarin?

Answer 29

• 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

Question 30

What should you consider when treating a patient on warfarin?

Answer 30

• 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.

Question 31

A patient is taking a single antiplatelet drug.

How is this relevant to your treatment?

Answer 31

They will stop bleeding but haemostasis will take longer.

Question 32

The patient is taking a combination of antiplatelet drugs.

How is this relevant to your treatment?

Answer 32

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.

Question 33

Compare antiplatelets and anticoagulants

Answer 33

Antiplatelets prevent the clumping of platelets.

Anticoagulants slow down clotting.