Dental and oral complications of bleeding disorders Flashcards
What 4 components do bleeding disorders generally involve one or more of the following?
Vascular - vessel walls
Platelets
Coagulation Factors
Fibrin
How can vascular bleeding disorders be catagorised?
Congenital
Acquired
Example of congenital vascular problems?
Ehler’s Danlos syndrome
What is Ehlers Danlos syndrome?
Collagen disorder - effecting collagen in BV walls
Example of acquired vascular bleeding disorder?
Scurvy
What causes Scurvy?
Vit C deficiency
How can platelet disorders be catagorised?
Disorder/function (congenital/acquired) or change in numbers through increased/decreased production/destruction
Example of functional congenital platelet disorder?
Von Willebrand’s disease
Effect of Von Willebrand’s disease?
Low plasma levels of VWF or low function of VWF = decreased aggregation and factor 8
Examples of acquired functional platelet disorders?
Aspirin induced or renal function induced (inhibits initial aggregation)
2 examples of platelet disorders - change in number?
Thrombocytopenia
Thrombocytosis
What is thrombocytopenia?
Decreased number of platelets
What is thrombocytosis?
Increased number of platelets
Mechanism of action of thrombocytopenia?
Abnormal bone marrow causes decreased formation
Normal bone marrow with autoimmune process can cause increased destruction
Causes thrombocytopenia?
Alcoholic liver disease, malignancy
What are the effects of thrombocytosis?
If you have too many platelets and they all work well = too much clotting
If you have too many and they don’t work well = bleeding
What 3 things can thrombocytosis result from?
Reactive or secondary thrombocytosis (result as result of a reaction)
Familial (genetic)
Clonal - can’t explain
How can coagulation bleeding disorders be catagorised?
Intrinsic defects
Extrinsic defects
What is meant by intrinsic or extrinsic coagulation disorders?
Effects intrinsic or extrinsic pathways
What effect do intrinsic coagulation disorders have?
Prolonged APTT (activated partial thromboplastin time)
How can intrinsic coagulation disorders be categorised further? give an example of both.
Congential - haemophilia A and B
Acquired - heparin induced
what effect does extrinsic coagulation disorders have?
Prolong prothrombin time (PT time)
How do extrinsic coagulation disorders generally occur?
Acquired e.g. liver disease, warfarin
What are fibrin disorders a result of?
Thrombolytic therapy
Pathological fibrinolysis e.g. tumour
How do vascular wall disorders present?
Superficial bruise at superficial layer
How do platelet disorders present?
Superficial bruise at superficial layer
Epistaxis (nosebleed), menorrhagia (mensuration)
Hematemesis (vomiting blood), melena (blood in stool)
How do coagulation disorders present?
Blood in body fluids (nose bleeds, mensturation, vomit, stool
Brusing at deeper layer
Bleeding disorders tend to present as one or more of these manifestations:
a) superficial bruising
b) bleeding from sites e.g. nose bleed, heavy menstruation, vomit, stool
c) deep, spreading bruising
Match each of these disorders to their manifestations
- vascular wall disorder
- Platelet disorder
- Coagulation disorder
- a
- a b
- b c
What are the key systems in the medical history that relate to bleeding disorders?
GIT/liver disease
Coagulation system
What evidence may suggest bleeding problems?
Regular nose bleeds, bruising, family history
Previous haemostatic challenges - after extraction
What is relevant in the social history for bleeding?
If they drink alcohol/how much and for how long?
What are the 2 functions of the liver?
Synthetic - makes clotting factors and albumin
Metabolic- breaks down drugs
What is relevant in dental history for bleeding?
Previous extractions - what happened
how they were managed
What is ecchymosis?
Bleeding into subcutaneous tissues - known as bruising, usually due to trauma
At what point does ecchymosis suggest bleeding disorders?
When the extent of the bruising is not appropriate for the trauma
What is purpura?
Spontaneous bleeding into skin causing pools of blood within the skin
How can purpura be catagorised?
Non-thrombocytopenic - not due to low levels of platelets
Thrombocytopenic - due to low levels of platelets
What caused non-thrombocytopenic purpura?
Ehlers Danlos
Infections
Ageing skins
How does thrombocytopenic purpra manifest/
Petechiae - small spots on the skin as a result of bleeding
Causes of thrombocytopenic purpura?
Impaired production of platelets
Excessive platelet destruction
Sequestration of platelets in spleen
Dilution loss following transfusions
What can cause impaired production of platelets?
Bone marrow failure
Selective reduction in megakaryocytes due to drugs or alcohol
What causes excessive platelet destruction?
Immune problems - autoimmune or triggered by particular viral infections
Coagulation problems
Name 2 types of vascular abnormalities
Telangiectasia
Haemangioma
What is telangiectasia?
Vascular abnormality
Dilation of small veins causing excessive bleeding
What are 2 important types of telangiectasia?
Spider
Hereditary haemorrhagic
Describe spider telangiectasia?
Radiate from central sport disappear on pressure
Describe herediatry haemorrhagic telangiectasia
Large dilated vessels on mucous membrane of mouth and nose
What is haemangioma?
Vascular abnormality due to abnormality of blood vessels. lumps on face
Blanch on pressure
What may be found in the social history that can be a clue for bleeding disorders, why?
Alcohol abuse
Liver disease - affects metabolic and synthetic function
Portal venous hypertension
Obstruction of bile duct
What visual clues suggest alcohol abuse?
Bruising
Jaundice
Spider telangectasia
What blood tests can diagnose bleeding disorders?
APTT
PT
Full blood count
Liver function tests
Most important point in managing bleeding disorders?
Liaise with other professionals
list 3 local measures for bleeding?
More pressure, more LA
Suture
Pack
Why do we pack?
Temporarily apply pressure
Adjust coagulation process
