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Dr C - Medical > Diseases of the blood & Coagulation (SDCEP) > Flashcards

Diseases of the blood & Coagulation (SDCEP) Flashcards

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USMLE® Step 1 flashcards
1
Q

What is anaemia

A

Reduction in HAEMOGLOBIN in the blood -
not necessarily RED CELLS
Below NORMAL for POPULATION
Increased demand/increased loss or decreased production

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2
Q

Reasons for reduced production

A 
Marrow failure - reduced normal cells
normal red cells, reduced Hb
deficiency states - Fe, Folate, Vit B12
abnormal globin chains
Thalassaemia
Sickle Cell
chronic inflammatory disease
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3
Q

Name some haemitinics

A

Iron
Folate
Vit B12

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4
Q

Conditions reducing iron resorption

A

Achlorahydria - lack of stomach acid

Coeliac

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5
Q

Reasons for increased iron loss

A

Colonic cancer/coeliac/crohns/gastic ulcers/haemorrhoids

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6
Q

Vitamin B12 deficiency causes

A

Strict vegans, pernicious anaemia (lack of intrinsic factor), crohn’s

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7
Q

Folic acid deficiency causes

A

Diet, Coeliac

Leads to foetal neural tube defects

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8
Q

What is thalassaemia?

A 
Normal Haem production - Genetic mutation of globin chains
 Alpha chains (alpha thalassaemia)
 Asians
 Beta chains (beta thalassaemia)
Mediterraneans
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9
Q

Thalassaemia complications

A 
Clinical Effects
Chronic anaemia
Marrow hyperplasia (skeletal deformities)
Splenomegaly
Cirrhosis
Gallstones

Management
Blood transfusions
Prevent iron overload

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10
Q

What is sickle cell anaemia

A 
Abnormal Globin chains
Change shape in low oxygen environments
Prevent RBC from passing through the capillaries
Tissue ischaemia – pain and necrosis
Heterozygous (sickle cell trait)
Homozygous (sickle cell disease)
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11
Q

Anaemia - >loss causes

A 
normal red cells – bleeding
Usually GI bleeding – chronic loss
abnormal red cells
autoimmune
hereditary - SICKLE, G6PD, spherocytosis
Cells have reduced life span (<120 days)
Removed by the spleen
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12
Q

Anaemia - increased demand

A

Pregnancy

Malignant disease

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13
Q

Anaemia terminology
Microcytic
Macrocytic
Normocytic

A

microcytic - small RBC - Fe def., Thalassaemia
macrocytic - large RBC - B12/folate def., Retics
normocytic - normal RBC - bleed, renal, chronic disease

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14
Q

Anaemia signs and symps

A

Signs: pale/tachycardia
rarely enlarged liver/enlarged spleen
Symptoms: tired & weak/dizzy/SOB/palpitations

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15
Q

Anaemia investigations

A 
HISTORY
FBC (Ferritin &amp; RC Folate/vit B12 )
FOB (Faecal Occult Blood)
Endoscopy/Colonoscoopy
Renal Function
Bone Marrow examination
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16
Q

Anaemia treatment

A 
treat cause!
Replace haematinics
FeSO4 200mg tds for 3months
1mg IM vit B12 x 6 then 1mg/2 months
5mg Folic acid daily
Transfusions - production failure
Erythropoeitin - production failure
Renal disease
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17
Q

Anaemia dental considerations

A 
General Anaesthesia - O2 capacity
Deficiency States - Fe usually
mucosal atrophy
Candidiasis
ROU
dysaesthesia
Check Haematinics in mucosal diseases
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18
Q 
Definitions of:
Anaemia
Leukopenia
Thrombocytopenia
Pancytopenia
A

Anaemia - low Hb
Leukopenia - low WCC
Thrombocytopenia - low platelets
Pancytopenia - all cells reduced

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19
Q

Definitions of:
Polycythemia
Leukocytosis
Thrombocythemia

A

Polycythaemia - raised Hb
Leukocytosis - raised WCC
Throbocythaemia - raised platelets

20
Q

Diseases of the blood investigations

A

FBC (platelet numbers)
Bleeding time (platelet function)
INR & APPT
LFT (Clotting factor synthesis) - liver function tests

21
Q

Prevention regime for those with a bleeding disorder

A

Oral Hygiene Regular dental care Fluoride supplements Fissure sealant Dietary advice

22
Q

Bleeding disorder - procedures that require no additional precautions

A 
Hygiene therapy
•Removable Prosthodontics
•Restorative dentistry, including crowns and bridges.
•Endodontics
•Orthodontic treatment
23
Q

Bleeding disorder - procedures that require additional care/specialist setting

A

Extractions/Minor oral surgery/Periodontal surgery/Biopsies

24
Q

How do you asses a patient’s bleeding risk (SDCEP)

A 
Assess treatment's risk of bleeding 
Ask patient's current/planned use of anticoagulants/APs
Ask patient length of drug therapy
Ask about MH - Haemophilia etc
Ask about patient's bleeding history
25
Q

Procedures taken to reduce bleeding in a patient

A

-Treatment carried out as atraumatically as possible
-Delay non urgent procedures where possible
-Plan treatment early in day and week - review if complications
Advise paracetemol for analgesia
Written post op instructions
Suture

26
Q

High bleeding risk procedures

A 
Elective surgical extractions 
Periradicular surgery
Preprosthetic surgery
Crown lengthening surgery
Periodontal surgery
Biopsies
Dental implant surgery
27
Q

Medical conditions that increase risk of bleeding

A
  • Liver disease: (alcohol/hepatitis/primary biliary cirrhosis) - reduction in coagulation factors/ Reduction in PLTs due to sphenomegaly
  • Haematological malignancy: Impaired coagulation/PLT function
  • Chemotheapy: Pancytopenia
  • Advanced Heart failure: Resulting in liver failure
  • Inherited bleeding disorder: coagulation factors
28
Q

Drug groups that may have a greater risk of bleeding

A

Anticoagulants
Antiplatelets
Cytotoxic drugs - gold/ azathioprine/methotrexate
NSAID - Aspirin/ibuprofen/diclofenac
Nervous system drugs - SSRI’s - impair PLT aggregation
Carbamazepine - affect liver function

29
Q

Procedure before treatment of a patient on warfarin

Treatment advice

A

CHECK INR <72hr, ideally within 24hrs
If INR >4.0 - inform medical practioner, if emergency, refer to secondary care

  • Limit treatment area - XLA of 1 teeth, only scale teeth
  • Local haemostatic measures - suturing/packing etc
30
Q

NOAC names and how many times are they taken per day?

A

Rivaroxiban -x1 daily – (aXi)
Apixaban -x2 daily – (aXi)
Dabigatran -x2 daily – (dTi)

31
Q

NOAC Interactions

A

Safe with ‘Dental’ Antibiotics except Macrolides
Erythromycin and Clarithromycin
Safe with Antifungals – topical and fluconazole
Safe with Local Anaesthetics
Safe with Antivirals
NSAID will prolong action and inhibit platelets – avoid

32
Q

Patient taking aspirin alone - treatment considerations

A

Limit area of treatment eg. XLA 1 tooth
Stage higher risk procedurs /secondary care referral
Local haemostatic measures

33
Q

Patient taking dual antiplatelet drugs - treatment considerations

A

Bleeding delayed for up to hour after
Limit treatment area - XLA 1 tooth
Stage treatments of a higher risk
Local haemostatic measures

34
Q

NOAC medication - treatment for a low risk procedure Will this affect drug treatment?

A

Treat without disrupting anticoagulant medicine

35
Q

NOAC Medication - treatment for higher risk of bleeding - Wil this affect drug treatment

A

Advise patient to miss (apixiban/dabigatran morning dose)

Delay Rivaroxiban dose

36
Q

NOAC patient - low risk of bleeding procedure - precautions

A

Plan treatment for early in day, limit treatment are, local haemostatic measures

37
Q

NOAC patient - higher risk of bleeding

Drug taking advice

A

Rivaroxiban - (once daily) Delay dose for 4hrs after haemostasis achieved

Apixaban/Dabigatran (twice daily) - miss morning dose, take other dose 4hr after haemostasis achieved
Emergency contact details in case of bleed in home

38
Q

Indications for anticoagulants/antiplatelets

A 
Stroke/TIA
AF - prevent stroke
DVT/Pulmonary embolism
Recent surgery
Prosthetic valve replacement 
Stable/unstable angina
Coronary stent
Kidney dialysis
Pregnancy - Venous Thromboembolism
Peripheral vascular diseases
39
Q

Warfarin interactions

A

Alcohol/Amoxicillin/apixiban/aspirin/azathioprine/

betametasone/carbamazepine/clarithromycin/doxycyline/ erythromycin/fluconazole

40
Q

Aspirin interactions

A

NSAIDs

41
Q

haemophilia A/B - how are they passed

  • types
  • how to treat
A 
Haemophilia A - reduced factor VIII
Haemophilia B - reduced factor IX
sex linked recessive
-carrier - <0.5iu/ml
-mild - 0.1-0.4iu/ml
-mod - 0.02-0.09iu/ml
-severe <0.02iu/ml

how to treat:
Haemophilia A
mild/carriers - DDAVP and tranexamic acid
mod-severe - replacement recombinant factor VIII
Haemophilia B
Not respond to DDAVP, need prophylactic cover of factor IX

42
Q

what is von willebrands disease and how is it:

  • inherited
  • types
  • treatment
A

autosomal dominant, both sexes equally affected
reduced factor VIII and reduced PLT aggregation
-T1 - DOMINANT - mild
-T2 - DOMINANT - mild
- T3 - RECESSIVE - SEVERE

treatment - mild - DDAVP and tranexamic acid

43
Q

LA techniques - safe and dangerous for coagulation disorder sufferers

A
  • safe - buccal infiltration, intraligamentry inj, intrapapillary inj
  • dangerous IDB, lingual infiltration, posterior superior nerve block
44
Q

what is thrombophilia

-inherited syndromes associated

A

increased risk of clots developing

-protein S syndrome / protein C syndrome / factor V leidin / antithrombin III deficiency

45
Q

acquired conditions that cause thrombophilia

A 
antiphospholipid syndrome (lupus anticoagulant)
OCP / trauma / pregnancy / cancer
46
Q

thrombocytopenia causes

safe PLT number

A

reduced PLTs - alcohol/penicillin/heparin

>50x10 9

Dr C - Medical (7 decks)

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