haematology Flashcards
histological presence of iron deficient anaemia?
RBC paler + smaller
what would blood test show for iron deficient anaemia?
low Hb
low MCV (size of RBC)
low ferritin levels
3 causes of iron deficient anaemia
- dietary deficiency
- malabsorption
- blood loss - GI tract, haemorrhage
common oral sign of iron deficient anaemia?
angular stomatitis
common oral cause of B12 deficient anaemia?
macroglossia + smooth tongue
histological presence of B12/folate deficient anaemia?
microcytic
what would blood test show for B12/folate deficient anaemia?
Hb low
high MCV
5 causes of folate deficient anaemia
- dietary deficiency
- increased requirement - pregnant
- malabsorption e.g. coeliac
- alcoholism
- drugs - septrin + methotrexate
4 causes of B12 deficient anaemia
- inadequate intake
- low gastric acid
- intrinsic factor/antibodies against parietal cells - pernicious aneamia
- abnormal terminal ileum
what causes petechiae?
reduced platelets
ITP most commonly
if you noticed petechiae on pts palate what would you need to be aware of?
pts bleed excessively
what is an oral manifestation of acute leukimia?
gingival hyperplasia
why is it important to be aware of myeloma pts as a dentist?
on bisphophonates
what sort of anaemia is found in myeloma patients?
normocytic anaemia
what is the WHO oral toxicity scale?
- grade 1 - soreness +/- erythema
- grade 2 - erythema, ulcers, can swallow solids
- grade 3 - ulcers, extensive erythema, cannot swallow solids
- can’t swallow liquids
4 main components of blood
plasma
platelets
RBC
crycoprecipitate
what is the role of collagen in haemostasis?
exposed when damage to vessel wall
binds to platelets or VWF
platelet plug forms
what is the role of clotting factor X?
prothrombin –> thrombin
what is the role of thrombin?
fibrinogen –> fibrin
how would you manage haemophiliacs undergoing dental surgery?
close liaison with haemophilia centre
- DDAVP infusion for mild haemophiliacs
- factor VIII/IX for mod/severe
- atraumatic as possible
- local haemostats measure - tranexamic acid
what is platelet count level for safe treatment?
> 50x10^9 /l
how may liver disease cause bleeding problems?
low platelet count - caused by portal venous hypertension which is caused by liver disease
clotting factors 2, 7, 9, 10
what is ITP?
immun thrombocytopenia pupura - autoimmune disease causing low platelets
how may local haemostasis be achieved?
pressure
oxidised cellulose (surgical), collagen sponges + sutures
5% tranexamic acid mouthwash
what must not be prescribed to pts who take warfarin following extraction?
cox-2 or NSAIDs as analgesic
an example of a congenital vascular bleeding disorder?
Ehlers dans
an example of an acquired vascular bleeding disorder?
chronic prednisolone use
difference in presentation between platelet disorders + coagulation disorders?
coagulation - present with bruising at deeper levels
importance of kidney disease in bleeding?
renal disease = impaired platelet function
what are thrombophillias?
conditions causing clotting
what is ecchymoses?
bruising
bleeding into subcutaneous tissue due to trauma
what is purpura?
spontaneous bleeding into skin
2 types of purpura?
- petechiae - small
2. senil purpura
what may spider telangiectasia be a sign of?
liver disease
what is haemangioma and how would you treat a pt with it?
dark ref pulsatile lesion along maxilla
DONT extract
What part of clotting pathway does APTT test?
intrinsic
what part of clotting pathway does PT test?
extrinsic + common
what effects APTT?
factor deficiencies + heparin
what effect PT?
warfarin + alcoholic liver disease
how would you measure platelet count?
FBC
what does TT test?
common pathway
LFT showing decreased synthesis
albumin down
factors down
PT up
LFT showing decreased excretion
bilirubin, alkaline phosphates + GGT up
LFT showing hepatocyte necrosis
AST + ALT up
in liver disease which anaesthetic is best used?
prilocaine - metabolised in lung not liver
articaine - partly metabolised in blood
what to use to stop bleeding post extraction if bleeding is from bone?
bone wax
how does tranexamic acid stop bleeding?
anti-fibrinolytic - stops breakdown of the clot
2 types of cautery that can be used post op?
chemical
electrical - bipolar or monopolar
how to treat urgent high INR
vitamin k 10mg IV or PO
life threatening - beriplex used (prothrombin complex conc from human plasma)
