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4th yr- CMS- Medicine > prolonged bleeding > Flashcards

prolonged bleeding Flashcards

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1
Q

What is haemostasis

A

The control of bleeding in health

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2
Q

What is prolonged bleeding defined as in the contact of dentistry

A

Bleeding which:

  1. Continues beyond 12 hours
  2. Causes the patient to call or return to the dental practitioner or A&E
  3. Results in the development of a large haematoma or ecchymosis within the oral soft tissues
  4. Requires a blood transfusion
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3
Q

How do we classify the aetiology of disordered haemostasis

A
  1. Congenital cause

2. Acquired cause

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4
Q

Which classification of aetiology of disordered bleeding is more commonly seen in dentistry

A

Acquired disorders

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5
Q

What can the abnormality responsible for disordered haemostasis be

A
  1. Quantitive (amount)

2. Qualitative (abnormality)

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6
Q

What can be affected in quantitative abnormalities of bleeding

A
  1. Reduced amounts of factor VIII (haemophilia A)

2. Reduced number fo platelets (thrombocytopenia)

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7
Q

What can be affected in Qualitative abnormalities of bleeding

A

Platelets with abnormal function

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8
Q

What is haemophilia A

A

Reduced amounts of factor VIII

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9
Q

What can congenital causes of prolonged bleeding be due to

A

Abnormalities of

  1. Soluble Coagulation Factors:
  2. Platelets
  3. Blood vessels
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10
Q

Give examples of disorders that can result in abnormalities of soluble coagulation factors

A
  1. Haemophilia A
  2. Haemophilia B
  3. Von Willebrand’s disease
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11
Q

Name the condition that results in congenital reduction in factor VIII

A

Haemophilia A

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12
Q

What Is haemophilia B

A

congenital reduction in factor IX

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13
Q

What is von Willebrand’s disease

A

Congenital reduction on von Willebrand’s factor

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14
Q

Give an example of a disorder that can result in abnormalities of blood vessels

A

Hereditary Haemorrhagic Telangiectasia

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15
Q

What can acquired causes of prolonged bleeding be due to

A
  1. Iatrogenic
  2. Renal failure
  3. Hepatic failure
  4. Boen marrow failure
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16
Q

Name the most common cause of prolonged bleeding in the UK

A

Iatrogenic

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17
Q

What can result in iatrogenic prolonged bleeding

A

Anti-platelet drugs and warfarin

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18
Q

What is renal failure associated with

A

impaired platelet function and prolonged bleeding.

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19
Q

Name the 2 mechanism which can contribute to disordered haemostasis in liver function

A
  1. Reduced synthesis of soluble clotting factors and hepatic failure
  2. Obstructive jaundice
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20
Q

What can happen in obstructive jaundice

A

Absorption of vitamin K is impaired

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21
Q

Why is vitamin K important

A

Needed for the synthesis of clotting factors II, VII, IX, X

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22
Q

Where are platelets formed

A

In the bone marrow

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23
Q

What can bone marrow failure result in

A

Reduced production of functional platelets

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24
Q

Other than platelets what else is formed in the bone marrow

A

Erythrocytes

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25
Q

What are erythrocytes

A

Red blood cells

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26
Q

What can bone marrow failure be caused by

A
  1. Leukaemia
  2. Therapeutic drugs
  3. Renal failure
  4. Alcohol abuse
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27
Q

How can we measure disordered haemostasis

A
  1. Prothrombin time
  2. International normalised ratio
  3. Activated partial Thromboplastin time
  4. Bleeding time
28
Q

How do we measure prothrombin time

A

By taking a venous damper of blood

29
Q

What is the value of the prothrombin time determined by

A

The activity of clotting factor VII

30
Q

How is the international normalised ratio calculated

A

(prothrombin time of patient)/ (mean thrombin time of healthy patient)

31
Q

What is the INR number in health

A

1.0

32
Q

What does a high iNR number mean

A

Greater:

  1. Degree of anticoagulation
  2. Risk of adverse side effects
33
Q

What is a therapeutic INR typically between

A

2.0-4.0

34
Q

Why do we calculate the activated partial thromboplastin time

A

For the assessment of heparin anticoagulation

35
Q

What is bleeding time a measurement of

A

Platelet function

36
Q

What are the consequences of prolonged bleeding

A
  1. Acute haemorrhage

2. Chronic haemorrhage

37
Q

What is chronic haemorrhage a MAJOR cause of in the UK

A

Anaemia

38
Q

How can we manage patients suffering with prolonged bleeding

A

A good HISTORY

39
Q

What do we want to fund out when taking a history

A

Identification of known and unknown problems

40
Q

How is haemostasis usual achieved

A
  1. Vascular spasms
  2. Platelets plug formation
  3. Blood coagulation
  4. Growth of fibrous tissue in the Hole in the vessel
41
Q

What is platelet plug formation activated by

A

Tissue damage which exposes sub endothelial collagen

42
Q

How is the Platelet plug formed

A
  1. Platelets activated as a result of tissue damage
  2. Enhanced Platelet adhesion and aggregation
  3. Enhanced activation of factor X
43
Q

When are antiplatelet drugs prescribed

A

Fore Treatment or prevention of further cardiovascular disease

44
Q

Give examples of Antiplatelet Drugs

A
  1. Aspirin

2. clopidogrel

45
Q

How does aspirin work

A

It binds irreversibly to platelets

It inactivated the COX-1 enzyme

46
Q

what is the importance of the COX-1 enzyme

A

is needed for thromboxane A2 mediated aggregation

47
Q

How does clopidogrel work

A

by binding to the P2Y12 receptor irreversibly and preventing Adenosine Di Phosphate (ADP) mediated aggregation

48
Q

When are platelets renewed

A

Every 10 days

49
Q

Over which age is aspirin prescribed

A

Over the age of 16

50
Q

Why is aspirin not given to children under 16 years

A

because of the risk of Reye’s Syndrome

51
Q

what is reyes síndrome

A

(rare condition which can cause potentially fatal swelling of the liver and the brain

52
Q

State the normal platelet level in venous blood

A

150,000 - 450,000/ml

53
Q

when are platelets levels reduced

A
  1. leukaemias,
  2. some anaemias,
  3. pregnancy,
  4. chronic alcohol abuse,
  5. medication
  6. Idiopathic Thromobocytopenia
54
Q

What is purpura

A

Teram used to describe a rash of tiny bruises

55
Q

What is eechymosis

A

refers to larger bruises

56
Q

A count of how many platelets is safe to carry on dental treatment

A

Over 80,000/ml

57
Q

What are the indications for the prescription of warfarin

A
  1. Atrial fibrilaion
  2. Previous recurrent DVT or PE
  3. Heart valve replacement
58
Q

What is warfarin

A

A vitamin K dependent clotting factor agonist

59
Q

How does paraffin work

A

It works at the level of the activation fo the clotting cascade leading to diminished clot formation

60
Q

What do patients on warfarin usually carry

A

A yellow book

61
Q

What does the yellow book warfarin patients carry record

A

Carries records of their iNR

62
Q

Give examples of drugs that can potentiate warfarin

A

MICONAZOLE
FLUCONAZOLE
METRONIDAZOLE
ERYTHROMYCIN

63
Q

What do drugs that potentiate warfarin do

A

Increase risk of haemorrhage

64
Q

Give examples of drugs that can reduce the effect warfarin

A

CARBAMAZEPINE

65
Q

Name some herbal medicines and food stuff that can interfere with warfarin metabolism

A
  1. Ginseng
  2. St Johns Wort
  3. Green tea (rich in vit K)
  4. Liver
  5. Broccoli
  6. Brussel sprouts
  7. High oxalate greens like spinach,
  8. Alcohol
  9. coriander and cabbage
  10. Grapefruit
  11. Pomegranate juice
  12. Cranberry juice

4th yr- CMS- Medicine (14 decks)

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