SPECIAL CARE bleeding disorders blood cancers MRONJ Flashcards
what are the 2 types of bleeding disorders?
platelet disorders
clotting disorders
describe normal haemostasis?
blood vessel vasoconstriction
platelet plug
activation of coagulation - stable fibrin plug
activation of fibrinolysis - clot dissolution
what are the 3 types of platelet disorders?
failed platelet production
excessive platelet destruction
abnormal platelet function
what is thrombocytopenia?
low platelets
what are causes of thrombocytopenia?
autoimmune
alcoholism
bone marrow disease
cancer
infection - HIV, EBV
cancer treatments
liver problems - cirrhosis and hepatitis
glanzmanns disease
what is glanzmanns disease?
autosomal disease which affects platelet aggregation
symptoms of Glanzmanns disease?
epistaxis
menorrhagia
gingival haemorrhage
dental management of pt with platelet disorder?
liaise with haematology/ oncology
FBC prior to procedure
platelet levels above 50 for xLA
platelet levels above 70 for major surgery
what is given to pt to increase platelet count?
steroids
eltrombopag
tranexamic acid
platelet transfusion
what is tranexamic acid used for?
treat or prevent excessive blood loss
what is the action of tranexamic acid?
antifibrinolytic action - stops clots breaking down
name the common clotting disorders?
Von Willebrand’s disease
haemophillia A (factor viii)
haemophillia B (factor IX)
what is von willebrand factor needed for?
it is a co-factor for normal platelet adhesion
also a carrier for factor VIII
what are symptoms of VWD?
excessive bleeding from injury, surgery, dental xla
frequent nosebleeds
heavy periods
heavy bleeding during labour and delivery
blood in urine or stool
easy bruising or lumpy bruises
what medications are available for VWD?
for dental procedure:
tranexamic acid (mouthwash or tablets)
desmopressin
factor VIII (only for severe cases)
what is desmopressin (DDAVP)?
synthetic version of vasopressin
stimulates the release of VWF and increase in factor VIII levels
how may desmopressin be delivered?
IV
IM
SC
Intranasal
what does the severity of haemophillia depend on?
depends on level of clotting factor
what are symptoms of haemophillia?
nosebleeds
prolonged bleeding from wounds
bleeding gyms
skin that bruises easy
pain and stiffness around joints
internal bleedingw
what type of haemophillia is more common?
A
Why must dental xla be planned for pts with severe haemophillia?
one of the most common life threatening bleeds
they will need prophylactic factor VIII
what is haemostatic cover therapy required for, according to WFH guidelines?
xla
oral surgery
perio surgery
implant surgery
IDBs, lingual infils
what must you do prior, during and after xla for a haemophillia pt?
liase with haemophillia centre to organise factor replacement therapy
use of buccal articaine
tranexamic acid mouthwash and/or tablets
topical haemostatic agents - pressure packs, sutures, oxidised cellulose
what management is required for perio tx of haemophillia pts?
pre and post op tranexamic acid required
what are the dental challenges of pts with bleeding disorders?
reluctance to brush teeth due to fear of bleeding
reluctance to access regular dental care due to fear of haemorrhage
poorer attendance
increased rate of extractions
what are challenges with haematological cover?
some pt develop inhibitors to replacement clotting factors so require more expensive drugs
name drugs which affect bleeding?
anti-platelet drugs - aspirin, clopidogrel
anti-coagulants - warfarin, heparin
newer anti-coagulants - dabigatran, apixaban, rivaroxaban, edoxaban
what are the types of blood cancer?
myeloma
leukaemia
lymphoma
myelodysplasia
what is multiple myeloma?
plasma cell neoplasm - production of abnormal serum immunoglobulins
what is multiple myeloma sometimes related to?
radiotherapy or petroleum products
how is myeloma diagnosed?
blood tests
CT/MRI scan
bone marrow biopsy
what are the affects of myeloma?
bone pain
renal failure
anemia
neurological lesions
hyperviscosity syndrome - thick blood
dental aspects of myeloma?
root resorption
loose teeth
mental anaesthesia
pathological fractures
rare cause of mandibular radiolucencies
what are the tx for myeloma?
chemotherapy
steroids
bisphosphonates
biological therapies
what are the 4 types of leukaemia?
acute lymphoblastic leukaemia
acute myeloid leukaemia
chronic lymphocytic leukaemia
chronic myeloid leukaemia
who is acute lymphocytic leukaemia more common in?
children
who is acute myeloid leukaemia more common in?
adults - poor prognosis
who is chronic leukaemia more common in?
adults
what are symptoms of chronic leukaemia that pts may present with?
splenomegaly
lymph node enlargement
what is treatment for leukaemia?
chemo
radiation therapy
stem cell transplant
immunotherapy
tyrosine kinase inhibitors
what are dental aspects of leukaemia?
crowding out of normal blood cells by the leukaemic cells
anaemia
bleeding tendencies
susceptibility to infections
septicaemia from oral infections
how may leukaemia present in the mouth?
mucosal pallor
ulceration
gingival swelling
spontaneous bleeding
what is lymphoma?
cancer of the lymph glands or other organs of the lymphatic system
what are the types of lymphoma?
Hodgkin’s lymphoma
Non Hodgkin’s lymphoma
what are symptoms of lymphoma?
non tender swollen lymph nodes, fever, night sweats and unexplained weight loss
how does Hodgkins lymphoma arise?
develops from B lymphocytes
characterised by reed-sternberg cells
how is hodgkins lymphoma treated?
aggressive chemotherapy and radiotherapy
what does non-hodgkins lymphoma affect?
B lymphocytes or T lymphocytes
name a monoclonal antibody therapy
rituximab
what is myelodysplasia?
rare type of blood cancer - dont have enough healthy blood cells, bone marrow makes abnormal cells instead of healthy blood cells
what are symptoms of myelodysplasia?
weakness, tiredness, breathlessness
frequent infections
bruising and easy bleeding, such as nose bleeds
what are treatments for myelodysplasia?
GF injections
blood transfusion
antibiotics
biologic therapies
chemotherapy
immunosuppressants
stem cells (bone marrow) transplant
what are the dental aspects of myelodysplasia?
risk of bleeding - platelets, clotting
may need platelet transfusion
may be on steroids, bisphosphonates
MRONJ risk
