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Module 7 > SPECIAL CARE bleeding disorders blood cancers MRONJ > Flashcards

SPECIAL CARE bleeding disorders blood cancers MRONJ Flashcards

1
Q

what are the 2 types of bleeding disorders?

A

platelet disorders
clotting disorders

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2
Q

describe normal haemostasis?

A

blood vessel vasoconstriction
platelet plug
activation of coagulation - stable fibrin plug
activation of fibrinolysis - clot dissolution

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3
Q

what are the 3 types of platelet disorders?

A

failed platelet production
excessive platelet destruction
abnormal platelet function

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4
Q

what is thrombocytopenia?

A

low platelets

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5
Q

what are causes of thrombocytopenia?

A

autoimmune
alcoholism
bone marrow disease
cancer
infection - HIV, EBV
cancer treatments
liver problems - cirrhosis and hepatitis
glanzmanns disease

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6
Q

what is glanzmanns disease?

A

autosomal disease which affects platelet aggregation

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7
Q

symptoms of platelet disorders?

A

epistaxis
menorrhagia
gingival haemorrhage

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8
Q

dental management of pt with platelet disorder?

A

liaise with haematology/ oncology
FBC prior to procedure
platelet levels above 50 for xLA
platelet levels above 70 for major surgery

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9
Q

what is given to pt to increase platelet count?

A

steroids
eltrombopag
tranexamic acid
platelet transfusion

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10
Q

what is tranexamic acid used for?

A

treat or prevent excessive blood loss

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11
Q

what is the action of tranexamic acid?

A

antifibrinolytic action - stops clots breaking down

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12
Q

name the common clotting disorders?

A

Von Willebrand’s disease
haemophillia A (factor viii)
haemophillia B (factor IX)

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13
Q

what is von willebrand factor needed for?

A

it is a co-factor for normal platelet adhesion

also a carrier for factor VIII

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14
Q

what are symptoms of VWD?

A

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

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15
Q

what is the tx for VWD?

A

often no day-to-day tx

for dental procedure:
tranexamic acid (mouthwash or tablets)
desmopressin
factor VIII (only for severe cases)

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16
Q

what is desmopressin (DDAVP)?

A

synthetic version of vasopressin
stimulates the release of VWF and increase in factor VIII levels

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17
Q

how may desmopressin be delivered?

A

IV
IM
SC
Intranasal

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18
Q

what does the severity of haemophillia depend on?

A

depends on level of clotting factor

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19
Q

what are symptoms of haemophillia?

A

nosebleeds
prolonged bleeding from wounds
bleeding gyms
skin that bruises easy
pain and stiffness around joints
internal bleedingw

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20
Q

what type of haemophillia is more common?

A

A

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21
Q

Why must dental xla be planned for pts with severe haemophillia?

A

one of the most common life threatening bleeds
they will need prophylactic factor VIII

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22
Q

what is haemostatic cover therapy required for, according to WFH guidelines?

A

xla
oral surgery
perio surgery
implant surgery
IDBs, lingual infils

23
Q

what must you do prior, during and after xla for a haemophillia pt?

A

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

24
Q

what management is required for perio tx of haemophillia pts?

A

pre and post op tranexamic acid required

25
Q

what are the challenged of pts with bleeding disorders?

A

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

26
Q

what are challenges with haematological cover?

A

some pt develop inhibitors to replacement clotting factors so require more expensive drugs

27
Q

name drugs which affect bleeding?

A

anti-platelet drugs - aspirin, clopidogrel
anti-coagulants - warfarin, heparin
newer anti-coagulants - dabigatran, apixaban, rivaroxaban, edoxaban

28
Q

what are the types of blood cancer?

A

myeloma
leukaemia
lymphoma
myelodysplasia

29
Q

what is multiple myeloma?

A

plasma cell neoplasm - production of abnormal serum immunoglobulins

30
Q

what is multiple myeloma sometimes related to?

A

radiotherapy or petroleum products

31
Q

how is myeloma diagnosed?

A

blood tests
CT/MRI scan
bone marrow biopsy

32
Q

what are the affects of myeloma?

A

bone pain
renal failure
anemia
neurological lesions
hyperviscosity syndrome - thick blood

33
Q

dental aspects of myeloma?

A

root resorption
loose teeth
mental anaesthesia
pathological fractures
rare cause of mandibular radiolucencies

34
Q

what are the tx for myeloma?

A

chemotherapy
steroids
bisphosphonates
biological therapies

35
Q

what are the 4 types of leukaemia?

A

acute lymphoblastic leukaemia
acute myeloid leukaemia
chronic lymphocytic leukaemia
chronic myeloid leukaemia

36
Q

who is acute lymphocytic leukaemia more common in?

A

children

37
Q

who is acute myeloid leukaemia more common in?

A

adults - poor prognosis

38
Q

who is chronic leukaemia more common in?

A

adults

39
Q

what are symptoms of chronic leukaemia that pts may present with?

A

splenomegaly
lymph node enlargement

40
Q

what is treatment for leukaemia?

A

chemo
radiation therapy
stem cell transplant
immunotherapy
tyrosine kinase inhibitors

41
Q

what are dental aspects of leukaemia?

A

crowding out of normal blood cells by the leukaemic cells
anaemia
bleeding tendencies
susceptibility to infections
septicaemia from oral infections

42
Q

how may leukaemia present in the mouth?

A

mucosal pallor
ulceration
gingival swelling
spontaneous bleeding

43
Q

what is lymphoma?

A

cancer of the lymph glands or other organs of the lymphatic system

44
Q

what are the types of lymphoma?

A

Hodgkin’s lymphoma
Non Hodgkin’s lymphoma

45
Q

what are symptoms of lymphoma?

A

non tender swollen lymph nodes, fever, night sweats and unexplained weight loss

46
Q

how does Hodgkins lymphoma arise?

A

develops from B lymphocytes
characterised by reed-sternberg cells

47
Q

how is hodgkins lymphoma treated?

A

aggressive chemotherapy and radiotherapy

48
Q

what does non-hodgkins lymphoma affect?

A

B lymphocytes or T lymphocytes

49
Q

name a monoclonal antibody therapy

A

rituximab

50
Q

what is myelodysplasia?

A

rare type of blood cancer - dont have enough healthy blood cells, bone marrow makes abnormal cells instead of healthy blood cells

51
Q

what are symptoms of myelodysplasia?

A

weakness, tiredness, breathlessness

frequent infections

bruising and easy bleeding, such as nose bleeds

52
Q

what are treatments for myelodysplasia?

A

GF injections
blood transfusion
antibiotics
biologic therapies
chemotherapy
immunosuppressants
stem cells (bone marrow) transplant

53
Q

what are the dental aspects of myelodysplasia?

A

risk of bleeding - platelets, clotting
may need platelet transfusion
may be on steroids, bisphosphonates
MRONJ risk

Module 7 (62 decks)

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