Bleeding & clotting disorders

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Bleeding & clotting disorders

  1. 1. • Dental procedures resulting in bleeding can have serious consequences in a pt. having bleeding disorder……… severe hemorrhage or even death.
  2. 2. • 2 theories::: ( MARKOWITZ---- 1903) (1964)-the coagulation mechanism results in a final explosive change of a liquid to a gel.
  3. 3. fibrinolysis (tPA)PLASMINOGEN PLASMIN. [FDPs]
  4. 4. Factor XII Factor XIIa tPA + high Mol.wt kininogen parakallikren kallikren FV F VIII plasminogen plasmin fibrin FDPs
  5. 5. tPA: Used in thromboembolicdisoders asso with Myocardialinfarction.(effective within 1st 6 hrs postinfarction.Fibrinolytic system activation turned off α by…… 2antiplasmin/ by plasminogen activator inhibitors ( PAI-1,PAI-2)
  6. 6. CLINICAL LABORATARY TESTS• Help to Platelet count Bleeding time PFA-100 CT PT/INR aPTT TT FDPs Factor assays Tests of capillary fragility
  7. 7. PLATELET COUNT:• Normal-150,000 to 450,000/mm3• If < 50,000/mm3 Hemorrhagic stroke Surgical/traumatic hemorrhage etc. may occur.• In such cases platelet transfusion may be necessary.
  8. 8. TESTS OF PLATELET FUNCTION: ADV Dis ADV
  9. 9. INR Intro.by WHO(1983):itzthe ratio of PT that adjusts for the sensitivity of thethromboplastin reagants,such that normal coagulation profile is reported as an INR of 1.0
  10. 10. USES of PT/INR:
  11. 11. • Measured using a specific latex agglutination system. Evaluates the presence of a D-dimer of fibrinogen / fibrin above normal levels.
  12. 12. CUSHING’S syndrome:Resulting from excessive corticosteroidIntake / production.Patient shows skin bleeding & easy bruising.
  13. 13. syndrome:• Autosomal dominant disorder:• Fragile skin vessels & easy bruising.
  14. 14. • HHT• Abnormal telangiectatic capillaries.• Frequent episodes of nasal & GI bleeding.• Telangiectases common on lips, tongue & palate.
  15. 15. :• Cryotherapy.• Laser ablation.• Electrocoagulation.• Blood replacement & iron therapy.
  16. 16. Thrombocytopaenia Quantity of platelets when reduced by * * *TREATMENTThrombocytopathies Qualitative
  17. 17. Corticosteroids Splenectomy Rituximab Anti-DThrombopoietin like agents.
  18. 18. TTP:• CAUSES:metastaticmalignancy,pregnancy,m itomycin & high dose chemotherapy.• SYMPTOMS: Thrombocytopaenia Microangiopathic hemolytic anemia Renal dysfunction Occasional fever Fluctuating neurologic abnormalities.
  19. 19. • Platelet count may also decreased by medications.• ASPIRIN
  20. 20. • ASPIRIN :• USES---- ANTIPLATELET THERAPY FOR THROMBOEMBOLIC PROTECTION.• INEXPENSIVE & EFFECTIVE
  21. 21. • No racial• AGE 6• SIGNS H H H GI B h s bleeding. H
  22. 22. DISADVViral transmission Large volume needed.
  23. 23. F VIII CONCENTRATES:• 1U= Amount present in 1ml fresh normal plasma.• High purity F VIII products mfg. by recombinant & monoclonal antibody purification tech. VIRAL SAFETY
  24. 24. Highly purified recombinant &monoclonal FIX conc.(mononine)F IX complex conc.(prothrombin complex conc.---PCC) proplex-T, Autoplex-T
  25. 25. Complications of factor replacement therapy Allergic reactions Viral disease transmission(hepatitis B & C, CMV,HIV) thromboembolic disorder, DIC, Devpt.of antibodies against factor concs.
  26. 26.
  27. 27. • Fibrin stabilizing factor def & Fibrinogen def.• Very rare.• Autosomal recessive traits.• Rx -Factor replacement therapy & FFP.
  28. 28. • TREATMENT: heparin LMWH activated protein C , Antithrombin III.
  29. 29. • Surveying the patient for current medication use.• History of heavy alcohol intake.• Medical conditions – hepatitis/cirrhosis,renal disease,hematologic malignancy&thrombocytopenia predispose patients to bleeding problems.

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