Blood Factors and Functions

Copyright © 2010 Pearson Education, Inc.
Blood

Clotting factors names
I ( fibrinogen )
II ( prothrombin )
III ( tissue factor )
IV ( calcium )
V ( proaccelerin )
VI ( old name of factor Va )
VII ( stable factor , proconvertion )
VIII ( antihemophilic factor a )

IX ( antihemophilic factor b , christmas
factor )
X ( Stuart – prower factor )
XI ( plasma thromboplastin antecedent )
XII ( hageman factor )
XIII ( fibrin stabilizing factor )

Functions of Blood
• Substance distribution:
• Oxygen from the lungs and nutrients from the digestive tract
• Metabolic wastes from cells to the lungs and kidneys for
elimination
• Hormones from endocrine glands to target organs
• Regulation:
• Appropriate body temperature by absorbing and distributing
heat
• Normal pH in body tissues using buffer systems
• Adequate fluid volume in the circulatory system

Functions of Blood
• Body protection
• prevents blood loss by:
• Activating plasma proteins and platelets
• Initiating clot formation when a vessel is broken
• Blood prevents infection by:
• Synthesizing and utilizing antibodies
• Activating complement proteins
• Activating WBCs to defend the body against foreign
invaders

Physical Characteristics and Volume
• Color varies from scarlet to dark red
• The pH of blood is 7.35–7.45
• Temperature is 38°C
• Blood accounts for approximately 8% of body weight
• Average volume: 5–6 L for males, and 4–5 L for
females

Composition of Blood
• What type of tissue is blood?
• It is composed of liquid plasma (matrix) and formed
elements
• Formed elements include:
• Erythrocytes, or red blood cells (RBCs)
• Leukocytes, or white blood cells (WBCs)
• Platelets

Blood Plasma
• Blood plasma contains over 100 solutes, including:
• Proteins – albumin, globulins, clotting proteins,
and others
• Lactic acid, urea, creatinine
• Organic nutrients – glucose, carbohydrates, amino
acids
• Electrolytes – sodium, potassium, calcium,
chloride, bicarbonate
• Respiratory gases – oxygen and carbon dioxide

• Accounts for 46-63% of blood volume
• 92% of plasma is water
• In many respects, plasma composition resembles that
of the interstitial fluid
• The differences between plasma and interstitial fluids
are:
• Concentration of dissolved oxygen and carbon
dioxide
• Concentration of dissolved proteins (plasma proteins
can not cross capillary walls)
Plasma

Blood Plasma proteins
• 8% of plasma weight
• Contribute to osmotic pressure
• Proteins are mostly produced by the liver
• 60% albumin
• 36% globulins
• 4% fibrinogen

Formed Elements
• Erythrocytes, leukocytes, and platelets make up the
formed elements
• Only WBCs are complete cells
• RBCs have no nuclei or organelles, and platelets
are just cell fragments
• Most formed elements survive in the bloodstream for
only a few days
• Most blood cells do not divide but are renewed by
cells in bone marrow

• What is the function of erythrocytes?
• What elements in their structure support their
function?
• Function – carry respiratory gases – mainly oxygen
• They contain hemoglobin and have a biconcave
structure that helps with moving into small blood
vessels

Erythrocytes (RBCs)
• Biconcave discs, anucleate, essentially no organelles
• Filled with hemoglobin (Hb), a protein that functions in gas transport
• The biconcave disc shape
• provides a large surface to volume ratio – help with fast exchange
between the cell and the plasma
• allows RBCs to stack – facilitate flow through narrow blood
vessels
• Allows the RBCs to bend and flex when entering small capillaries
• Structural characteristics contribute to its gas transport function
• Erythrocytes are more than 97% hemoglobin
• ATP is generated anaerobically through glycolysis (they lack
mitochondria), so the erythrocytes do not consume the oxygen
they transport

Erythrocyte Function
• RBCs are dedicated to respiratory gas transport
• Hb reversibly binds with oxygen and most oxygen in
the blood is bound to Hb
• Hb is composed of the protein globin, made up of two
alpha and two beta chains, each bound to a heme
group
• Each heme group bears an atom of iron, which can
bind to one oxygen molecule (O2)
• Each Hb molecule can transport four molecules of
oxygen
• Each RBC contains ~280 million Hb molecules

• Erythropoiesis requires:
• Proteins, lipids, and carbohydrates
• Iron
• vitamin B12, and folic acid (necessary for DNA
production)
• Location of iron in the body
• The body stores iron in Hb (65%), the liver, spleen, and bone
marrow
• Intracellular iron is stored in protein-iron complexes such as
ferritin and hemosiderin
• Circulating iron is loosely bound to the transport protein
transferrin
Dietary Requirements of Erythropoiesis

RBC formation and turnover
• The life span of an erythrocyte is 100–120 days
• Old RBCs become rigid and fragile, and their Hb begins
to degenerate
• RBC travels about 700 miles in 120 days and is being
colliding in other RBCs or the vessels walls
• The damage in the RBC is detected by phagocytes that
engulf the RBCs
• RBCs are replaced at a rate of approximately 3 million
new blood cells entering the circulation per second.

• Why we study RBCs disorders ??
• Oral manifestations related to RBCs disorders
• Delayed wound healing causes heamorrhage and infection
• To take some precautions before and during working
• RBCs disorders divided into :
•  polycythemia  Anemia
• Anemia – Reduction of oxygen-carrying capacity (( maybe
decrease in number or dysfunction of RBCs with normal
count ))
Erythrocyte Disorders

• It is a symptom rather than a disease itself
• Classification :
• According to size : normocytic , macrocytic & microcytic
anemia
• According to Hb conc. : hypochromic & normochromic
anemia
• According to etiology : blood loss , decrease in production or
increase of RBCs destruction rate

• All types of anemia have these manifestations :
• General manifestations :
1- pallor 2- weakness easy fatigue 3- blurred vision
4- tachycardia 5- shortness of breathe 6- palpitation
7- angina in effort 8- unexplained headache
Oral manifestations :
1- pallor mucosa 2- slow wound healing
3-  tendency of infection
4- tongue (( atrophic , sorness , burn ))

• Iron-deficiency anemia results from:
• Severe blood loss ( menstrual loss , epistaxis , GIT
bleeding )
• Poor iron intake
• Impaired iron absorption physiological or
pathological
• Increase iron requirement physiological or
pathological
• Common type of anemia
• Common in females

• Clinical features :
Due to  iron Related to anemia
Spare hair General fatigue ,
headache
Brittle cracked split nails Breathlessness , pallor
cardiac murmurs
Koilonchias ( flattened
spoon shaped & thinned
nails )
Palpitation , tachycardia

koilonycias
Brittle
cracked nails

• Oral features :
• Pallor mucosa
• Sore mouth
•  wound healing so maybe lead to bleeding
• Glossitis in severe cases atroph of filli and fungi form
papillae appear red atrophic with painful surface
• (( angular chelitis ))

• Treatment
• Elimiination of the cause
• Ferrous sulphate tab. ( 600 mg ) for a month
• In case of constipation or diarrhea :
A- Patient take drug during meals
B- ferrous gluconate ( 600 mg )

• Pernicious anemia results from:
• Pernicious anemia is a type of vitamin B12 anemia. The body needs
vitamin B12 to make red blood cells. You get this vitamin from eating
foods such as meat, shellfish, eggs, and dairy products.
• A special protein, called intrinsic factor (IF), helps your intestines
absorb vitamin B12. This protein is released by cells in the stomach.
When the stomach does not make enough intrinsic factor, the intestine
cannot properly absorb vitamin B12.
• Common causes of pernicious anemia include:
• Weakened stomach lining (atrophic gastritis)
• An autoimmune condition in which the body's immune system attacks
the actual intrinsic factor protein or the cells in the lining of your
stomach that make it.

• Megaloblastic changes :
• Due to delayed maturation of RBCs as a result of defective
DNA formation so, RBCs will be ( macrocytic , fragile and
easy to ruptured )
• Benefits of vit B12 :
• Maturation of RBCs
• Cell division – DNA synthesis
• Metabolism of ( nervous cells , fatty acids and folic acids )
•

• lemon yellow color of the skin due to ( ppaloor due to anemia
itself & jaundice due to early breakdown of newly formed
RBCs )
• Neurological symptoms ( CNS ):
• Symmetrical numbness of extremities
• Neuro muscular incoordination and muscular weakness
• Ataxia dementia ( loss of memory )
• Paraplegia
• Optic nerve atrophy

• GIT symptoms :
• Diarrhea , constipation , epigastric may lead to stomach
cancer
• Oral features :
• Pallor of all mucosa of oral cavity
•  wound healing
• Disturbance in taste sensation
• Hunter tongue ( red , atrophic , ulceration ,sore , painful &
tremors in tongue ) ( fiery red beefy tongue )
• Xerostomia due to  salivary flow

• Treatment :
• The goal of treatment is to increase your vitamin B12 level:
• Treatment involves a shot of vitamin B12 once a month. People
with severely low levels of B12 may need more shots in the
beginning.
• Some people may also need to take vitamin B12 supplements by
mouth.
• A certain type of vitamin B12 may be given through the nose.
• Your provider will also recommend eating a variety of foods.

• Folate deficiency anemia :
• Causes :
•  intake  absorption  requirements
• Resembling that of pernicious anemia
• Difference from pernicious anemia in :
• Does not lead to neurological disorders
• No antibody againest intrinsic factor
• Treatment  folic acid 5mg/day orally

• Aplastic anemia results from :
• Maybe due to immunosuppression of bone marrow by T-
suppressor cells or secondary to :
• Drugs as ( chloramphenicol )
• Chemicals as ( benzene )
• Insecticides
• Viral infections
• Leukemia
• Chemotherapy
• Radiation

• General manifestations of anemia , susceptibility of infection
and bleeding tendency
• Oral manifestations :
• Pallor of oral mucosa
• Petechiae and ecchymosis in hard and soft palate due to 
platelets
• Ulceration of oral mucosa not surrounded by erythema
• Treatment : elimination of cause , supportive include RBCs &
platelets transfusion , B.M transplantation ,
immunosuppressive drugs as ( cuclosporine )

Anemia: Abnormal Hemoglobin
• Sickle-cell anemia – results from a defective gene coding for an
abnormal Hb called hemoglobin S (HbS)
• This defect causes RBCs to become sickle-shaped in low
oxygen situations

• Sickle cell anemia precipitated by ( CHADI ) :
• Cold
• Hypoxia ( high altitude , G.A )
• Acidosis
• Dehydration
• Infection

• All features of anemia and leading to :
( extremities )
Bone pain ,
tenderness
Increased viscosity
and clumbing of
cells in circulation
Destruction of sickle
cells
( kidney )
Renal failure
Thrombosis ,
ischemia and
infarction
Impaired growth
( lung )
Pneumonia
Abdominal infarction
( gut )
Skeletal deformities
( heart )
Heart failure
( spleen )
Spleenic infarction
Susceptibility to
infection

• Oral features :
• Yellowish oral mucosa esp. soft palate
• Delayed eruption and enamel hypoplasia
• Maxillary over growth lead to flare of teeth
• Osteomyelitis
• Ulcerations
• Odontalgia ( pain in sound tooth )
Anemia: Decreased Hemoglobin Content

• Radiographic changes :
• Bone show both osteoporosis and osteosclerosis :
• Osteoporosis due to short life span of RBCs
• Osteosclorosis as aresult of thrombosis occuring in
capillaries of bone marrow
• Alveolar bone show ladder like appearance
• Skull x-ray show hair on end appearance

• Dental considerations of sickle cell anemia :
• G.A is hazardous and may develop crisis
• Dental treatment should carried under L.A and preffer not to
use V.C agent to avoid crisis
• Antibiotic should used as prophylactic
• Poor wound healing after extraction
• Odontalgia
• Risk to fracture of bones of the jaw due to osteoporosis

• Treatment :
• No treatment except symptomatic ttt
• In case of crisis ( blood transfusion , O2 , antibiotic ,
analgesic )
• Repeated blood transfusion must be avoided due to :
• It is effect is transitory
• The pt. may develop ab against donor RBCs
• Risk of transmission of viral hepatitis
• Risk of iron overload

Erythrocyte Disorders - polycythemia
• Polycythemia: excess of RBCs that increase blood
viscosity
• Divided to :
• Relative due to : decrease plasma volume with normal
amount of RBCs e.g.: ( dehydration , burns ,
prolonged vomiting , diarrhea , ketoacidosis )
• Absolute : true increase of nuumber of RBCs maybe
primary or idiopathic and secondary

• Primary due to :
•  number of RBCs , platelets count , hemoglobin ,
granular cell count , viscosity of blood
• Secondary due to :
• RBCs increased due to increase eretropiotiene
hormone to compensate for hypoxic state as people
lived in high altitude , heart failure , chronic
pulmonary disease , heave smoking
• Or secondary to tumor like brain tumor lead to
increase erythropiotiene

• Purplish red skin color ( angry like appearance )
• Superficial veins of neck are dark and distended
• Bleeding ( petecchiae and ecchymyosis )
• Thrombosis due to  viscosity
• Oral features :
• Gingival bleeding , multiple ulceations , petechial and
ecchymyosis , purplish red color mucosa and
prominent sublingual varices .

• Treatment :
• Aim of treatment is to prevent thrombosis and
hemorrhage and this include :
• Repeated venesection
• Cytotoxic drugs
• Radioactive phosphorus

Leukocytes (WBCs)
• Leukocytes, the only blood components that are complete
cells:
• Are less numerous than RBCs
• Make up 1% of the total blood volume
• Can leave capillaries via diapedesis
• Move through tissue spaces
• Leukocytosis – WBC count over 11,000 / mm3
• Normal response to bacterial or viral invasion

Types of WBC
• Five types of WBC: neutrophils, eosinophils, basophils,
monocytes, lymphocytes
• First 4 are part of the body non-specific defense and
lymphocytes are part of the specific defense
• WBC are divided into 2 groups on the basis of their
appearance after staining:
• Granulocytes – visible stained granules
• Agranulocytes – non-visible granules

Leukopoiesis
• Production of WBCs
• Stimulated by chemical messengers from bone
marrow and mature WBCs
• Interleukins (e.g., IL-1, IL-2)
• Colony-stimulating factors (CSFs) named for the
WBC type they stimulate (e.g., granulocyte-CSF
stimulates granulocytes)

Leukocyte Disorders
• Leukopenia
• Abnormally low WBC count—drug induced
• Leukemias
• Cancerous conditions involving WBCs
• Named according to the abnormal WBC clone
involved
●
Myelocytic leukemia involves myeloblasts
●
Lymphocytic leukemia involves lymphocytes

Leukemia
• Bone marrow totally occupied with cancerous
leukocytes
• Immature nonfunctional WBCs in the bloodstream
• Etiology :
• Genetic factors : chromosomal abnormalities e.g.
philadilphia chromosome associated in 95% of cases
• Viral factors : ( HTLV)
• Environmental factors : radiation , chemicals ,
chloramphenicol , drugs as cytotoxic drugs

Leukemia
• Classification :
• 1- acute – chronic
• 2- individual cell ( lymphocytic leukemia , mylocytic
leukemia )
• 3- according to number of circulating leukemic cells :
• Aleukemic leukemia :
• Normal number of WBCs in peripheral circ. , no
immature cells in peripheral circ. , B.M crowded with
immature cells of WBCs

Leukemia
• Subleukemic leukemia :
• Normal number of WBCs in peripheral circ. ,
• Leukemic leukemia :
• Increased number of WBCs in peripheral circ. ,

Leukemia
• Mostly due to suppression of B.M by leukemia cells
which lead to :
• A- anemia ( pallor – fatigue – breatlessness )
• B- thrombocytopenia ( epistaxis – petteciae –
ecchymyosis )
• C- impaired normal function of neutrophils
• D- impaired function of immune system ( B or T
lymphocyte ) liable to infection

Leukemia
• Also due to invasion of leukemic cells organs and
tissues like :
• Liver
• Lymph node
• CNS
• Spleen and GIT
• Gingiva and skin

Leukemia
• Oral manifestations due to :
• B.M suppression ( anemia & thrombocytopenia )
• Leukemic cell infiltration in various tissues which
impair their function as :
• Lymph node
• PDL lead to mobility of teeth
• Gingiva lead to enlargment og gingiva
• 5th & 7th cranial nerves ( neuralgia & pels palsy )

Leukemia
• Impaired function of immature granulocytes / B & T
lymphocytes lead to :
• Candidiasis
• Periodontitis
• Pericoronal infection
• ANUG & recurrent herpes labialis resist the ttt

Leukemia
• The use of anti cancer drugs ( chemotherapy ) :
• Direct effect on oral mucosa by its ulceation
• Indirect effect manifested by oral bleeding and oral
infection
• What is the problems related to leukemic patients that
affect receiving dental ttt ??

Leukemia
• Oral infection
• Bleeding
• Anemia
• DIC & complication of B.M transplantation ( acute )
• Ulceration
• Delayed wound healing
• Give leukemic patient anti ( fungal – viral – biotic ) &
chlorohexidine M.W as he is liable to infected easily

Leukemia
• Acute leukemia in dental work :
• No surgery is performed except emergencies and
patient is hospitilized
• Only palliative dental care
• Gelatin sponge with thrombin soln. in case of gingival
bleeding

Leukemia
• Chronic leukemia in dental work :
• The infection in this case is less problematic than
acute cases because of there are more mature and
functional cells so patient with chronic leukemia can
receive dental work but with cautions as :
• Work in asepsis conditions and atraumatic work
• Not give him aspirin to avoid hemorrhage
• In case of suturing use absorbable suture materials

Leukemia
• Treatment :
• Anti leukemic chemotherapy drugs
• Platelet transfusion to control hemorrhage
• Packed RBCs to control anemia
• Anti ( bacterial – fungal – viral )
• Anti coagulants as heparin to prevent thrombosis ( 
viscosity )
• B.M transplantation
• Acute ( abnormal 2 ) chronic ( normal – abnormal )

Leukocyte Disorders
• Leukopenia
• N.B :
• Normal count of neutrophils is ( 3000 – 6000 )
• Mild neutropenia ( 1000 – 2000 )
• Moderate neutropenia ( 500 – 1000 )
• Severe neutropenia below ( 500 )

Leukocyte Disorders
• Leukopenia
• Examples :
• Agranulocytosis :
• Def. no neutrophils in periph. Circ.
• Etiology  idiopathic , secondary to ( RADI )
• Clinical features  high fever , chills , fatigue ,
sorethroat , infection ( characteristic features afeeting
mouth , GIT , R.T , skin ) , swelling and pus is
minimal (  localization of inflammation )

Leukocyte Disorders
• Oral features :
• Painful necrotizing ulcerations in oral cavity ( gingiva
and palate esp. ) with no inflammatory reactions
• Regonal lymphadenopathy
• Gingvitis and periodontitis
• Foul odour due to fusospirochetal infection
• Lab investegations :
• Absence of granulocytosis in circ. And B.M

Leukocyte Disorders
• Treatment :
• Eliminate cause ( stop drug – spleenectomy )
• B.M transplantation
• Give parental antibiotics broad spectrum ,
combination of antibiotics to control infection ( 3rd
generation cephalosporin against GM-ve )
• Keep mouth clean by :
• Chlorohexidiene M.W ( antibacterial )
• Topical antibiotic and topical anaesthesia
• ( bacteriacin – neomycin – nystatin in custom tray )

Leukocyte Disorders
• Cyclic neutropenia :
• cyclic decrease of circulating neutrophils under 500
cells/ cm3 secondary to bone marrow maturation
arrest
• Episodes occur every 21 days and last for afew days
( 3 – 7 days )
• Etiology :
• Idiopathic
• Secondary to ( RADI )

Leukocyte Disorders
• Affect both sexes
• More in infants and children
• As same as features of agranulocytosis but milder than
it and also infection not significant due to :
• Shorter duration of neutropenia
• Compensatory increase of monocytes which prevent
spread of infection

Leukocyte Disorders
• Oral features : during episodes :
• severe repeated gingivitis
• Progressive periodontitis  bone resorption
• Ulcerations but disappear after episode
• isolated major aphthous like ulcer maybe found
( large – deep – heal with scar – persist for weeks )
• Lab investgations :
• Periodic decrease of circulating neutrophils
• Diagnosis by making 3 c.b.c in one week for 4-6
weeks

Leukocyte Disorders
• Treatment :
• Maintain good oral hygiene
• Periodic recall for periodontal ttt every 2 month
• Avoid working in the period of neutropenia

Platelets
• Small fragments in the blood stream
• A normal platelet count ranges from 150,000 to
450,000 platelets per microliter of blood. Having more
than 450,000 platelets is a condition called
thrombocytosis; having less than 150,000 is known as
thrombocytopenia. You get your platelet number from
a routine blood test called a complete blood count
(CBC)

Platelets
• Oral manifestations of platelets disorders :
• Petechiae & ecchmyosis near to junction between soft
and hard palate
• Oozing blood from gingival margin
• Foul odour
• Hemorrhage even on small operations
• Gingival necrosis

Platelets
• Dental considerations :
• Avoid surgery
• Cotton whips with thrombin
• Emergency must be hospitalized
• Atruamatic work as possible
• Platelets at least 50000 / microlitre

Platelets
• What it means to have too many platelets
(thrombocytosis)
• The medical term for having too many platelets is
thrombocytosis, and there are two types:
• Primary or essential thrombocytosis – Abnormal
cells in the bone marrow cause an increase in platelets,
but the reason is unknown
• Secondary thrombocytosis – The same condition as
primary thrombocytosis, but may be caused by an
ongoing condition or disease such as anemia, cancer,
inflammation, or infection

Platelets
• When there are symptoms, they include spontaneous
blood clots in the arms and legs, which if untreated
can lead to heart attack and stroke
• With secondary thrombocytosis, the symptoms are
usually related to the associated condition. For
example, if you have an infection or anemia, you treat
those conditions and the platelet count comes down.

Platelets
• Treatment :
• over-the-counter, low-dose aspirin to reduce blood
clotting
• prescription medications to lower the risk of clotting
or to reduce platelet production in the bone marrow
• platelet pheresis, which is a procedure to remove
platelets directly from the blood

Platelets
• Thrombocytopenia :
• When you don’t have enough platelets, it’s called
thrombocytopenia. Symptoms include easy bruising,
and frequent bleeding from the gums, nose, or GI
tract. Your platelet count drops when something is
preventing your body from producing platelets. There
are a wide range of causes, including:
• Medications
• An inherited condition
• Certain types of cancer, such as leukemia or
lymphoma

Platelets
• Thrombocytopenia :
• Chemotherapy treatment for cancer
• Kidney infection or dysfunction
• Too much alcohol
• Treatment :
• People with mild thrombocytopenia may not need
treatment. For example, they may not have symptoms
or the condition clears up on its own

Platelets
• Treatment :
Some people develop severe or long-term (chronic)
thrombocytopenia. Depending on what's causing your
low platelet count, treatments may include:
Treating the underlying cause
If your doctor can identify a condition or a medication
that's causing your thrombocytopenia, addressing that
cause may clear up your thrombocytopenia
For example, if you have heparin-induced
thrombocytopenia, your doctor will direct you to stop
using heparin and prescribe a different drug

Platelets
• Treatment :
Blood or platelet transfusions :
If your platelet level becomes too low, your doctor can
replace lost blood with transfusions of packed red blood
cells or platelets
Medications :
If condition related to immune disease the doctor
prescribe drug to boost platelets count the 1st choice is
corticosteroids . In severe conditions give stronger
medications to suppress immune system .

Platelets
• Treatment :
Surgery:
If other treatment options don't help, your doctor may
recommend surgery to remove your spleen
(splenectomy).
Plasma exchange .

Hemophilia :
• Definition :
• Hemophilia, also spelled hemophilia, is a
mostly inherited genetic disorders that impairs the
body's ability to make blood clots. This results in
people bleeding longer after an injury
• Males mostly affected than females which tend to be
carriers of the disease
• N.B : factor VIII is a complex protien consists of
small molecules with coagulant activity and larger part
of VW factor with normal value of ( 50% - 150% )
• It is a rare condition and type A is common type

Hemophilia :
• Hemophilia A  factor VIII deficiency
• Hemophilia B  factor IX deficiency
• Von Willebrand’s disease  VIII : VWF deficiency
• General features of hemophilia A :
• Bleeding after minimal injury
• Hemorrhage under skin and around internal organs &
joints lead to hematoma
• Hemorrhage from nose , mouth , U.T & tonsillar area

Hemophilia :
• Oral features of hemophilia A :
• Bleeding from any site in oral cavity
• Gingival hemorrhage
• Even exofoliation of teeth physiologically may cause
hemorrhage
• Minor oral surgery lead to hemorrhage

Hemophilia :
• Dental management of hemophilia A :
• Prophylactic measures  to reduce the need of EX. ,
flouride application , sugar restrections in diet ,
prevention of periodontal disease .
• Endo  avoid reamming through apex , hemorrhage
into canal controlled by ( 1/1000 ) adren. On P.P
• PDL therapy  scaling with caution to avoid bleeding
• Conservative  R.D is useful , avoid S.T trauma , use
high speed with caution , gingival retractor with V.C
• RPD  designed to avoid food retention which may
lead to bleeding & gingival inflammation

Hemophilia :
• Anesthesia  G.A may lead to bleeding , N.B may
cause hematoma , all anesthesia is hazardous in case
of absent of factor replacement , topical application of
anesthetic agent is better than injection , infiltration is
safer than N.B , conservative dental ttt can carried out
without anesthesia .
• Extraction and surgery  Hb estimation , blood group
matching & factor VIII measure , factor VIII must
raised to 50 – 70 % before dental extraction and to
100% for major surgery

Hemophilia :
• Local measures  preoperative radiographs are
essential , avoid trauma to soft tissues and bone
• Suturing  it is preffered to stabilize flap and prevent
its disturbance , lingual tissue in lower molar area
should be left un disturbed , packing the socket if
necessary
• Patient hospitalized after surgery
• And take penicillin antibiotic for 10 days

Hemophilia :
• Treatment of hemophilia A :
• Replacing missing factor and use antifibrinolytic
agents depending on
• 1- severity of disease 2- level of factor VIII
• 3- severity of trauma 4- presence or absence of
factor VIII inhibitor
• Factor VIII conc. ( it is stable for 1 y at 4 C )
• Desmopressin  stimulate release of factor VIII:C
and VWF from cell stores followed by tranaxemic
acid to inhibit fibrinolytic activity . & cryoprecipitate

Hemophilia :
• Hemophilia B ( Christmas disease ) :
• May be hereditary ( sex linked ) factor IX deficiency
• Or acquired as result of VIT K deficiency
• Has same features of hemophilia A
• Treatment :
• Mild  F.F.P to control bleeding
• Severe  factor IX conc.
• Before working give factor IX conc. 1 hr preoperative

Hemophilia :
• Von Willebrand’s disease :
• Deficiency of VWF which is essential for platelets
adhesion .
• Type 1  mild reduction of VWF
• Type 2  molecular defect of VWF
• Type 3  there is nearly no VWF detected
• Disease begins in infants & children the bleeding
pattern is petehial , epistaxis & GIT bleeding
• Bleeding following minor trauma or EX. Is common

Hemophilia :
• Treatment :
• Mild and moderate VWD :
• Desmopressin for minor surgery
• FFP
• Cryoprecipitate (fibrinogen, von Willebrand factor,
factor VIII, factor XIII and fibronectin )
• Severe VWD :
• VIII & VWF for major surgeries

Hemophilia :

Thank you

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