2. Coagulation Defects
Aiman A. Ali DDS, PhD.
Clot formation
Aiman A. Ali DDS, PhD.
Aiman A. Ali DDS, PhD.
Lack of coagulation
factors
Coagulation disorders
Lack of VIII factors Hemophilia A
Hemophilia BLack of IX factors
Aiman A...
There are some conditions, which alter the vascular wall as :
1- Scurvy.
2- Infection: measles, scarlet fever, endocarditi...
Aiman A. Ali DDS, PhD.
Aiman A. Ali DDS, PhD.
Von Willebrands disease
It is deficiency of von Willebrands factor which is
necessary for normal ad...
Vitamin K deficiency
vitamin K is necessary for the synthesis of many
coagulation factors II , VII , IX, X. It is synthesi...
Comparison between platelet and
coagulation disorders
Platelet
disorder
Coagulation
disorder
sex More in females Males mor...
Investigation of a patient who gives a
history of prolonged bleeding:
1- history:
1- feature of pervious bleeding episodes...
2- Laboratory tests.
Partial thromboplastin time [factors, VIII, IX, XI, XII] 25-35 sec.
Prothrombin time [factors, V, V...
1 - preventive dental care
2- In case of extraction:
 lab. Tests for hemoglobin estimation.
 Factor VIII should be raise...
3- Anesthesia:
 local and general anesthesia are hazardous in the absence
of factor VIII replacement.
 Operative treatme...
Aiman A. Ali DDS, PhD.Aiman A. Ali DDS, PhD.
Normal Blood
Cells
Basophils
Aiman A. Ali DDS, PhD.
Disorders of red and
white blood cells
Aiman A. Ali DDS, PhD.
Red blood cells White blood cells
Anemia.
Polycythemia
Leuko...
Anemia
Iron deficiency Anemia.
Folate deficiency anemia.
Vitamin B12 deficiency anemia
(pernicious).
Glucose-6-Phosphate D...
Thalassaemias
Anemia
ά-Thalassaemia
β-Thalassaemia Mediterranean
Asians, Africans & Caribbeans
It results from decreased s...
Common signs and symptoms
Fatigue.
Palpitations.
Shortness of breath.
Abdominal and bone pain.
Pallor.
Lymphadenopat...
Oral manifestations of anemia
Aiman A. Ali DDS, PhD.
Polycythemia
Increase number of circulating
RBCs
Aiman A. Ali DDS, PhD.
Physiologic Pathologic
Leukopenia
Normal count of WBC 4.5 to 11 X1000/cm3
Leukopenia: decrease in the number of
WBC.
Aiman A. Ali DDS, PhD.
Aiman A. Ali DDS, PhD.
Chronic L. L.Chronic M. L.
Acute L. L.
Acute M. L.
Acute M. L.Acute monocytic L.
Leukemia
Acute Chronic
Aiman A. Ali DDS, PhD.
Oral Manifestations
Aiman A. Ali DDS, PhD.
Lymphomas
Hodgkin’s Non-Hodgkin’s
Aiman A. Ali DDS, PhD.
Dental managements of patient with
anemia
Confirm with physician.
Short appointments.
Preventive dental care.
Avoid oral i...
Dental managements of patient with leukemia
Aiman A. Ali DDS, PhD.
Confirm with physician.
Treatment of oral ulcers.
Antif...
Bleeding disorder 2
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Bleeding disorder 2

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Oral Diagnosis I
Third Year

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Bleeding disorder 2

  1. 1. 2. Coagulation Defects Aiman A. Ali DDS, PhD.
  2. 2. Clot formation Aiman A. Ali DDS, PhD.
  3. 3. Aiman A. Ali DDS, PhD.
  4. 4. Lack of coagulation factors Coagulation disorders Lack of VIII factors Hemophilia A Hemophilia BLack of IX factors Aiman A. Ali DDS, PhD.
  5. 5. There are some conditions, which alter the vascular wall as : 1- Scurvy. 2- Infection: measles, scarlet fever, endocarditis, malaria. 3-Allergy 4- H H T. (Hereditary Hemorrhagic Telengiectasia ). vascular diseases Aiman A. Ali DDS, PhD.
  6. 6. Aiman A. Ali DDS, PhD.
  7. 7. Aiman A. Ali DDS, PhD. Von Willebrands disease It is deficiency of von Willebrands factor which is necessary for normal adherence of platelets. It is hereditary disease. Clinically: 1- affects from 1 to 45 per 100.000 of population and is there at least as common as hemophilia A. 2- Affects both males and females. 3- Usually less severe than hemophilia A.
  8. 8. Vitamin K deficiency vitamin K is necessary for the synthesis of many coagulation factors II , VII , IX, X. It is synthesized by normal intestinal bacterial flora. causes of vitamin K deficiency: 1- Poor dietary intake. 2- Poor absorption. 3- Anticoagulation therapy. 4- Prolonged use of broad spectrum antibiotics Aiman A. Ali DDS, PhD.
  9. 9. Comparison between platelet and coagulation disorders Platelet disorder Coagulation disorder sex More in females Males more Family history Negative Positive Nature of bleeding Immediately after trauma Delayed after trauma Effect of locally applied pressure Bleeding may stop Bleeding recur upon pressure removal Spontaneous bleeding into skin and mucous membrane Common Uncommon Deep hemorrhage or hemoarthrosis Rare Common Bleeding time Prolonged Normal Platelet count Normal but defective Normal Clotting funciton Normal abnormal Item Aiman A. Ali DDS, PhD.
  10. 10. Investigation of a patient who gives a history of prolonged bleeding: 1- history: 1- feature of pervious bleeding episodes. 2- Past history. 3- surgery. 4- Previous treatment of bleeding. 5- Family history. 6-Relevant medical history. Aiman A. Ali DDS, PhD.
  11. 11. 2- Laboratory tests. Partial thromboplastin time [factors, VIII, IX, XI, XII] 25-35 sec. Prothrombin time [factors, V, VII, X] 11-15 SEC. Platelet count: 140-400 x 103 ml Bleeding time and Ivy BT: 1-6 min. Thrombin time: 9-13 sec. Diagnostic tests Aiman A. Ali DDS, PhD.
  12. 12. 1 - preventive dental care 2- In case of extraction:  lab. Tests for hemoglobin estimation.  Factor VIII should be raised to 50-70% before dental extraction and 100% for major surgery  Postoperatively the patient should be given factor VIII q12h for a week  Antibiotic cover should be given to avoid infection  Avoid the use of aspirin, codeine and panadol are better alternatives Dental managements Aiman A. Ali DDS, PhD.
  13. 13. 3- Anesthesia:  local and general anesthesia are hazardous in the absence of factor VIII replacement.  Operative treatment can be done without anesthesia unless there is pain intraligamintary injection may be used 4- periodontal therapy:-  scaling can be done (except in severe hemophilia) under antifibrinolytic cover.  Periodontal surgery need factor replacement. Dental managements Aiman A. Ali DDS, PhD.
  14. 14. Aiman A. Ali DDS, PhD.Aiman A. Ali DDS, PhD.
  15. 15. Normal Blood Cells Basophils Aiman A. Ali DDS, PhD.
  16. 16. Disorders of red and white blood cells Aiman A. Ali DDS, PhD. Red blood cells White blood cells Anemia. Polycythemia Leukopenia. Leukemia Acute. Chronic. Lymphomas Hodgkin. non-Hodgkin.
  17. 17. Anemia Iron deficiency Anemia. Folate deficiency anemia. Vitamin B12 deficiency anemia (pernicious). Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency. Sickle cell anemia. Thalassaemia. Other classification Aiman A. Ali DDS, PhD.
  18. 18. Thalassaemias Anemia ά-Thalassaemia β-Thalassaemia Mediterranean Asians, Africans & Caribbeans It results from decreased synthesis of one or more of the globin chains of hemoglobin. Aiman A. Ali DDS, PhD.
  19. 19. Common signs and symptoms Fatigue. Palpitations. Shortness of breath. Abdominal and bone pain. Pallor. Lymphadenopathy. Aiman A. Ali DDS, PhD.
  20. 20. Oral manifestations of anemia Aiman A. Ali DDS, PhD.
  21. 21. Polycythemia Increase number of circulating RBCs Aiman A. Ali DDS, PhD. Physiologic Pathologic
  22. 22. Leukopenia Normal count of WBC 4.5 to 11 X1000/cm3 Leukopenia: decrease in the number of WBC. Aiman A. Ali DDS, PhD.
  23. 23. Aiman A. Ali DDS, PhD. Chronic L. L.Chronic M. L. Acute L. L. Acute M. L. Acute M. L.Acute monocytic L.
  24. 24. Leukemia Acute Chronic Aiman A. Ali DDS, PhD.
  25. 25. Oral Manifestations Aiman A. Ali DDS, PhD.
  26. 26. Lymphomas Hodgkin’s Non-Hodgkin’s Aiman A. Ali DDS, PhD.
  27. 27. Dental managements of patient with anemia Confirm with physician. Short appointments. Preventive dental care. Avoid oral infection. Avoid barbiturates, sedation and epinephrine. Oxygen. Aiman A. Ali DDS, PhD.
  28. 28. Dental managements of patient with leukemia Aiman A. Ali DDS, PhD. Confirm with physician. Treatment of oral ulcers. Antifungal treatment. Control of pain with strong analgesics. Prophylactic antibiotic therapy. Surgical treatment Bleeding time & platelet replacement if necessary. Prophylactic antibiotic therapy.

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