Recommended
More Related Content
Similar to Coagulation and Bleeding Disorders Guide
Similar to Coagulation and Bleeding Disorders Guide (20)
Recently uploaded
Recently uploaded (20)
Coagulation and Bleeding Disorders Guide
- 1. Coagulation Disorders 1. Inherited: Hemophilia A Christmas disease von Willebrandis Disease 2. Acquired: Liver disease Vitamin K deficiency Anticoagulation drugs (heparin, coumarin) Anemia
- 2. Evaluation of bleeding disorders 1. Take history 2. Physical examination 3. Screening clinical laboratory tests 4. Observation of excessive bleeding following a surgical procedure
- 3. History • Bleeding problems in relatives • Bleeding problems following operations and tooth extractions, trauma • Use of drugs for prevention of coagulation or pain • Spontaneous bleeding from nose mouth etc..
- 4. Physical Examination • Jaundice • Petechiae: <0.2 cm • Purpura: 0.2 cm-1 cm • Eccymoses : >1 cm • Spider angioma • Oral ulcer • Hyperplasia of gingiva • Hemarthrosis
- 5. Screening laboratory tests • 1. Platelet count • 2. BT (Bleeding Time) • 3. PT (Prothrombin Time) • 4. aPTT (active Partial Thrombopastin Time) • 5. TT (Thrombin Time)
- 6. Anticoagulant (Heparin) • Complex inhibited ( IXa, Xa, Xla, XIla) • Used in deep vein thrombosis, renal dialysis > Rapid onset, Duration 4-6hrs (given IV) • Monitoring by aPTT: 50-65 sec • Discontinue 6 hrs before surgery then reinstituting therapy 6-12hrs post-op
- 7. Antiplatelet (Asprin) • Inhibit cycloxygenase, TXA2 formation! • Analgesic drug impairs platelet function • Arterial thrombosis, MI • Tests-BT, aPTT • If tests are abnormal, MD should be consulted before dental surgery is done • Stop aspirin for 5 days, substitute alternative drug in consultation with MD
- 8. Thrombocytopenic purpura • Thrombocytopenic purpura is a blood disorder characterized by an abnormal decrease in the number of platelets in the blood • This disease is caused by an immune reaction against one's own platelets. It has also been called autoimmune thrombocytopenic purpura. • A decrease in platelets can result in easy bruising, bleeding gums, and internal bleeding
- 9. Treatment Platelet count of <20,000 is an indication of treatment. 20,000-50,000 patients are monitored. >50,000 treatment is not necessary. • • Steroids i.e prednisone. • Immunoglobulins (IgG). • Anti-D administration. • • Thrombopoietin Rececptor agonists are available. Romiplostim & Eltrombopag. • Surgery (splenctomy). • Antibiotics used for the treatment of Helicobacter.pylori. • Platelet transfusion.
- 10. Non Thrombocytopenic purpura • Nonthrombocytopenic purpuras result from either vascular wall fragility or thrombasthenia . • Vascular wall fragility may result from hypersensitiv- ity reactions, scurvy, infections, chemicals (phenacetin and aspirin), dysproteinemia, and other causes. • Thrombasthenia occurs in uremia, Glanzmann disease, aspirin ingestion, and von-Willebrand disease • Both types of nonthrombocytopenic purpura may result in
- 11. Treatment 1) Treatment consists primarily of direct pressure applied for at least 15 min. 2) This initial pressure should control the bleed- ing unless coagulation times are abnormal or reinjury occurs. 3) Surgical therapy should be avoided until the qualitative and quantitative platelet problems are resolved.