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![fibrinolysis
(tPA)
PLASMINOGEN PLASMIN.
[FDPs]](https://image.slidesharecdn.com/bleedingclottingdisorders-111121084102-phpapp02/85/Bleeding-clotting-disorders-12-320.jpg)
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Bleeding & clotting disorders
Dental procedures can have serious consequences for patients with bleeding disorders, possibly resulting in severe hemorrhage or death. Laboratory tests help evaluate coagulation disorders and bleeding risks, including platelet count, bleeding time, PT/INR, aPTT, and tests for factors, fibrin degradation products, and capillary fragility. Treatment depends on the specific disorder or condition, and may include replacement of platelets, coagulation factors, cryotherapy, laser ablation, or medications like tranexamic acid, desmopressin, corticosteroids, or thrombopoietin agents.
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Bleeding & clotting disorders
- 2. • Dental procedures resulting in bleeding can have serious consequences in a pt. having bleeding disorder……… severe hemorrhage or even death.
- 8. • 2 theories::: ( MARKOWITZ---- 1903) (1964)-the coagulation mechanism results in a final explosive change of a liquid to a gel.
- 12. fibrinolysis (tPA) PLASMINOGEN PLASMIN. [FDPs]
- 13. Factor XII Factor XIIa tPA + high Mol.wt kininogen parakallikren kallikren FV F VIII plasminogen plasmin fibrin FDPs
- 14. tPA: Used in thromboembolic disoders asso with Myocardial infarction.(effective within 1st 6 hrs postinfarction. Fibrinolytic system activation turned off α by…… 2antiplasmin/ by plasminogen activator inhibitors ( PAI-1,PAI-2)
- 17. CLINICAL LABORATARY TESTS •Help to Platelet count Bleeding time PFA-100 CT PT/INR aPTT TT FDPs Factor assays Tests of capillary fragility
- 18. PLATELET COUNT: • Normal-150,000to 450,000/mm3 • If < 50,000/mm3 Hemorrhagic stroke Surgical/traumatic hemorrhage etc. may occur. • In such cases platelet transfusion may be necessary.
- 19. TESTS OF PLATELETFUNCTION: ADV Dis ADV
- 20. INR Intro.by WHO(1983):itz theratio of PT that adjusts for the sensitivity of the thromboplastin reagants,such that normal coagulation profile is reported as an INR of 1.0
- 22.
- 26. • Measured usinga specific latex agglutination system. Evaluates the presence of a D-dimer of fibrinogen / fibrin above normal levels.
- 32. CUSHING’S syndrome: Resulting fromexcessive corticosteroid Intake / production. Patient shows skin bleeding & easy bruising.
- 33. syndrome: • Autosomal dominantdisorder: • Fragile skin vessels & easy bruising.
- 34. • HHT • Abnormal telangiectatic capillaries. • Frequent episodes of nasal & GI bleeding. • Telangiectases common on lips, tongue & palate.
- 35. : • Cryotherapy. • Laser ablation. • Electrocoagulation. • Blood replacement & iron therapy.
- 36. Thrombocytopaenia Quantity of platelets when reduced by * * * TREATMENT Thrombocytopathies Qualitative
- 39. Corticosteroids Splenectomy Rituximab Anti-D Thrombopoietin like agents.
- 40. TTP: • CAUSES:metastaticmalignancy,pregnancy,m itomycin & high dose chemotherapy. • SYMPTOMS: Thrombocytopaenia Microangiopathic hemolytic anemia Renal dysfunction Occasional fever Fluctuating neurologic abnormalities.
- 41. • Platelet countmay also decreased by medications. • ASPIRIN
- 42. • ASPIRIN : •USES---- ANTIPLATELET THERAPY FOR THROMBOEMBOLIC PROTECTION. • INEXPENSIVE & EFFECTIVE
- 47. • No racial •AGE 6 • SIGNS H H H GI B h s bleeding. H
- 50. DISADV Viral transmission Large volume needed.
- 51. 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
- 54. Highly purified recombinant& monoclonal FIX conc.(mononine) F IX complex conc.(prothrombin complex conc.---PCC) proplex-T, Autoplex-T
- 55. Complications of factor replacement therapy Allergic reactions Viral disease transmission(hepatitis B & C, CMV,HIV) thromboembolic disorder, DIC, Devpt.of antibodies against factor concs.
- 60.
- 62. • Fibrin stabilizingfactor def & Fibrinogen def. • Very rare. • Autosomal recessive traits. • Rx -Factor replacement therapy & FFP.
- 74. • TREATMENT: heparin LMWH activated protein C , Antithrombin III.
- 78. • Surveying thepatient for current medication use. • History of heavy alcohol intake. • Medical conditions – hepatitis/cirrhosis,renal disease,hematologic malignancy&thrombocytopenia predispose patients to bleeding problems.