This document discusses coagulation defects and disorders of blood cells. It covers topics like hemophilia A and B caused by a lack of coagulation factors VIII and IX, von Willebrand disease caused by a deficiency of von Willebrand factor, and vitamin K deficiency affecting coagulation factors. Laboratory tests for investigating prolonged bleeding and dental management of patients with coagulation disorders are also summarized. Common blood disorders discussed include anemias, polycythemia, leukopenia, leukemias, and lymphomas.

1. 2. Coagulation Defects
Aiman A. Ali DDS, PhD.

2. Clot formation
Aiman A. Ali DDS, PhD.

3. Aiman A. Ali DDS, PhD.

5. Lack of coagulation
factors
Coagulation disorders
Lack of VIII factors Hemophilia A
Hemophilia BLack of IX factors
Aiman A. Ali DDS, PhD.

6. 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.

7. Aiman A. Ali DDS, PhD.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. Aiman A. Ali DDS, PhD.Aiman A. Ali DDS, PhD.

16. Normal Blood
Cells
Basophils
Aiman A. Ali DDS, PhD.

17. 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.

18. 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.

19. 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.

20. Common signs and symptoms
Fatigue.
Palpitations.
Shortness of breath.
Abdominal and bone pain.
Pallor.
Lymphadenopathy.
Aiman A. Ali DDS, PhD.

21. Oral manifestations of anemia
Aiman A. Ali DDS, PhD.

22. Polycythemia
Increase number of circulating
RBCs
Aiman A. Ali DDS, PhD.
Physiologic Pathologic

23. Leukopenia
Normal count of WBC 4.5 to 11 X1000/cm3
Leukopenia: decrease in the number of
WBC.
Aiman A. Ali DDS, PhD.

24. Aiman A. Ali DDS, PhD.
Chronic L. L.Chronic M. L.
Acute L. L.
Acute M. L.
Acute M. L.Acute monocytic L.

25. Leukemia
Acute Chronic
Aiman A. Ali DDS, PhD.

26. Oral Manifestations
Aiman A. Ali DDS, PhD.

27. Lymphomas
Hodgkin’s Non-Hodgkin’s
Aiman A. Ali DDS, PhD.

28. 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.

29. 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.