Bleeding disorder Flashcards

1
Q

List three acquired hemorrhagic disorders.

A

Disseminated intravascular coagulation (DIC) and liver disease

Vitamin K deficiency
Drug induced (anti-platelet, anti- coagulant)

pdf 150 for more info

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2
Q

List three methods to control epistaxis

A

Manual haemostasis

Nasal packing

Nasal cauterisation

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3
Q

How does manual haemostasis control epistaxis?

A

Squeeze nostrils together for 5-10 min, without frequent peeking

Head in neutral/lowered position (NOT hyperextended ∵ risk of aspiration)

± gauze moistened with adrenaline (1 : 10000) / phenylephrine (for vasoconstriction)

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4
Q

How does nasal packing control epistaxis?

A

Anterior: Vaseline® (petroleum jelly gauze filled with Abio ointment), Merocel® (expandable)

Posterior: rolled gauzes, inflatable balloon devices

All packing should be removed in 3-4 days

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5
Q

How does nasal cauterisation control epistaxis?

A

Chemical: silver nitrate

Electrocauterisation: requires LA, use rigid endoscopy, reserved for severe/pos bleeding

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6
Q

List two causes of bleeding tendency resulting in epistaxis

A

Haemophilia A (F8), B (F9), von Willebrand disease

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7
Q

What are the causes of hemorrhagic disorders?

A

Genetics (haemophilia, vWD), liver disease (liver failure), medications (anticoagulants, antiplatelets)

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8
Q

What are the salient points of a history-taking for a patient with previous post-operative bleeding history?

A

Time:
How long have you had the bleeding problem? How long have you been on anticoagulants?

Describe:
your bleeding problem

Past:
Have you had problems with previous dental appointments?

Cause:
What is the cause of your bleeding problem/ why are you on anticoagulants?

Lab:
What are your most recent laboratory results relative to your anticoagulation/ bleeding problem status?

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9
Q

What are the types of anticoagulants?

A

Aspirin, warfarin, heparin

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10
Q

List the laboratory blood tests for a patient with previous post-operative bleeding history.

A

Activated partial thromboplastin time (aPTT) (intrinsic)

Prothrombin time (PT) (extrinsic)

INR (normal = 1; therapeutic = 2-3; OK for extraction if under 3.5)

Bleeding time (BT) (Simplate)

Platelet count

Thrombin time (TT)

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11
Q

What is the dental management before the appointment? (on warfarin)

A

Consult patient’s physician

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12
Q

List 4 conditions that may need to consider for post-operative bleeding after extraction (2)

A

Haemophili A
Haemophilia B
von Willebrand disease
Liver cirrhosis

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13
Q

List two causes of bleeding tendency resulting in epistaxis

A

Thrombocytopenia

Drug induced such as aspirin

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14
Q

Patient got mitral valve replacement in the past and is on anticoagulant. He is scheduled for extraction.
a. What anticoagulant is he taking? (3)

A

Wafarin, heparin

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15
Q

Patient got mitral valve replacement in the past and is on anticoagulant. He is scheduled for extraction.
b. What blood test would you perform? (2)

A

INR, aPTT, PT, platelet count

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16
Q

Patient got mitral valve replacement in the past and is on anticoagulant. He is scheduled for extraction.
c. What are the dental complications of his condition? (2.5)

A

Infection, bleeding

17
Q

Patient got mitral valve replacement in the past and is on anticoagulant. He is scheduled for extraction.
d. What is the dental management before the appointment? (2.5)

A

FROM: BCSH: British committee of standard hematology
Check INR prior 72 hours (<4safe, > 4 send to hospital)

Heparin: significant first pass effect, only iv, latest heparin in capsule can be taken orally

Antibiotic Prophylaxis

18
Q

Given: the patient has history of atrial fibrillation (2010, 2)
a. Give 2 medications that the patient should take to prevent stroke?

A

Aspirin, warfarin

19
Q

Given: the patient has history of atrial fibrillation (2010, 2)
b. Give the laboratory test that test anti-coagulation status.

A

INR

20
Q

Given: the patient has history of atrial fibrillation (2010, 2)
c. What are the complications in major oral surgery?

A
Pacemaker
Bleeding
Fresh frozen plasma transfusion
Give vit K
Thromboembolism
Infection control
Antibiotic Prophy for major surgery: cellulitis, more than 4hours, foreign body like implant, immunocommpromsed like chemotherapy, DM, kidney dialysis, organ transplant (also need prophy in MOS) *in hospital*