Dental and oral complications of bleeding disorders

Question 1

What 4 components do bleeding disorders generally involve one or more of the following?

Answer 1

Vascular - vessel walls
Platelets
Coagulation Factors
Fibrin

Question 2

How can vascular bleeding disorders be catagorised?

Answer 2

Congenital

Acquired

Question 3

Example of congenital vascular problems?

Answer 3

Ehler’s Danlos syndrome

Question 4

What is Ehlers Danlos syndrome?

Answer 4

Collagen disorder - effecting collagen in BV walls

Question 5

Example of acquired vascular bleeding disorder?

Answer 5

Scurvy

Question 6

What causes Scurvy?

Answer 6

Vit C deficiency

Question 7

How can platelet disorders be catagorised?

Answer 7

Disorder/function (congenital/acquired) or change in numbers through increased/decreased production/destruction

Question 8

Example of functional congenital platelet disorder?

Answer 8

Von Willebrand’s disease

Question 9

Effect of Von Willebrand’s disease?

Answer 9

Low plasma levels of VWF or low function of VWF = decreased aggregation and factor 8

Question 10

Examples of acquired functional platelet disorders?

Answer 10

Aspirin induced or renal function induced (inhibits initial aggregation)

Question 11

2 examples of platelet disorders - change in number?

Answer 11

Thrombocytopenia

Thrombocytosis

Question 12

What is thrombocytopenia?

Answer 12

Decreased number of platelets

Question 13

What is thrombocytosis?

Answer 13

Increased number of platelets

Question 14

Mechanism of action of thrombocytopenia?

Answer 14

Abnormal bone marrow causes decreased formation

Normal bone marrow with autoimmune process can cause increased destruction

Question 15

Causes thrombocytopenia?

Answer 15

Alcoholic liver disease, malignancy

Question 16

What are the effects of thrombocytosis?

Answer 16

If you have too many platelets and they all work well = too much clotting
If you have too many and they don’t work well = bleeding

Question 17

What 3 things can thrombocytosis result from?

Answer 17

Reactive or secondary thrombocytosis (result as result of a reaction)
Familial (genetic)
Clonal - can’t explain

Question 18

How can coagulation bleeding disorders be catagorised?

Answer 18

Intrinsic defects

Extrinsic defects

Question 19

What is meant by intrinsic or extrinsic coagulation disorders?

Answer 19

Effects intrinsic or extrinsic pathways

Question 20

What effect do intrinsic coagulation disorders have?

Answer 20

Prolonged APTT (activated partial thromboplastin time)

Question 21

How can intrinsic coagulation disorders be categorised further? give an example of both.

Answer 21

Congential - haemophilia A and B

Acquired - heparin induced

Question 22

what effect does extrinsic coagulation disorders have?

Answer 22

Prolong prothrombin time (PT time)

Question 23

How do extrinsic coagulation disorders generally occur?

Answer 23

Acquired e.g. liver disease, warfarin

Question 24

What are fibrin disorders a result of?

Answer 24

Thrombolytic therapy

Pathological fibrinolysis e.g. tumour

Question 25

How do vascular wall disorders present?

Answer 25

Superficial bruise at superficial layer

Question 26

How do platelet disorders present?

Answer 26

Superficial bruise at superficial layer Epistaxis (nosebleed), menorrhagia (mensuration) Hematemesis (vomiting blood), melena (blood in stool)

Question 27

How do coagulation disorders present?

Answer 27

Blood in body fluids (nose bleeds, mensturation, vomit, stool Brusing at deeper layer

Question 28

Bleeding disorders tend to present as one or more of these manifestations: a) superficial bruising b) bleeding from sites e.g. nose bleed, heavy menstruation, vomit, stool c) deep, spreading bruising Match each of these disorders to their manifestations 1. vascular wall disorder 2. Platelet disorder 3. Coagulation disorder

Answer 28

1. a 2. a b 3. b c

Question 29

What are the key systems in the medical history that relate to bleeding disorders?

Answer 29

GIT/liver disease | Coagulation system

Question 30

What evidence may suggest bleeding problems?

Answer 30

Regular nose bleeds, bruising, family history | Previous haemostatic challenges - after extraction

Question 31

What is relevant in the social history for bleeding?

Answer 31

If they drink alcohol/how much and for how long?

Question 32

What are the 2 functions of the liver?

Answer 32

Synthetic - makes clotting factors and albumin | Metabolic- breaks down drugs

Question 33

What is relevant in dental history for bleeding?

Answer 33

Previous extractions - what happened | how they were managed

Question 34

What is ecchymosis?

Answer 34

Bleeding into subcutaneous tissues - known as bruising, usually due to trauma

Question 35

At what point does ecchymosis suggest bleeding disorders?

Answer 35

When the extent of the bruising is not appropriate for the trauma

Question 36

What is purpura?

Answer 36

Spontaneous bleeding into skin causing pools of blood within the skin

Question 37

How can purpura be catagorised?

Answer 37

Non-thrombocytopenic - not due to low levels of platelets | Thrombocytopenic - due to low levels of platelets

Question 38

What caused non-thrombocytopenic purpura?

Answer 38

Ehlers Danlos Infections Ageing skins

Question 39

How does thrombocytopenic purpra manifest/

Answer 39

Petechiae - small spots on the skin as a result of bleeding

Question 40

Causes of thrombocytopenic purpura?

Answer 40

Impaired production of platelets Excessive platelet destruction Sequestration of platelets in spleen Dilution loss following transfusions

Question 41

What can cause impaired production of platelets?

Answer 41

Bone marrow failure | Selective reduction in megakaryocytes due to drugs or alcohol

Question 42

What causes excessive platelet destruction?

Answer 42

Immune problems - autoimmune or triggered by particular viral infections Coagulation problems

Question 43

Name 2 types of vascular abnormalities

Answer 43

Telangiectasia | Haemangioma

Question 44

What is telangiectasia?

Answer 44

Vascular abnormality | Dilation of small veins causing excessive bleeding

Question 45

What are 2 important types of telangiectasia?

Answer 45

Spider | Hereditary haemorrhagic

Question 46

Describe spider telangiectasia?

Answer 46

Radiate from central sport disappear on pressure

Question 47

Describe herediatry haemorrhagic telangiectasia

Answer 47

Large dilated vessels on mucous membrane of mouth and nose

Question 48

What is haemangioma?

Answer 48

Vascular abnormality due to abnormality of blood vessels. lumps on face Blanch on pressure

Question 49

What may be found in the social history that can be a clue for bleeding disorders, why?

Answer 49

Alcohol abuse Liver disease - affects metabolic and synthetic function Portal venous hypertension Obstruction of bile duct

Question 50

What visual clues suggest alcohol abuse?

Answer 50

Bruising Jaundice Spider telangectasia

Question 51

What blood tests can diagnose bleeding disorders?

Answer 51

APTT PT Full blood count Liver function tests

Question 52

Most important point in managing bleeding disorders?

Answer 52

Liaise with other professionals

Question 53

list 3 local measures for bleeding?

Answer 53

More pressure, more LA Suture Pack

Question 54

Why do we pack?

Answer 54

Temporarily apply pressure | Adjust coagulation process