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Special Care Dentistry BDS3 > Haematology > Flashcards

Haematology Flashcards

1
Q

Haemophilia A is a deficiency of which factor?

A

VIII

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2
Q

Apixiban inhibits which factor?

A

Factor Xa

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3
Q

The extraction of a single tooth is a high risk procedure when assessing bleeding risk

True or false.

A

False

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4
Q

A person with moderate haemophilia has what percentage of normal factor in their blood?

A

1-5%

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5
Q

Von williebrands type 2 is normally managed with which product to manage bleeding

A

Factor VIII concentrate

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6
Q

Augmentation of factor levels is required for which of the inherited bleeding conditions
-Moderate Haemophilia B
-Type 3 Von Willebrand’s Disease
-Mild Haemophilia A
-Type 2a Von Willebrand’s Disease
-All of the above

A

All of the above

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7
Q

Takes the medication warfarin with associated blood testing every week and requires a single tooth extraction.

What is the most appropriate management strategy?

A

INR required within 24 hours

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8
Q

Takes the medications aspirin and clopidogrel following a STEMI two weeks ago and requires the extraction of two asymptomatic teeth.

What is the most appropriate management strategy?

A

Delay extractions until 6 month point

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9
Q

Takes the medication Rivaroxaban once a day in the morning and requires the extraction of 5 teeth at 0900 in the morning.

Most appropriate management strategy

A

Delay the morning dose and take it four hours after haemostatis has been achieved

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10
Q

Takes the medication Dabigatran and requires the surgical extraction of two teeth at 0900 in the morning

Most appropriate management?

A

Miss the morning dose of medication and take the evening dose as usual

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11
Q

Takes the medication Apixaban and requires a single extraction

Most appropriate management?

A

Do not change drug regime

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12
Q

The prothrombin time(PT) would be deranged in

A

Liver disease or warfarin therapy

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13
Q

The activated partial thromboplastin time (APTT) would be deranged in

A

Haemophilia

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14
Q

Activated partial thromboplastin time (APTT) measures

A

Factors VIII,IX,XI,XII and factors X,V, prothrombin and fibrinogen

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15
Q

Prothrombin time (PT) measures

A

Factors VII,X,V,prothrombin and fibrinogen

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16
Q

A patient with moderate haemophilia A requires factor coverage for supra—gingival scaling true or false

A

False

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17
Q

Topical miconazole for the management of oral candidosis presents a risk for patients prescribed Warfarin by potentiating bleeding

A

True

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18
Q

What kind of inheritance pattern do haemophilia A and B follow

A

Sex linked recessive

Defective gene on the X chromosome - males are affected and females are the carries.
Unusual for females to have both X chromosomes affected

19
Q

If a patient has a severe/ moderate case of haemophilia A - what treatment would the use

A

Recombinant factor 8

20
Q

If a patient has a mild case of haemophilia A or they are a carrier what treatment would they receive

A

The majority of patients respond well to DDVAP ( desmppressin)

Very mild cases may only require oral tranexaic acid

21
Q

How does DDVAP work and what are its limitations

A

It works by releasing the factor VIII that has Beene bound to endothelial cells giving a temporary boost to factor 8 levels and clotting ability

This has no effect on the coagulation cascade and can only be used a few times before all of the factor 8 has been displaced.
Therefore this isn’t a medication that is used on a daily basis.

22
Q

How does tranexamic acid work?

A

Inhibits fibrinolysis
This works by counteracting the affect of the clot breaking down therefore allowing the clot to persist for longer.

23
Q

A person who has haemophilia B is deficient in what factor

A

Factor 9

24
Q

What ar the deficiency’s in VON-willebrands disease

A

Reduced factor 8 level
Reduced platelet aggregation

25
Q

What is the only treatment for Haemophilia B despite the severity and why is this?

A

Recombinant factor 9

This is because factor 9 isn’t bound to the vascular surface therefore DDVAP cannot b used

26
Q

How does von willebrands disease lead to decreased factor 8 and reduced platelet aggregation

A

This is because Von willebrands factor is not present in adequate numbers and this produces a reduction in factor 8 levels and a reduction in platelet activity

27
Q

How is Von willebrands diease treated

A

Severe and moderate - DDVAP
Mild and carries - oral tranexamic acid

28
Q

Name two local anaesthetic techniques that are dangerous to administer on a patient with haemophilia

A

IDB and lingual infiltration

Due to he risk of bleeding following injection

29
Q

What is thrombocytopenia

A

Low number of platelets

30
Q

In a primary care setting what must the platelet count be at least to carry out treatment.

What must it be in a hospital setting

A

100x10^(9)/L in a primary care setting

50x10^(9) in a hospital as they are more equipped to deal with haemorrhage

31
Q

What is thromocythemia

A

High platelet count

32
Q

Why when a patient initially starts ion their warfarin treatment do they also require heparin

A

This is because initially when a patient begins on warfarin they are going to be at increased risk of coagulation (hypercoaguability) due to the inhibition of protein c and S.

33
Q

What does warfarin inhibit

A

It inhibits the production of vitamin K clotting factors 2,7,9,10

34
Q

How do NOACs work

A

They prevent the effect of factorXa

35
Q

What is the only NOAC that needs to be taken twice a day and why

A

Apixiban

Because it has a shorter Half life

36
Q

Name two types of drugs that should be omitted during warfarin treatment

A

Antifungals
NSAIDS

37
Q

What vitamin k clotting factors does warfarin inhibit?

A

2,7,9 and 10

38
Q

If a patient has just started their warfarin treatment but you require them to be immediately anticoagulated what can you give them?

A

low molecular weight heparin

39
Q

If a patient has had a reccurent DVT/embolism what is thier target iNR?

A

3.5

40
Q

if a patient has DVT/pulmarory embolism/AF/mitral stenosis/MI/ heart valve, what is thier target iNR

A

2.5

41
Q

what is a hemarthosis and what condition is it usually associated with?

A

Bleeding into the joint space and it is usually assocated with haemophilia

42
Q

Why do we want to reduce the amount of times a patient is exposed to factor replacment therapy?

A

even though it is screeened there is a risk of blood borne infections from the plasma derived factor.
risk of local site infection
risk of inhibitors/antibodies developing

43
Q

what does dabigatran do?

A

it is a reversible inhibitor of free thrombin, fibrin bound thrombin and thrombin induced platelet aggregation

44
Q

What do apixiban, rivoxaban and edoxaban do?

A

they are reverisble inhibitors of factorXa which prevents thrombin generation and thrombus development.

Special Care Dentistry BDS3 (4 decks)

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