Haematology/ Coagulation Tutorial

Question 1

What is the soft tissue diagnosis for the white patch on Mr Fraser’s palate?

Answer 1

pseudomembranous candidosis

Question 2

Briefly explain Mr Fraser’s three main medical conditions

Answer 2

Atrial Fibrillation: Irregular heart rhythm that increases stroke risk
Diabetes Type II: Metabolic disorder with high blood sugar levels (HbA1c = 9%)
Hypertension: Chronic high blood pressure condition

Question 3

What are the oral health implications of Mr Fraser’s medications?

Answer 3

Warfarin/Apixaban: Anticoagulants requiring special bleeding risk management
Simvastatin: Cholesterol-lowering drug (no direct oral implications)
Furosemide: Loop iuretic that can cause dry mouth
Carvedilol: Blood pressure medication
Diabetes medications (Metformin, Sulfonylurea, Dapagliflozin): May impact wound healing

Question 4

Why does diabetes affect healing?

Answer 4

microvascular disease causing poor circulation and therefore poor perfusion

Question 5

What are the key stages in Mr Fraser’s treatment plan?

Answer 5

Acute: Address immediate concerns (soft tissue infection, sensitive teeth)
Prevention: Improve oral hygiene, control caries
Stabilisation: Manage existing dental issues
Restorative: Repair and replace defective restorations
Maintenance: Regular follow-up and ongoing care

Question 6

What does an INR of 4 indicate?

Answer 6

Significantly elevated anticoagulation level, increasing bleeding risk and requiring careful dental management

Question 7

How should dental treatment be managed for a patient with Haemophilia A?

Answer 7

Consult with haematology team
Assess Factor VIII levels
Plan treatment with minimal invasiveness
Potential pre-treatment factor replacement
Close monitoring for bleeding risks

Question 8

How is bleeding risk assessed in patients with inherited bleeding disorders?

Answer 8

Use Dental Bleeding Risk Assessment and Treatment Tool (DeBRATT)
Consider:

Type of procedure
Severity of haemophilia
Patient’s current factor levels
Potential need for factor replacement

Question 9

What are the treatment plan stages for a patient with Haemophilia A?

Answer 9

Short-term:

Manage acute dental infection
Minimal invasive interventions
Coordinate with haematology team

Mid-term:

Comprehensive oral rehabilitation
Gradual restoration of dental health
Ongoing bleeding risk management

Long-term:

Regular dental maintenance
Preventive care
Continuous monitoring and coordination with haematology specialists