Lab Values & Bleeding Disorders

Question 1

What is normal hemoglobin range?

Answer 1

12-18g/100mL

Question 2

What is normal hematocrit?

Answer 2

35-50%

Question 3

What is a normal RBC count?

Answer 3

4-6 million/mm3

Question 4

What is a normal WBC count for an infant?

Answer 4

8,000-15,000/mm3

Question 5

What is a normal WBC count for a 4-7 year old?

Answer 5

6,000-15,000/mm3

Question 6

What is a normal WBC count for an 8-18 year old?

Answer 6

4,500-13,500/mm3

Question 7

What is a normal ANC?

Answer 7

> 1500/uL

Question 8

What defines neutrophilia?

Answer 8

ANC > 7,000/uL

Question 9

What defines neutropenia?

Answer 9

ANC < 1,000/uL

Question 10

At what ANC should elective dental care be deferred?

Answer 10

ANC < 1,000/uL

Question 11

At what ANC should antibiotic prophylaxis be provided before dental care?

Answer 11

ANC < 2,000/uL

Question 12

What is a normal platelet count?

Answer 12

150-450k/mL

Question 13

What test evaluates the extrinsic clotting cascade?

Answer 13

prothrombin time (PT)

Question 14

What test evaluates the intrinsic clotting cascade?

Answer 14

partial thromboplastin time (PTT)

Question 15

What is the MOA of anticoagulation of warfarin?

Answer 15

Inhibition of Vitamin K reductase involved in synthesis of factors II, VII, IX, X

Question 16

What is the MOA of anticoagulation of heparin?

Answer 16

Blocks inhibitory binding site on antithrombin III enzyme to keep it actively degrading thrombin

Question 17

What is the MOA of anticoagulation of eliquis?

Answer 17

Direct inhibitor of factor Xa

Question 18

What is the MOA of anti-platelet effects of aspirin?

Answer 18

Irreversible inhibition of COX-1, blocking thromboxane synthesis.

Question 19

What type of hemoglobin is seen in sickle cell disease?

Answer 19

Hemoglobin S

Question 20

What is the life span of sickle cell red blood cell?

Answer 20

10-20 days

Question 21

What is the 10/30/50 rule for elective dental surgery?

Answer 21

Hemoglobin = 10+
Hematocrit = 30% +
Platelet count = 50k +

Question 22

What medication are sickle cell patients often taking?

Answer 22

folic acid - helps in proliferation of new RBCs

Question 23

To what age do children with sickle cell disease take daily penicillin to prevent infection?

Answer 23

6 years

Question 24

What occurs in sickle cell crisis?

Answer 24

sickle RBCs block blood flow to bones and results in intense pain that can last hours - days

Question 25

What occurs in aplastic crisis?

Answer 25

a stop in the production of RBCs

Question 26

Why do you have to be aware of ischemia in sickle cell patients?

Answer 26

can cause tooth pain without the presence of dental caries

Question 27

T/F: nitrous oxide use is contraindicated in patients with sickle cell disease

Answer 27

False

Question 28

What test is prolonged by vitamin K deficiency?

Answer 28

PT (extrinsic pathway)

Question 29

What test is prolonged by hemophilia and von willebrands disease?

Answer 29

PTT (intrinsic pathway)

Question 30

Why can't patients with bleeding disorders take NSAIDs or aspirin?

Answer 30

they both inhibit COX which decreases platelet aggregation and causes bleeding

Question 31

What metabolizes NSAIDs?

Answer 31

kidney

Question 32

What metabolizes acetaminophen?

Answer 32

liver

Question 33

What occurs in von willebrands disease?

Answer 33

deficiency in von willebrand factor affecting platelet adhesion

Question 34

What factor is deficient in hemophilia A?

Answer 34

Factor VIII

Question 35

What factor is deficient in hemophilia B?

Answer 35

Factor IX

Question 36

What factor is deficient in hemophilia C?

Answer 36

Factor XI

Question 37

How is hemophilia inherited?

Answer 37

X-linked recessive

Question 38

What is considered mild hemophilia A?

Answer 38

5-25% factor activity

Question 39

What is considered moderate hemophilia A?

Answer 39

1-5% factor activity

Question 40

What is considered severe hemophilia A?

Answer 40

<1% factor activity

Question 41

What treatment is given to treat von willebrand?

Answer 41

humate P and desmopressin

Question 42

What treatment is given for Hemophilia A?

Answer 42

Desmopressin and/or recombianant factor VIII

Question 43

What treatment is given for hemophilia B?

Answer 43

Benefix

Question 44

How is recombinant factor provided to patients undergoing surgical procedures?

Answer 44

1 infusion gives 60-80% recovery for minor surgeries, repeated every 8-24 hours for major surguries

Question 45

What is Avitene?

Answer 45

topical agent that attracts platelets and triggers aggregation to produce fibrin

Question 46

What is the MOA of aminocaproic acid (Amicar) and Tranexamic acid (Cyclokapron)?

Answer 46

inhibit fibrinolysis mechanism by blocking the binding site of plasminogen

Question 47

What cannot be given to a hemophilia patient for pain control?

Answer 47

NSAIDs or Aspirin