SPECIAL CARE bleeding disorders blood cancers MRONJ

Question 1

what are the 2 types of bleeding disorders?

Answer 1

platelet disorders
clotting disorders

Question 2

describe normal haemostasis?

Answer 2

blood vessel vasoconstriction
platelet plug
activation of coagulation - stable fibrin plug
activation of fibrinolysis - clot dissolution

Question 3

what are the 3 types of platelet disorders?

Answer 3

failed platelet production
excessive platelet destruction
abnormal platelet function

Question 4

what is thrombocytopenia?

Answer 4

low platelets

Question 5

what are causes of thrombocytopenia?

Answer 5

autoimmune
alcoholism
bone marrow disease
cancer
infection - HIV, EBV
cancer treatments
liver problems - cirrhosis and hepatitis
glanzmanns disease

Question 6

what is glanzmanns disease?

Answer 6

autosomal disease which affects platelet aggregation

Question 7

symptoms of Glanzmanns disease?

Answer 7

epistaxis
menorrhagia
gingival haemorrhage

Question 8

dental management of pt with platelet disorder?

Answer 8

liaise with haematology/ oncology
FBC prior to procedure
platelet levels above 50 for xLA
platelet levels above 70 for major surgery

Question 9

what is given to pt to increase platelet count?

Answer 9

steroids
eltrombopag
tranexamic acid
platelet transfusion

Question 10

what is tranexamic acid used for?

Answer 10

treat or prevent excessive blood loss

Question 11

what is the action of tranexamic acid?

Answer 11

antifibrinolytic action - stops clots breaking down

Question 12

name the common clotting disorders?

Answer 12

Von Willebrand’s disease
haemophillia A (factor viii)
haemophillia B (factor IX)

Question 13

what is von willebrand factor needed for?

Answer 13

it is a co-factor for normal platelet adhesion

also a carrier for factor VIII

Question 14

what are symptoms of VWD?

Answer 14

excessive bleeding from injury, surgery, dental xla
frequent nosebleeds
heavy periods
heavy bleeding during labour and delivery
blood in urine or stool
easy bruising or lumpy bruises

Question 15

what medications are available for VWD?

Answer 15

for dental procedure:
tranexamic acid (mouthwash or tablets)
desmopressin
factor VIII (only for severe cases)

Question 16

what is desmopressin (DDAVP)?

Answer 16

synthetic version of vasopressin
stimulates the release of VWF and increase in factor VIII levels

Question 17

how may desmopressin be delivered?

Answer 17

IV
IM
SC
Intranasal

Question 18

what does the severity of haemophillia depend on?

Answer 18

depends on level of clotting factor

Question 19

what are symptoms of haemophillia?

Answer 19

nosebleeds
prolonged bleeding from wounds
bleeding gyms
skin that bruises easy
pain and stiffness around joints
internal bleedingw

Question 20

what type of haemophillia is more common?

Answer 20

A

Question 21

Why must dental xla be planned for pts with severe haemophillia?

Answer 21

one of the most common life threatening bleeds
they will need prophylactic factor VIII

Question 22

what is haemostatic cover therapy required for, according to WFH guidelines?

Answer 22

xla
oral surgery
perio surgery
implant surgery
IDBs, lingual infils

Question 23

what must you do prior, during and after xla for a haemophillia pt?

Answer 23

liase with haemophillia centre to organise factor replacement therapy
use of buccal articaine
tranexamic acid mouthwash and/or tablets
topical haemostatic agents - pressure packs, sutures, oxidised cellulose

Question 24

what management is required for perio tx of haemophillia pts?

Answer 24

pre and post op tranexamic acid required

Question 25

what are the dental challenges of pts with bleeding disorders?

Answer 25

reluctance to brush teeth due to fear of bleeding reluctance to access regular dental care due to fear of haemorrhage poorer attendance increased rate of extractions

Question 26

what are challenges with haematological cover?

Answer 26

some pt develop inhibitors to replacement clotting factors so require more expensive drugs

Question 27

name drugs which affect bleeding?

Answer 27

anti-platelet drugs - aspirin, clopidogrel anti-coagulants - warfarin, heparin newer anti-coagulants - dabigatran, apixaban, rivaroxaban, edoxaban

Question 28

what are the types of blood cancer?

Answer 28

myeloma leukaemia lymphoma myelodysplasia

Question 29

what is multiple myeloma?

Answer 29

plasma cell neoplasm - production of abnormal serum immunoglobulins

Question 30

what is multiple myeloma sometimes related to?

Answer 30

radiotherapy or petroleum products

Question 31

how is myeloma diagnosed?

Answer 31

blood tests CT/MRI scan bone marrow biopsy

Question 32

what are the affects of myeloma?

Answer 32

bone pain renal failure anemia neurological lesions hyperviscosity syndrome - thick blood

Question 33

dental aspects of myeloma?

Answer 33

root resorption loose teeth mental anaesthesia pathological fractures rare cause of mandibular radiolucencies

Question 34

what are the tx for myeloma?

Answer 34

chemotherapy steroids bisphosphonates biological therapies

Question 35

what are the 4 types of leukaemia?

Answer 35

acute lymphoblastic leukaemia acute myeloid leukaemia chronic lymphocytic leukaemia chronic myeloid leukaemia

Question 36

who is acute lymphocytic leukaemia more common in?

Answer 36

children

Question 37

who is acute myeloid leukaemia more common in?

Answer 37

adults - poor prognosis

Question 38

who is chronic leukaemia more common in?

Answer 38

adults

Question 39

what are symptoms of chronic leukaemia that pts may present with?

Answer 39

splenomegaly lymph node enlargement

Question 40

what is treatment for leukaemia?

Answer 40

chemo radiation therapy stem cell transplant immunotherapy tyrosine kinase inhibitors

Question 41

what are dental aspects of leukaemia?

Answer 41

crowding out of normal blood cells by the leukaemic cells anaemia bleeding tendencies susceptibility to infections septicaemia from oral infections

Question 42

how may leukaemia present in the mouth?

Answer 42

mucosal pallor ulceration gingival swelling spontaneous bleeding

Question 43

what is lymphoma?

Answer 43

cancer of the lymph glands or other organs of the lymphatic system

Question 44

what are the types of lymphoma?

Answer 44

Hodgkin's lymphoma Non Hodgkin's lymphoma

Question 45

what are symptoms of lymphoma?

Answer 45

non tender swollen lymph nodes, fever, night sweats and unexplained weight loss

Question 46

how does Hodgkins lymphoma arise?

Answer 46

develops from B lymphocytes characterised by reed-sternberg cells

Question 47

how is hodgkins lymphoma treated?

Answer 47

aggressive chemotherapy and radiotherapy

Question 48

what does non-hodgkins lymphoma affect?

Answer 48

B lymphocytes or T lymphocytes

Question 49

name a monoclonal antibody therapy

Answer 49

rituximab

Question 50

what is myelodysplasia?

Answer 50

rare type of blood cancer - dont have enough healthy blood cells, bone marrow makes abnormal cells instead of healthy blood cells

Question 51

what are symptoms of myelodysplasia?

Answer 51

weakness, tiredness, breathlessness frequent infections bruising and easy bleeding, such as nose bleeds

Question 52

what are treatments for myelodysplasia?

Answer 52

GF injections blood transfusion antibiotics biologic therapies chemotherapy immunosuppressants stem cells (bone marrow) transplant

Question 53

what are the dental aspects of myelodysplasia?

Answer 53

risk of bleeding - platelets, clotting may need platelet transfusion may be on steroids, bisphosphonates MRONJ risk