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What is anemia?
- Anemia is a condition when red blood cells and/or hemoglobin are insufficient.
- This will cause tissue hypoxia.
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There are three main causes of anemia?
- 1. Excessive blood loss (could be acute and chronic)
- 2. Red blood cell destruction (ie G-6-PD deficiency anemia, thalassemia, sickle cell anemia)
- 3. Deficient red blood cell production (iron, B12, folate)
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Iron deficiency anemia found in patient with (3)?
- 1. Insufficient iron intake/ absorption
- 2. Pregnant, breast feeding
- 3. Celiac disease
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Vitamin B12 deficiency anemia can be caused by autoimmune disease called?
Pernicious anemia which is the disease that body produces antibody against parietal cell in stomach that absorb vit B12
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How does G-6-PD deficiency condition lead to anemia?
G-6-PD is an enzyme used in producing an antioxidant called NADPH. Lacking in NADPH results in the breakdown of RBC when exposed to infection or certain drugs (oxidants)
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Thalassemia is an autosomal recessive disease caused by abnormal in ...
- ... the synthesis of globin peptide chain.
- This make RBC vulnerable to mechanical injury and then hemolysis.
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Potential problem in pt with thalassemia?
- Infection
- Delayed healing (caused by tissue hypoxia)
- Fracture of the bones (large bone marrow)
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Dental management to prevent complication in pt with thalassemia?
- Consult physician
- might need Hb or Hct before dental treatment
- risk of HIV or hepatitis infection from blood transfusion
- antibiotic prophylaxis for pt with splenectomy
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What are three contribution in hemostasis?
- 1. blood vessel
- 2. Platelet
- 3. Coagulation and fibrinolysis
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The first cause of bleeding disorder is pathology of blood vessel. Which medication has an effect on blood vessel?
Corticosteroid (ทำให้ blood vessel เปราะบาง)
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Which vitamin deficiency has an effect on blood vessel?
Vitamin C
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There are bleeding condition that relate to impared function of coagulpathy :
(2 are heriditary and the other2 are acquired)
- Hereditary:
- - Hemophelia
- - von Wilebrand’s disease
- Acquired:
- - medication eg heperin, coumadin
- - liver disease
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Which factors are deficient in pt with haemophilia A, B and C?
- Haemophilia A: factor VII (x-link recessive)
- Haemophiia B: factor IX (x-link recessive)
- Haemophilia C: factor XI (autosomal recessive)
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Which lab tests will be affected by hemophilia?
- Delayed PTT (intrinsic pathway)
- Delayed Clotting time (crude test) in severe hemophilia
Remember: TT, PT and Bleeding time wont be affected as they test the extrinsic pathway.
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What is the treatment for hemophilia?
- There is no treatment!
- Pt get deficient clotting factor regularly (depend on severity of disease)
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Von Willebrand’s disease is a bleeding disorder when vWF is insufucient. What are two function of vWF?
- 1. vWF bridge platelets to the site of vascular injury.
- 2. Carrier of factor VIII (increasing half-life of factor VIII)
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Which test will be affected by vWD?
- Delayed PTT
- Delayed Bleeding time
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Dental management for pt with hemophilia and vWD :
- Lab test
- admit and giving insufficient factors :
- - fresh frozen plasma
- - prothrombin complex concentrate (II, VII, IX, X)
- or DDAVP for vWD
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Which medications should be avoided in pt with hemophilia and vWD?
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What test should be done for pt having heparin injection?
Remember: low molecular weight heparin (eg Enoxaparin, Certaparin) wont affect the test and pt doesnt need to stop taking it for dental visit.
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Dental management for pt haveing heparin injection:
- Consult physician
- Lab test: PTT, cloting time
- giving Protamine sulfate 6hr before extraction or minor surgery (protamin sulfate destroy heparin effect)
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How does Coumadin (Warfarin, Dicumarol) work?
They are vit K antagonist which obstruct the production of clotting factors in liver (ie factor II, VII, IX, X)
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Dental management for pt taking Warfarin, Coumadin or Dicumarol:
- Consult physician about off Warfarin for 3 days (or do heparin bridging)
- Lab test: PT or INR (surgery; INR ≤3.0)
- May need Vit K supplement
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What is the main function of aspirin and clipidogrel?
Antiplatelet
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When pt have delayed bleeding time and PTT, how many days should they stop taking aspirin and clopidogrel?
- Aspirin: at least 5 days
- Clopidogrel 7-9 days
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