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For More Info see & Pathex4Bleedingdisorders (by robbypowell)

Bleeding Disorders

Question Answer
Blood disorders are especially important because the ______ and ______ of blood affect every systemQuantity & Quality
T/F: Most Hematopoietic system disorders manifest in the Head and Neck and affect dental patient managementTrue
Roughly ___-___% of patients will have some form of bleeding problem5-10%
_____ bleeding is often the first sign of a bleeding disorderGingival
Bleeding disorders can be split into 3 categories: _____ deficiencies, ______ abnormalities, and _____ ______ deficienciesPlatelet; Vascular; & Clotting Factor
Thrombocytes (platelets) are made by ________ in bone marrowMegakaryocytes (those jellyfish looking mofo's)
What is the life span of a thrombocyte? What cells remove them from circulation?1 wk; Splenic Macrophages
Some meds, such as _______, affect platelets for the entirety of their lifespan and effects on bleeding will not resolve until that generation of platelets senesces and are removed from circulationAspirin
______ initiate repair of damaged endothelial lining in blood vessels by acting as temporary plugsPlatelets ((thrombocytes)
When blood vessel injury occurs, _____ ____ factors attach to the area of injury (usually exposed collagen) and act as a signal for platelet adhesionVon Wildebrand Factors
Immediate vasoconstriction is a _____-genic effectNeurogenic
"Temporary phase" of hemostatic plug is comprised of what two steps?Platelet Adhesion (via vWF) and Platelet Activation
The ______ cascade is responsible for turning a temporary plug into a fibrin-ized clotCoagulation Cascade
What is the normal range of platelets ___-___k/mL150k-450k/mL (normal)
Excessive bleeding from surgery/trauma is seen when platelet levels are between ___k-___k/mL; Spontaneous bleeding at <___k/mL; and Intracranial bleeds at <____k/mL20-50k/mL (excessive bleeding); <20k (spontaneous); <10k (intracranial)
t/f: the vast majority of thrombocytopenia cases are hereditary in originFalse (acquired or iatrogenic)
t/f: the vast majority of thrombocytopenia cases are acquired or iatrogenic in originTrue
Bleeding from skin (petechiae, purpura, ecchymoses), Mucous membranes of gingiva, GI and Hematuria are signs of what type of bleeding disorder?Thrombocytopenia
How do low platelets affect the coagulation profile?Prolonged Bleeding Time
_____ deficiency leads to ______ anemia and the formation of megakaryocytes is affected b/c of defective DNA synthesisB12 deficiency (needed for proper DNA synthesis); Megaloblastic Anemia
Alcohol, _______, & Cytotoxic drugs can cause drug induced thrombocytopeniaThiazides (class of diuretics for HTN)
Patients with Thrombocytopenia of an unknown cause are likely to have ________ induced thrombocytopeniaDrug-induced
______ infections can cause thrombocytopenia (bacterial, fungal, or viral)Viral
Taking ______ at 1000mg prolongs BT significantly and IRREVERSIBLY for 10 days; _____ effects last only 1-2 days except for ______ which also has an effect for 10 daysAspirin; NSAID's; Ibuprofen
End stage _____ disease or _____ disease can cause thrombocytopathies (2 organs)Kidney & Liver
t/f: Alcoholism can affect platelet formation leading to thrombocytopathyTrue (liver not functioning properly, affecting bone marrow)
Clinical Signs of Bleeding: _____ & _____ are similar, with the former <5 mm & the latter being > 5 mmPetechiae & Purpura
Clinical Signs of Bleeding: ________ is discoloration of the skin resulting from bleeding underneath due to bruisingEcchymosis
Clinical Signs of Bleeding: ________ is solid swelling of blood within tissuesHematoma (can be clotted)
Clinical Signs of Bleeding: ________ bleeding into joint spaces, commonly seen with hemophiliaHemarthrosis
Platelet Count & Bleeding Time abnormalities would indicate a problem with ______ or _____, while PT or PTT abnormalities would indicate _____ _____Platelets & Vasculature; Clotting Factors
A standard blood test captures ______ & _____ countCBC (Complete Blood Count) & Platelet count
You should order PT/PTT/specific factor assays only when you suspect some sort of ______ disorderCoagulation
INR (international normalized ratio) is normalized ____ scoresPT
The "ideal" INR range is < ___ and should be taken within 48 hours before procedure<3.0 (or 3.5)
Patients on chronic ______ use will develop vascular disorder caused bleeding signsSteroid (loss of CT support --> fragile blood vessels)
This congenital vascular disease causes tortuous, thin-walled, & dilated BV's that easily bleed, are susceptible to trauma and bacteremia (predisposed to brain abscesses due to bacteremia risk)Hereditary Hemorrhagic Telangiectasia (aka Osler-Weber-Rendu syndrome)
The Liver produces most coagulation factors EXCEPT FOR ______vFW (von Wildebrand Factor)
_____% of liver disease patients have at least one hemostatic abnormality; ___% have clinical bleeding signs85%; 15%
T/F: Liver disease can affect bleeding by either decreasing ability to clot OR increasing clottingTrue
____ disease is the main reason for acquired clotting factor diseaseLiver
What is the most common hereditary hemophilia?von Wildebrand's Disease (often discovered for the first time during a procedure, such as dental)(often subclinical)
most cases of VWD (von wildebrand's disease) is autosomal ________dominant
List 4 common signs of VWDEcchymosis & hematoma (50%); Epistaxis (nose bleeds, 25-50%); gingival bleeding (33%); Hemarthrosis (joint bleeding, 8%)
Hemophilia A is due to a clotting factor _____ deficiency (or dysfunction) and is (autosomal/X-linked)_____ (dominant/recessive)CF8; X-linked Recessive (both hemophilias are x-linked recessive)
Hemophilia B is due to a clotting factor _____ deficiency (or dysfunction) and is (autosomal/X-linked)_____ (dominant/recessive)CF9; X-linked Recessive (both hemophilias are x-linked recessive)
Both Hemophilia A & B are (autosomal/X-linked)_____ (dominant/recessive), while VWD is (autosomal/X-linked)_____ (dominant/recessive)X-linked Recessive (hemophilias); Autosomal Dominant (vWD)
What is the best way to differentiate Hemophilia A from Hemophilia B clinically?trick question they are clinically indistinguishable
If PT or PTT is ____ that of normal, then you should do no oral surgery, perio surgery and extractions must be done in a hospital settingTwice Normal

normal values

Question Answer
platelets ___-___k/uL150k-450k/uL (normal)
RBC ___-___ million / uL3500k-6000k/uL
WBC's (leukocytes) ___-___k / uL4k-10k/uL

what condition from coagulation profile

Question Answer
low platelet count, prolonged bleeding timeThrombocytopenia
normal platelet count, defective platelets, prolonged BTThrombocytopathy
normal platelet count, normal platelets, normal OR prolonged BT with clinical bleeding signsVascular Disorder