# PT: same as INR, used for extrinsic factors and
warfarin
# PTT: used for intrinsic factors and heparin
# Haemophilia A:
- Most common blood coagulation hereditary
condition
- Sex linked so males >females
- Disease is characterised by excessive bleeding
that starts after blood clot is formed
- Deficiency of factor VIII
- Most cases are severe
- Lab test will show: low VIII levels, normal PT,
prolonged PTT, normal bleeding time.
- Treated by: fresh frozen factor, dried factor
VIII, Desmopressin, Tranexemic acid.
# Haemophilia B:
- Chirstmas disease
- Factor IX
- Trated by replacing IX factor
- Prolonged PTT and low IX
# Haemophilia C:
- Rare
- Deficiency of facto XI
- Fresh frozen plasma treatment
# Dental management of haemophilia:
- Preventive dentistry
- Caution with endo
- Avoid ID block and IM injections
- Involve a hospital setting in surgeries
# von Willbrand disease:
- Pseudohaemphilia
- Most common inherited bleeding disorder
- V.W factor deficiency
- Males = females
- Decreased factor VIII and vWF, normal PT,
prolonged PTT, prolonged Bleeding time
- Type 1 can be controlled by desmopressin
spray
- Type II and III needs replacement therapy
# Notes:
- Vitamin K is important for the synthesis of
factor (X, IX, VII and II)
# warfarin patients:
- Vitamin K antagonist
- Effect start after 8-12 hours
- Maximal at 36 hours
- Lasts for 72 hours
- Prolonged INR
- INR should be measured within 24 hours and
should not exceed 2.5 for surgical procedures
- Post op. bleeding is controlled by local
measures, antifibrinolytics, fresh frozen
plasma, vitamin K if a haematologist decides
so.
- Can interact with prolonger antibiotic therapy,
Ritovavir, Miconazole, Aspirin
# Heparin patients:
- Immediate action
- Lasts for 4-6 hours
- Test using APTT
- If more that 5 days use monitor for
thrombocytopenia
- If dialysis patient on heparin treat patient
one day after procedure.
- Protamine sulphate IV is the antidote
# Antiplatelet disorders:
- Superficial effect
- Aspirin most common acquired cause
- vWF disease included
- if ID block 25*10^9 platelet count
- If Minor OS 50*10^9 platelet count
- IF Major OS 75*10^9 platelet count
- Can be managed by local measures,
tranexamic acid and platelet transfusion (
within 6-24h)
# Aspirin patients:
- Irreversible effect
- For effective stop of aspirin effect it should be
stopped for about 10 days, this will cause to
put the patient at risk, so DO NOT STOP
ASPIRIN
# Clopidogrel patients:
- Don’t stop unless patient is on both aspirin
and Plavix, in this case we stop Plavix.
 # Anemia:

- Should test MCV, normal range is 79-100

- Microcytic: iron deficiency is the most
common cause. Thalassemia is another cause
- Normocytic: anemia of chronic disease
- Macrocytic: common cause is B12 or low
folate
- Sickle cell anemia: causes to lessen RBCs in
the blood, and vasculopathy
- Can be homozygous or heterozygous

# Thalassemia:

- Caused by abnormal rate of synthesis of

globin chains
- Has two types: alpha and beta
- Can lead to pallor and jaundice,
splenomegaly, and skeletal deformity
- Lab tests shows: low haemoglobin, microcytic
pattern, normal or elevated RBCs

Done by: Raneem Malkawi.