47
Bleeding Disorders
Introduction
Patients with bleeding disorders are at an increased risk from certain dental procedures. The principles of safe dental management of these patients are:
- accurate diagnosis from appropriate history, examination and special tests (Table 47.1);
- intensive prevention and regular review;
- careful preoperative planning and communication;
- use of appropriate local measures;
- careful prescribing;
- appropriate post-operative care.
Table 47.1 Special investigations for children with suspected bleeding disorders.
| Full blood count | Will identify thrombocytopenia and anaemia which could have been induced through haemorrhage |
| Clotting screen | Required in all cases |
| Prothrombin time | Measures effectiveness of extrinsic pathway factors I, II, V, VII, IX, X Increased in warfarin or heparin therapy |
| INR | Patient’s thrombin time divided by normal thrombin time (normal=1) |
| Required for all children on warfarin who require invasive dental treatment | |
| Activated partial thromboplastin time (APTT) | Is increased in the haemophilias, von Willebrand’s disease and deficiency of factors XI and XII |
| Thrombin time | Increased in parenchymal liver disease |
| Group and save | If possibility of prolonged haemorrhage is anticipated blood sample can be grouped facilitating requests for blood or blood products at short notice |
| Cross match | If severe haemorrhage is expected a number of units can be cross matched |
Inherited Coagulation Defects
Haemophilia A
Haemophilia A is an X-linked recessive deficiency in factor VIII, whose prevalence is around 1 in 20 000. The degree of severity is varied:
Stay updated, free dental videos. Join our Telegram channel
VIDEdental - Online dental courses
