47 Bleeding disorders


Bleeding Disorders


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:

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Jan 17, 2015 | Posted by in Pedodontics | Comments Off on 47 Bleeding disorders
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