2. • Dental procedures
resulting in bleeding can
have serious
consequences in a pt.
having bleeding
disorder……… severe
hemorrhage or even
death.

8. • 2 theories:::
( MARKOWITZ----
1903)
(1964)-the
coagulation mechanism results in a final
explosive change of a liquid to a gel.

12. fibrinolysis
(tPA)
PLASMINOGEN PLASMIN.
[FDPs]

13. Factor XII Factor XIIa tPA
+ high Mol.wt
kininogen
parakallikren kallikren
FV F VIII
plasminogen plasmin
fibrin
FDPs

14. tPA:
Used in thromboembolic
disoders asso with Myocardial
infarction.(effective within 1st
6 hrs postinfarction.
Fibrinolytic system activation
turned off
α
by…… 2antiplasmin/ by
plasminogen activator
inhibitors
( PAI-1,PAI-2)

17. CLINICAL LABORATARY TESTS
• Help to
Platelet count
Bleeding time
PFA-100 CT
PT/INR
aPTT
TT
FDPs
Factor assays
Tests of capillary fragility

18. PLATELET COUNT:
• Normal-150,000 to 450,000/mm3
• If < 50,000/mm3
Hemorrhagic
stroke
Surgical/traumatic
hemorrhage
etc. may occur.
• In such cases platelet transfusion may be
necessary.

19. TESTS OF PLATELET FUNCTION:
ADV
Dis ADV

20. INR Intro.by WHO(1983):itz
the ratio of PT that adjusts for
the sensitivity of the
thromboplastin reagants,such
that normal coagulation
profile is reported as an INR
of 1.0

22. USES of PT/INR:

26. • Measured using a specific latex
agglutination system.
Evaluates the presence
of a D-dimer of
fibrinogen / fibrin above
normal levels.

32. CUSHING’S syndrome:
Resulting from excessive corticosteroid
Intake / production.
Patient shows skin bleeding & easy bruising.

33. syndrome:
• Autosomal dominant disorder:
• Fragile skin vessels & easy bruising.

34. • HHT
• Abnormal telangiectatic capillaries.
• Frequent episodes of nasal & GI bleeding.
• Telangiectases common on lips, tongue &
palate.

35. :
• Cryotherapy.
• Laser ablation.
• Electrocoagulation.
• Blood replacement & iron therapy.

36. Thrombocytopaenia Quantity of platelets when
reduced by *
*
*
TREATMENT
Thrombocytopathies Qualitative

39. Corticosteroids
Splenectomy
Rituximab
Anti-D
Thrombopoietin like agents.

40. TTP:
• CAUSES:metastaticmalignancy,pregnancy,m
itomycin & high dose chemotherapy.
• SYMPTOMS:
Thrombocytopaenia
Microangiopathic hemolytic
anemia
Renal dysfunction
Occasional fever
Fluctuating neurologic
abnormalities.

41. • Platelet count may also decreased by
medications.
• ASPIRIN

42. • ASPIRIN :
• USES----
ANTIPLATELET THERAPY
FOR THROMBOEMBOLIC
PROTECTION.
• INEXPENSIVE & EFFECTIVE

47. • No racial
• AGE 6
• SIGNS H
H H GI
B h
s bleeding.
H

50. DISADV
Viral transmission
Large volume
needed.

51. F VIII CONCENTRATES:
• 1U= Amount present in 1ml fresh normal
plasma.
• High purity F VIII products mfg. by
recombinant & monoclonal antibody
purification tech. VIRAL SAFETY

54. Highly purified recombinant &
monoclonal FIX conc.(mononine)
F IX complex conc.(prothrombin
complex conc.---PCC)
proplex-T,
Autoplex-T

55. Complications of factor
replacement therapy
Allergic reactions
Viral disease
transmission(hepatitis
B & C, CMV,HIV)
thromboembolic
disorder,
DIC,
Devpt.of antibodies
against factor concs.

60. •

62. • Fibrin stabilizing factor def &
Fibrinogen def.
• Very rare.
• Autosomal recessive traits.
• Rx -Factor replacement
therapy & FFP.

74. • TREATMENT:
heparin LMWH
activated protein C ,
Antithrombin III.

78. • Surveying the patient for current medication
use.
• History of heavy alcohol intake.
• Medical conditions – hepatitis/cirrhosis,renal
disease,hematologic
malignancy&thrombocytopenia predispose
patients to bleeding problems.