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Bleeding Disorders Shalu Rai et al

Review: Medical Management UpdateReview: Medical Management Update
R
Review: Medical Management Updateeview: Medical Management Update

Bleeding Disorders

1
Shalu Rai , Mandeep Kaur 2
1
Professor & Head, Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Modinagar, U.P
2
Profesor, Oral Medicine and Radiology, Jamia Milia Dental College, New Delhi, India

(Received Nov 16, 2010 and Accepted April 19, 2011)

Abstract
Initial recognition of a bleeding disorder, which may indicate the presence of a systemic pathologic process, may occur in dental
practice. Oral physicians must be aware of the impact of bleeding disorders on the management of dental patients. The article is an
effort to review the management of common bleeding disorders along with their dental considerations.
Keywords: Bleeding disorders, management, oral health considerations

JOOS 2011; 3 (2):

Bleeding, also called as hemorrhage is the loss of blood or common coagulation pathway evaluated by activated
blood escape from the blood vessel. Bleeding can occur normal thromboplastin time (normal range is 15-35 sec)
internally, where blood leaks from blood vessels inside the Other tests are Thrombin time, Fibrin degradation
body or externally, either through a natural opening such as the products, Fibrinogen assay, Coagulation factor assays,
vagina, mouth, nose, ear or anus, or through a break in the skin. and Coagulation factor inhibitor assays. 1-5
Bleeding from oral cavity can be a result of trauma to the oral
cavity during any dental or surgical procedure, vessel wall MANAGEMENT:
disorders (like scurvy), congenital quantitative platelet Management of these disorders should result in
disorders (like Aldrich Wiskott syndrome), congenital correction of the reversible defects, prevention of
qualitative platelet disorders (like Bernard Soulier syndrome), hemmorrhagic episodes, prompt control of bleeding
acquired quantitative platelet disorders (like idiopathic when it occurs and management of sequele of the
thrombocytopenic purpura, thrombotic thrombocytopenic disease. Proper history along with dental and medical
purpura, leukemias, infections), acquired qualitative platelet evaluation of patients is necessary before treatment,
disorders (like liver diseases, chronic alcoholism), coagulation especially if an invasive dental procedure is planned.
disorders (like hemophilia, Disseminated intravascular Patient evaluation and history should begin with
coagulation, von Willibrand’s disease) and drugs like aspirin, standard medical questionnaires. Identifications of
Nsaids, chemotherapeutic agents, coumarin anticoagulants, medications with hemostatic effects like heparin,
trimethoprim, rifampin. 1,2 aspirin is important. Most reported bleeding episodes
are minor and do not require a visit to the dentist or
Clinical evaluation of the patient with coordinated history and the emergency department and do not affect dental
physical examination gives an idea whether the bleeding treatment significantly. 1
abnormality resides in vessels walls or platelets or is in the
process of coagulation. During physical examination one Platelet Disorders (TABLE 1)
should note any hepatomegaly, spleenomegaly, adenopathy. Thrombocytopenias are usually managed by platelet
The clinical features of bleeding disorders include bleeding transfusions, corticosteroids and splenectomy may be
from superficial cuts and scratches, delayed bleeding, necessary for chronic ITP. Plasma exchange therapy in
spontaneous gingival bleeding, petechiae, epistaxis, hematuria, combination with aspirin or corticosteroids can be
hemarthoses and excessive menstrual flow. 1-4 used for TTP. Bone marrow transplantation may be
Laboratory investigations for screening major defects of required for Wiskott Aldrich Syndrome. 1-4
hemostasis include platelet count (normal range:1,50,000-
4,50,000 per cu mm. <10,000- spontaneous clinical hemorrhage, Hemophilia A & B (TABLE 1)
<50,000- surgical hemorrhage), bleeding time (Normal range 1- Commercially prepared Fs VIII and IX complex
6minutes (modified Ivy’s Test), Extrinsic pathway of concentrates, DDAVP (Desmopressin acetate), FFP
coagulation phase by prothrombin time (normal 11-13 seconds), (freshly frozen plasma) and cryoprecipitate are used

Journal of Oral Sign 2011, Vol 3, No 2 (May-Aug)