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Haematology for Dental Students - Bleeding Disorders

Haematology for Dental Students - Bleeding Disorders

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Haematology for Dental Students - Bleeding Disorders

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  1. Pathology of Bleeding Disorders: Dr. Shashidhar Venkatesh Murthy A/Prof. & Head of Pathology

  2. Learning Outcomes: At the end of the session student will be able to,  Discuss normal hemostasis, how bleeding stops.  Discuss common bleeding disorders: 1. Common Blood Vessel disorders. 2. Common Platelet disorders. 3. Common Coagulation disorders. 4. Hypercoagulability/Thrombophilia disorders.  Discuss Pathology of each: • Clinical features, Pathogenesis & Laboratory diagnosis. Top Disorders: • Thrombocytopenia, ITP. • Vit-K deficiency. • Heparin, Warfarin, Aspirin • Cong: Haemophilia, VWD Less  More

  3. Bleeding Disorders - Clinical

  4. Normal Hemostasis Components: 1. BV – Vasoconstriction 2. Platelet plug formation 3. Activation of Coagulation – stable fibrin plug. 4. Activation of fibrinolysis – clot dissolution. Injury BV spasm Plt. plug. Fibrinolysis Coagulation

  5. Haemostasis overview: Injury BV Injury BV spasm PLt. Act. Plasma Platelets Blood Vessel Coag. Disorders of Coagulation Cascade Coagulation Platelet Aggregation Blood Vessel Constriction Blood vessel Platelets Primary hemostatic plug Reduced Blood flow Platelet Activation Fibrin formation* Disorders Disorders Fibrinolysis Fibrinolysis Stable Fibrin Plug Anticoagulants Thrombophilia

  6. LAB TEST: PT ~10 sec. Prothrombin Time. Factor 7 LAB TEST: aPTT ~20 sec. Activated Partial Thromboplastin Time. Factor 12, 9, 8 Bl. Clot

  7. What actions are most excellent? To gladden the heart of a human being, to feed the hungry, to help the afflicted to lighten the sorrow of the sorrowful and to remove the wrongs of injured...” - Dr. APJ Abdul Kalam. This is the reason medical profession is considered special…!

  8. Clinical bleeding symptoms:  Petechiae  Purpura  Echymosis  Hematoma Blood Vessel / Platelet disorder <3mm <1 cm >1cm Key Words: • Hemostasis • Primary plug • Sec. / stable plug • Blood clot. • Plt. Aggregation. • Plt. Adhesion • Plt. Activation • Coagulation • Thrombosis • Thrombolysis • Thrombophilia Trauma / Coagulation 

  9. Superficial Platelet / BV / Deep Bleeding Coagulation A. Superficial & small  Platelet & BV disorder B. Deep & Big  Coagulation disorder

  10. Good and Evil, happiness and misery, merit and sin depend on our actions. As is the action so is the result. It is easy & fun to indulge in sinful deeds but it is extremely painful to bear the bad results they yield. Karma – You reap what You sow.. . — Sai Baba

  11. Bleeding Disorders: Classification Coagulation Cascade Platelet Aggregation Blood Vessel Constriction Blood Vessel Disorders: Hereditary • H.H.telangiectasia • Marfans sy. Acquired • Simple easy bruising • Aging,Scurvy, • Drugs - steroids • Viral infections. Platelet Disorders: Function disorder • Drugs – Aspirin • Kidney failure: uremia. Thrombocytopenia: • Immune - ITP • Drugs, viral Infection • Aplastic anemia. • Chemotherapy. Coagulation Disorders: Hereditary: • Haemophilia A, B • Von Willebrand’s Acquired: • Liver disease. • Drugs - Heparin. • Inhibitors – immune. • Blood Transfusion DIC – Disseminated Intravascular Coagulation  All factor deficiency – Septicemia

  12. “Thinking” should become your capital asset, no matter whatever ups and downs you come across in your life.” - Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.

  13. Disorders of Haemostasis: Blood vessel & Platelet disorders Shashidhar Venkatesh Murthy B.Sc, MBBS, MD(path), GCTT, MBA(Edu), IFCAP(USA) A/Prof. & Head of Pathology

  14. Dengue – Hemorrhagic fever BV & Plt Purpura in viral infections: Direct vascular damage, immune vasculitis leading to platelet activation & Coagulation.

  15. Thrombocytopenia: Commonest bleeding. Immune, Bone marrow dis, drugs, infections, Spleen Spleen Bone Marrow Circulation Coag.

  16. ITP: Immune Thrombocytopenic Purpura.  Autoimmune disorder.  IgG Ab against plt. Mem. glycoproteins. • Destroyed in Spleen. Thrombocytopenia, giant plts. • Insidius onset, Petechiae, purpura, easy bruising.  Acute & Chronic types. • Acute (children, post infections) • Chronic (females, 20-40y, Autoimmune)  Platelet counts & bone marrow examination. • BM: Increased Immature megakaryocytes. • Blood: Thrombocytopenia with giant platelets. • Other hemostasis tests normal. Acute ITP: Petechiae Chronic ITP: Female 28y.

  17. Vit-K Deficiency:  Green Veg & Intestinal bacteria.  Deficiency of 2,7,9 & 10, C & S.  Diet, Drugs & Liver Disease  Warfarin *  Lab:  PT. Normal PTT (F7) Factors: 2,7,9,10 Warfarin

  18. Von Willebrand Disease:   Plt & F VIII • Commonest Cong. Bl. Disorder. • Autosomal recessive (M:F) • Deficiency of vWF & F VIII* • Both Plt & Coag. Disorder. • Type-1 85%, Quantitative, mild. • Type 2 – Qualitative, rare. • Type 3 – total absence, rare. • Easy bruising & muco-cutaneous bleeding. Petechiae, Purpura. • Lab Diagnosis: • Prolonged bleeding time & normal coagulation time (mild F8 def.). • Normal platelet count.

  19. Haemophilia-A Mod 1-5%  X linked. Xq 2.8, Factor VIII def.  Males affected, Female carrier.  Factor level of >30% normal.  Factor level <1%, 1-5%, >5% mild  Wound bleeding & Hematoma.  aPTT prolonged PT normal, FVIII assay. Treat: FVIII.  Haemophilia B: similar, F IX def. Mild >5% Chronic deformity Severe <1%

  20. DIC: Disseminated Intravascular Coagulation.  Excess whole body activation of hemostasis  Consumption of factors  Bleeding.  Cause / Etiology: (infection, trauma, cancer) • Tissue factor release into circulation - trauma • Or Widespread endothelial damage - infection  Morphology / Clinical features: • Thrombosis, Severe bleeding, shock, renal failure.  Laboratory Diagnosis: • All tests abnormal*

  21. “To educate a person in the mind but not in morals is to educate a menace to society.” -Theodore Roosevelt

  22. Anticoagulants & Hypercoagulability Disorders.

  23. Warfarin Warfarin Heparin Bl. Clot

  24. Arterial thrombosis Thromboembolism Venous thrombosis Abortions. • • • • Thrombophilic disorders:  Hereditary: • Factor V Leiden (resistant to breakdown) • Protein C or S deficiency (anticoag.). • Prothrombin Gene mutation (hyperact.)  Acquired: • CVS disorders – MI, DM, HPTN. • Major trauma or inflammation or malignancy – procoagulants. • Drugs - Oestrogen therapy. • Hyperhomocyteinaemia (rarely hereditary) • Antiphospholipid syndrome. • Lupus anticoagulant & Anti cardiolipin Ab.

  25. “Intelligence plus character, that is the goal of true education” - Martin Luther King Jr.

  26. Students today enticed by modernity, have become oblivious to their identity & purpose in life.

  27. “In order to succeed, your desire for success should be greater than your fear of failure.” - Bill Cosby

  28. “To educate a person in the mind but not in morals is to educate a menace to society.” -Theodore Roosevelt

  29. What you admire in others will develop in yourself. Therefore, to love the ordinary in any one is to become ordinary, while to love the noble and the lofty in all is to grow into the likeness of that which is noble and lofty. — Christian Larson

  30. Why only PT abnormal in Vit-K def? Vit-K  Liver  Coag. Factors 2,7,9,10 – both PT & aPTT should raise…? Ans: Shortest half life…!  Why no effect?

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