Coagulation Disorders: A Comprehensive Overview for Medical Students, Slides of General Surgery

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COAGULATION DISORDERS

SUBMITTED BY :

Dr NIKITA JAIN

INTRODUCTION

Definition : Coagulation disorders are a group of diseases

caused due to deficiency of clotting factors leading to

defects in normal clotting process.

Normal Hemostatic Mechanism includes : a) Vascular

Spasm

b) Platelet

plug formation

c)

Coagulation

CLOTTING FACTORS

I –Fibrinogen

II – Prothrombin

III- Thromboplastin

IV - Ca++

V – Labile Factor

VI – Stable Factor

VIII – AHF

IX- Christmas Factor

X- Stuart Prower factor

XI – Hagman Factor

XII – Fibrin Stabilizing factor

HMWK – Fitzgerald Factor

COAGULATION DISORDERS

a)

a) Vitamin K Deficiency

b)Coagulation disorder in

liver disease

c) Deep Venous

Thrombosis

a) Hemophilia a) Von Willebrand’s Disease

CLASSIFICATION

HEREDITARY ACCQUIRED

SEX LINKED (^) AUTOSOMAL

HEMOPHILIA

• An X Linked Recessive genetic disorder of coagulation.

• It is also known as “Royal disease”

• It almost exclusively affects males while females are the

carriers.

• It is of two types : a) Hemophilia A

b) Hemophilia B

TRANSMISSION OF HEMOPHILIA

CLASSICAL HEMOPHILIA

CHRISTMAS DISEASE

• (^) Occurs due to deficiency of factor IX and is clinically

indistinguishable from Hemophilia A.

• (^) Clinical Features : i)Recurrent bleeding in joints

ii)Epistaxis

iii)Bleeding Gums

iv)Bleeding after tooth extraction.

MANAGEMENT OF HEMOPHILICS DURING

MINOR DENTAL PROCEDURES

Before Surgical Procedure

• Avoid Aspirin and its derivatives.
• (^) Screening for hepatitis B, C and HIV
• (^) If oral hygiene is poor ,give antibiotics and chlorhexidine mouth wash
• Anti –fibrinolytic agents(tranexamic acid, epsilon aminocaproic acids) are started a

day before surgery and continued for 7 days.

During Surgical Procedure

• (^) Endodontic therapy is preferred over extraction whenever possible.
• (^) Avoid high speed suction that can damage the oral mucosa.
• Careful use of saliva ejectors.
• (^) Protection of soft tissues during restorative treatment using a rubber dam or

Vaseline.

• (^) Post extraction bleeding managed with pressure and local hemostatic

measures(absorbable sulfates, fibrin glue, oxidized cellulose).

• (^) Local anaesthesia with vasoconstrictors provides additional local

hemostasis

• (^) Observe all patients for a prolonged period after a dental

extraction.

Post Operative Care

• (^) No mouth rinsing for 24 hours.
• No smoking for 24 hours.
• (^) Soft diet for 24 hours.
• (^) No strenuous activities for 24 hours.

TYPES

I)Type 1 : Partial quantitative deficiency of vWF ,

Most common form , Autosomal dominant,

Mucocutaneous bleeding, Prolonged bleeding time

, normal platelet

II)Type 2 : Qualitative alterations in the vWF

structure and function.

III)Type 3 : Complete absence of vWF in the plasma

or storage organelle, Autosomal Recessive.

IV)Acquired VWD : Tumors , Autoimmune diseases.

LAB FINDINGS

V)Increased bleeding time with normal platelet

count.

VI)Decreased vWF concentration in plasma

VII)Decreased factor VIIIactivity

TREATMENT

I)Administration of DDAVP

( synthetic Vasopressin )

shortens the bleeding time and

normalizes factor VIII and vWF

activities.

II)Cryoprecipitate infusion

replaces vWF and controls or

prevents bleeding.

III)In recent years , factor VIII a has

been found to control bleeding

effectively in coagulation

defects.

VITAMIN K DEFICIENCY

• Vitamin K serves as a co factor in the formation of 6 prothrombin complex

proteins (Vitamin K dependent coagulation factors ) synthesized in the liver

namely : Factor II, VII, IX , X ,Protein C and Protein S.

• Causes of Vitamin K Deficiency : a) Obstructive jaundice

b) Hemorrhagic states in infants

c) Inadequate dietary intake

d) Antibiotics

• (^) Symptoms in Adults : a) Easy bruising

b) Bleeding from gums and epistaxis

c) Excessive bleeding due to an injury or wound

d) Menorrhagia in females

COAGULATION DISORDER IN

LIVER DISEASE

• (^) Liver is the site of synthesis and metabolism of coagulation factors.
• (^) Liver disease leads to hypercoagulability and predispose to develop DIC.
• (^) Major causes of bleeding in liver disease :

I ) Morphologic lesions: Portal Hypertension ,

gastritis.

II) Hepatic dysfunction : Impaired hepatic synthesis

of coagulation factors, impaired absorption and metabolism of vitamin K

III) Complication of therapy : Massive transfusion

leading to platelet and clotting factors dilution , following heparin therapy

• LAB DIAGNOSIS : Prolonged PTT and PTTK , mild thrombocytopenia,

normal fibrinogen level.

DISSMENIATED INTRAVASCULAR

COAGULATION

• (^) Also called as “ Defibrinate Syndrome ” or “ Consumption Coagulopathy ”
• It is a complex thrombo-hemorrhagic disease occurring as a secondary

complication of some systemic disease.

• (^) Major Disorders associated with DIC :

a) Infections : gram –ve sepsis , malaria.

b) Neoplasms : carcinoma of pancreas, stomach , lungs

c) Massive Tissue Injury : burns, extensive surgery