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Guidelines for patient with thrombocytopenia

Discussion in 'Dental' started by HuyetKiem, Aug 24, 2006.

  1. HuyetKiem

    HuyetKiem Senior Member
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    Hi folks!

    Is there any guideline out there we should know in treating dental patient with thrombocytopenia ?

    Any helpful link ?
     
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  2. capisce?

    capisce? ssc machine
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    Yes, there certainly are. You should consult hematology and find out the patient's platelet levels. If you haven't done so, there are two major dental procedures you need to avoid until you have consulted hem: extractions, and IAN blocks. Obviously you need to be cautious w/ extractions due to the inability to clot. As far as mand blocks, should you pierce any vessels on your way towards the IAN, if the patient has lowe platelets they may not clot properly. That blood can pool in the sublingual space, and eventually get to the point where it restricts the airway.

    Patients w/ thrombocytopenia many times will get ddAVP, which is intranasal desmopressin. This can increase plasma levels of von willebrand factor and also factor VIII. This is done prior to the ext to compensate for any inability to clot. More importantly, it covers your ass should any complications arise.

    As I stated in the beginning of my response, the main thing you need to do is consult their hematologist and follow their recommendations. They may take some platelet studies and will likely admin ddAVP prior to blocks and extractions.

    That, or you can be like a certain oral surgery program near us, who decided they knew more than the hemonc consult that was provided and went ahead with the extractions on the patient without the ddavp. They then decided to call us and whine when the patient wouldn't clot even though we had spent 20 mins doing the legwork for them which they simply chose to ignore :)
     
  3. scalpel2008

    scalpel2008 beep beep beep...smash
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    dude, you are confusing thrombocytopenia with von willebrand's disease. thrombocytopenia, by definition, is decreased number of platelets whether it's because of decreased production or increased destruction. Treatment = transfuse with platelets till patient has a platelet count of 50,000 for surgical procedures (some prefer 75,000-100,000 for elective surgery). von willebrand's disease(which affects platelet aggregation, not necessarily low number of platelets) warrants desmopressin.
     
  4. capisce?

    capisce? ssc machine
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    the hem md i consulted last week informed me that was the tx he wanted for a pt w/ thrombocytopenia and not vwb. in writing. not my call, just regurgitating. but thanks for the clarification, i'll make a note of it.
     
  5. scalpel2008

    scalpel2008 beep beep beep...smash
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    fair enough. my guess would be that the patient had adequate platelets to avoid a transfusion but low enough that they wanted to him to have some desmopressin to mobilize all his vwf to maximize aggregation (even w/o knowing the status of his vwf count).
     
  6. TucsonDDS

    TucsonDDS Senior Member
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    Plenty of patients with ITP haven't had platelet counts higher than 10k let alone 50K for years, transfusion or not. I took care of a patient who after 1g/kg of IVIG and 2 units of HLA platelets had a post platelet count of 3K. So they went ahead and did the Bone Marrow Aspirate anyways. We went through a lot of thrombin and surgicel after that one. Oh, and 4x4s.
    When patients need something to be done it needs to be done, just in an atmosphere with the equiptment neccessary for safe treatment.
     
  7. OP
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    HuyetKiem

    HuyetKiem Senior Member
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    Thanks for ya info.
     
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  8. OP
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    HuyetKiem

    HuyetKiem Senior Member
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    What is HLA platelet ? I'd worked at hospital's transfusion service dept and never heard about it.
     
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  9. TucsonDDS

    TucsonDDS Senior Member
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    I should have said HLA matched. HLA is Human Leukocyte Antigen, just another way of saying Major Histocompatability Complex. Most people will not need HLA matched platelets but people who have recieved a lot of transfusions will become refractory to further platelet transfusions. The HLA typing will help to prevent the hosts body from seeing them as foriegn and breaking them down. HLA typing is the same thing they do for organ transplantation.
     

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