Task 2. To assess hematomic hemorrhagia type.
Distinguishing signs for this hemorrhagia type are the following: deep, tensed, painful hemorrhagias in articular cavities, muscles, subcutaneous fat, in retroperitoneal space and other places. One can observe also spontaneous nasal, nephral, gastro-intestinal bleedings. Such hemorrhagias type may be at hemophily, at factor VIII or IX immune inhibitors occurrence in blood (the most often in women after labour and in pregnant women with immune diseases), at indirect anticoagulants overdosage and others.
Bleedings from oral cavity are in dentistry at hemophilia.
Typical coagulogram necessary for this hemorrhagia type determining must include following tests:
Norm:
1. Factor VIII 70-150%
2. Factor IX 70-150%
3. Prothrombin time 12-15 sec
4. Thrombin time 15-18 sec
5. Fibrinogen 2-4 g/l
6. Fibrinogen degradation products 7,3±3,9 mg%
7. Ethanoletest negative
8. Prothamine-sulphatetest negative
9. Fibrinogen“B” negative
Task 3. To assess microcirculative (petekchio-spotted) haemorrhagia type
Distinguishing features are: capillary bleedings, petekchias on skin, painfulless ekchimoses, gingival, nasal bleedings, menometrorrhagias, bleedings at othorhinolaryngologic operations.
This bleeding type is observed at all forms of thrombocytopenias, platelets defects, fibrinogen hereditary deficiency, II, V and X coagulation factors genetic and acquired deficiency.
In dentistry any gingival bleedings may serve as suspicion to any of these states. Coagulogram in such a case must include such probes as:
Norm:
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1. Thrombocytes 180-400 x 109/l
2.Thrombocytic aggregation: spontaneous absent
on ADP present
on adrenaline present
3. Platelet adhesiveness 20-50%
4. Factor III activity -
5. Factor 4 activity -
6. Clot retraction 48-64%
7.Bleeding time 2-4 min
8. Prothrombin time 12-15 sec
9. Thrombin time 15-18 sec
10.Fibrinogen 2-4 g/l
Task 4. To assess mixed (microcirculative-haematomic) bleeding type
Distinguishing signs are the following: petekchio-spotted bleedings together with painful, tensed haematomas in subcutaneous and retroperitoneal fat, abdominal cavity, visceral organs. Described haemorrhagia type is observed at Willebrand’s disease, VII and XIII factors deficiency, at complex deficiency of prothrombine complex factors (II, V, VII, X) and of factor XI which is also delt with liver disorders or vitamin K intestinal absorbtion disturbances, for example, at mechanical jaundice.
Main sign in dental practice is bleeding from oral cavity, gingival bleedings.
Coagulogram must be the following:
Norm:
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I. For Willebrand’s disease exclusion:
1. Thrombocytes 180-400 x 109/l
2. Thrombocytic aggregation: spontaneous absent
on ADP present
on adrenaline present
3. Platelet adhesiveness 20-50%
4. Bleeding time 2-4 min
5. Willebrandt’s factor -
II. For II, V, VII, IX and X factors deficiency exclusion:
1. Prothrombin time 12-15 sec
III. For factor XIII (fibrinase) deficiency exclusion:
1. Fibrinase activity determining 70 sec (100%)
Task 5. To get acquainted to doctor tactics at vasculite-purpure and microangiomatose bleedings types
1. Vasculite-purpure type - is characterized by hemorrhagies caused by multiple local inflammatory processes in microvessels of skin, mucosa, inner organs (kidney, lungs, intestine), the most often of immune genesis. Such bleedings are observed at hemorrhagic vasculitis of Shenlein-Genoch’s, viral fevers. Localization – gingival, nasal, uterine, pulmonal, gastro-intestinal bleedings. Doctor’s tactics - to propose to laboratory to determine tests applied for DIC-syndrome diagnosis because this haemorrhagia type is a characteristic of DIC hemorrhagic phase and it is its expression.
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2. Microangiomatose type – is characterized by strong, long-termed, repeated bleedings from nose, oral cavity, kidney, lungs, gastro-intestinal tract. It is observed at hereditary teleangioectasia different variants. Doctor tactics – blood mustn’t been taken for analysis! It’s necessary to perform only endoscopic investigation because vessels are not bleeded out of teleangioectases and all haemostatic probes will be under norm!
5. Literature recommended:
1. Lecture course.
2. Mistchenko V.P., Tkachenko E.V. Methodical instructions for dental students (short lecture course).-Poltava, 2005.-P.43-44.
3. Mistchenko V.P., Tkachenko E.V. Methodical instructions for medical students (short lecture course).-Poltava, 2005.-P. 73-74.
4. Mistchenko V.P., Tkachenko E.V. Blood system Physiology //Methodical recommendations to practical classes for students of medical and dental departments.-Poltava, 2005.-20p.
5. Kapit W., Macey R.I., Meisami E. The Physiology Colouring Book: Harpers Collins Publishers, 1987.-P. 138.
6. Guyton – Ganong – Chatterjee. Concise Physiology /Ed. By Dr Raja Shahzad Gull: M.B.B.S., F.C.P.S., King Edward Medical College.-Lahore, 1998 (1st Edition).-P.198-202, 209-210.
7. Stuart Ira Fox. Human Physiology.-8th Ed.-McGrawHill, 2004.-P.374-375.
8. Seeley R.R., Stephens T.D., Tate P. Essentials of Anatomy and Physiology.-The 3rd Ed.-McGraw Hill, 1999.-P.294-295, 300-303.
6. Materials for self-control:
Control questions
1. Coagulational factors.
2. Coagulation mechanism.
3. Fibrin and fibrinogen degradation products and their role in hemostasis.
4. Oral cavity role in coagulational hemostasis support.
5. Positive paracoagulational probes at dental diseases.
LESSON 38
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