Haematology Key Concepts
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Questions and Answers

What is the typical haemoglobin (Hb) range for a healthy adult female?

  • 130-180 g/l
  • 110-180 g/l (correct)
  • 90-110 g/l
  • 150-200 g/l

Which set of findings is most indicative of iron deficiency anaemia?

  • Hyperchromic, macrocytic red cells with high ferritin levels.
  • Normochromic, macrocytic red cells with high ferritin levels.
  • Normochromic, normocytic red cells with normal ferritin levels.
  • Hypochromic, microcytic red cells with low ferritin levels. (correct)

What does the term 'thrombocytopenia' refer to?

  • An insufficient number of platelets. (correct)
  • An excessive number of platelets.
  • An insufficient number of red blood cells.
  • An excessive number of white blood cells.

Which of these conditions is most likely to cause a normocytic anaemia?

<p>Chronic kidney disease. (A)</p> Signup and view all the answers

Where is vitamin B₁₂ primarily absorbed in the body?

<p>Terminal ileum. (D)</p> Signup and view all the answers

A patient presents with macrocytic anaemia and neurological symptoms. Which deficiency is most likely?

<p>Vitamin B₁₂. (A)</p> Signup and view all the answers

A patient with a history of partial gastrectomy presents with anaemia. What is the most probable cause of their condition?

<p>Decreased intrinsic factor production leading to B₁₂ malabsorption. (A)</p> Signup and view all the answers

A patient is suspected of having pernicious anaemia. Which of the following tests would be most useful in confirming this diagnosis?

<p>Intrinsic factor antibody test. (C)</p> Signup and view all the answers

Which of the following blood transfusion scenarios should generally be avoided?

<p>As a routine procedure, regardless of the patient's condition. (A)</p> Signup and view all the answers

A patient presents with a suspected bacterial infection. Which type of white blood cell count would you expect to be elevated?

<p>Neutrophils (B)</p> Signup and view all the answers

A patient's platelet count is reported as 40 x 10^9/l. What condition does this indicate?

<p>Thrombocytopenia (D)</p> Signup and view all the answers

Prior to a dental procedure, a patient is taking Warfarin. According to the guidelines, what is the maximum acceptable INR level for this patient, assuming local haemostatic measures are also used?

<p>4.0 or less (C)</p> Signup and view all the answers

Which of the following Direct Oral Anticoagulants (DOACs) acts as a direct thrombin inhibitor?

<p>Dabigatran (B)</p> Signup and view all the answers

A patient taking Rivaroxaban once daily in the morning is scheduled for a complex extraction. How should their DOAC dosage be managed in relation to the procedure?

<p>Delay the morning dose, administering it at least 4 hours post-haemostasis. (C)</p> Signup and view all the answers

What is the primary clinical significance of monitoring the APTT (Activated Partial Thromboplastin Time)?

<p>To monitor the effects of Heparin therapy. (D)</p> Signup and view all the answers

A 70-year-old female patient's Erythrocyte Sedimentation Rate (ESR) is reported as 40 mm/hr. Considering the age-dependent nature of ESR, how would you interpret this result?

<p>Slightly elevated, warranting further investigation (C)</p> Signup and view all the answers

What is the primary mechanism of action of Dabigatran?

<p>Direct thrombin inhibition (B)</p> Signup and view all the answers

According to the information, what is the 'universal donor' blood type for transfusions?

<p>O Rhesus negative (D)</p> Signup and view all the answers

A patient with a known platelet abnormality is scheduled for a dental extraction. Besides an atraumatic technique, which of the following is the MOST important immediate step in managing this patient?

<p>Close liaison with a Haemophilia Centre (D)</p> Signup and view all the answers

What is the upper limit of the target INR range for a patient on Warfarin undergoing a dental procedure, assuming local haemostatic measures are used?

<p>4.0 (D)</p> Signup and view all the answers

A patient taking Rivaroxaban once daily in the evening is scheduled for a higher risk procedure. Assuming haemostasis is achieved by midday, when should the next Rivaroxaban dose be administered?

<p>At the next usual scheduled evening time (D)</p> Signup and view all the answers

A 35-year-old male patient has an Erythrocyte Sedimentation Rate (ESR) of 20 mm/hr. Considering the age-dependent nature of ESR, how would you interpret this result?

<p>Normal for his age (A)</p> Signup and view all the answers

Which of the following scenarios would NOT typically lead to an increase in neutrophil count?

<p>Viral infection (D)</p> Signup and view all the answers

A 68-year-old patient presents to your dental clinic. Their medical history includes myelodysplasia, but is otherwise unremarkable. According to information provided, which of the following substances should be avoided due to its interactions with this condition?

<p>Alcohol (B)</p> Signup and view all the answers

Which of the following correctly matches a haematological term with its definition?

<p>Erythrocytosis: Increased red blood cell count (C)</p> Signup and view all the answers

A patient's FBC results show a Mean Corpuscular Volume (MCV) of 65 fl. Which type of anaemia is most likely indicated by this result?

<p>Microcytic (B)</p> Signup and view all the answers

A patient presents with fatigue, pallor, and complains of pica. Initial blood tests reveal a low haemoglobin level and reduced MCV. What should be the next investigation?

<p>Serum ferritin levels (B)</p> Signup and view all the answers

Which of the following conditions is LEAST likely to result in iron deficiency anaemia?

<p>Vitamin B12 deficiency (D)</p> Signup and view all the answers

Why do patients with a partial gastrectomy sometimes develop anaemia?

<p>Impaired production of intrinsic factor (C)</p> Signup and view all the answers

A patient is diagnosed with pernicious anaemia. Which of the following antibodies is most likely to be present in their serum?

<p>Anti-parietal cell antibodies (A)</p> Signup and view all the answers

Which of the following has the longest bodily store?

<p>Vitamin B12 (A)</p> Signup and view all the answers

A patient presents with macrocytic anaemia and peripheral neuropathy. Supplementation with which of the following may mask an underlying deficiency, potentially leading to irreversible neurological damage?

<p>Folate (A)</p> Signup and view all the answers

Which of the following is the correct definition of 'cytosis' in haematological terminology?

<p>An abnormal increase in the number of cells in the blood. (D)</p> Signup and view all the answers

A patient's blood film shows hypochromic, microcytic red blood cells. Assuming no other information, which type of anaemia is MOST likely?

<p>Iron deficiency anaemia (D)</p> Signup and view all the answers

A patient presents with fatigue and pallor. Their FBC reveals a normal MCV and haemoglobin level is slightly below normal (105 g/L). What is the MOST likely classification of their anaemia?

<p>Normocytic (D)</p> Signup and view all the answers

Following a gastrectomy, why is a patient at risk of developing anaemia?

<p>Impaired intrinsic factor production leading to B₁₂ malabsorption. (B)</p> Signup and view all the answers

Which of the following conditions is MOST likely to cause macrocytic anaemia?

<p>Folate deficiency. (A)</p> Signup and view all the answers

A patient with diagnosed pernicious anaemia is likely to have antibodies against which of the following?

<p>Parietal cells. (B)</p> Signup and view all the answers

Which of the following conditions is LEAST likely to be associated with iron deficiency anaemia in a pre-menopausal female?

<p>Vitamin B12 deficiency (A)</p> Signup and view all the answers

A patient presents with macrocytic anaemia and neurological symptoms. Supplementation with which of the following may mask an underlying deficiency, potentially leading to irreversible neurological damage?

<p>Folate (B)</p> Signup and view all the answers

Why is it important to use blood that is closely matched to the patient's own blood group during transfusions?

<p>To minimise the risk of transfusion reactions due to antigen-antibody incompatibility. (B)</p> Signup and view all the answers

A patient presents with a suspected viral infection. Which type of white blood cell count would you MOST likely expect to be elevated?

<p>Lymphocytes (A)</p> Signup and view all the answers

A patient with a known platelet abnormality is scheduled for a dental extraction. What additional pharmacological intervention might be considered alongside an atraumatic technique and local haemostatic measures?

<p>Oral tranexamic acid or tranexamic acid mouthwash (C)</p> Signup and view all the answers

What is the MOST critical consideration regarding INR (International Normalized Ratio) when managing dental patients on Warfarin?

<p>The INR needs to be 4 or less, alongside local haemostatic measures. (C)</p> Signup and view all the answers

For a patient taking Dabigatran twice daily who requires a higher risk dental procedure, what specific adjustment to their medication schedule is recommended?

<p>Instruct the patient to miss their morning dose and take the evening dose, provided it is more than 4 hours after haemostasis. (B)</p> Signup and view all the answers

How should the morning dose of Rivaroxaban be managed in relation to a higher risk dental procedure, if the patient takes it once daily in the morning?

<p>The morning dose should be delayed and given 4 hours post haemostasis. (C)</p> Signup and view all the answers

In the context of haematological considerations for dental patients, what does 'RSI' refer to under 'DOACs-Low Risk of bleeding'?

<p>Root Surface Instrumentation (B)</p> Signup and view all the answers

What is the underlying rationale for the age-dependent adjustments applied when interpreting a patient's Erythrocyte Sedimentation Rate (ESR)?

<p>The concentration of acute phase proteins, which influence ESR, tends to increase with age, even in the absence of pathology. (D)</p> Signup and view all the answers

Which of the following laboratory findings is MOST indicative of microcytic hypochromic anaemia?

<p>Decreased Hb, decreased MCV, and low ferritin. (B)</p> Signup and view all the answers

A patient presents with anaemia associated with rheumatoid arthritis. Which type of anaemia is MOST likely?

<p>Normocytic anaemia (C)</p> Signup and view all the answers

A patient is diagnosed with folate deficiency. Assuming no other underlying conditions, approximately how long would it take for a deficiency to develop if folate intake ceased completely?

<p>4 months (D)</p> Signup and view all the answers

Which of the following conditions is LEAST likely to be a cause of B₁₂ deficiency?

<p>Coeliac disease (B)</p> Signup and view all the answers

A patient presents with suspected pernicious anaemia. Which of the following antibody tests is MOST relevant to confirm this diagnosis?

<p>Intrinsic factor antibodies (C)</p> Signup and view all the answers

Which of the following is the MOST common cause of iron deficiency anaemia worldwide?

<p>Chronic blood loss (B)</p> Signup and view all the answers

A female patient presents with menorrhagia and is subsequently diagnosed with iron deficiency anaemia. What is the MOST appropriate initial management strategy?

<p>Oral iron supplementation (B)</p> Signup and view all the answers

A patient with a history of alcoholism is diagnosed with macrocytic anaemia. Which of the following is the MOST likely underlying cause?

<p>Folate deficiency (D)</p> Signup and view all the answers

A patient with a known history of myelodysplasia is scheduled for a dental procedure. Which substance should be used with caution, considering potential interactions?

<p>Aspirin (B)</p> Signup and view all the answers

What is the primary reason for ensuring blood used in transfusions is closely matched to the patient's own blood group?

<p>To minimize the risk of a transfusion reaction (B)</p> Signup and view all the answers

A patient presents with a suspected bacterial infection following a dental extraction. Which type of white blood cell would MOST likely be elevated in their complete blood count (CBC)?

<p>Neutrophils (C)</p> Signup and view all the answers

A patient taking Dabigatran twice daily is scheduled for a complex dental extraction requiring flap elevation. How should their Dabigatran dosage be managed in relation to the procedure, according to the guidelines?

<p>Omit the morning dose and administer the evening dose, providing it is &gt; 4 hours after haemostasis (D)</p> Signup and view all the answers

For a patient taking Rivaroxaban once daily in the morning, who is scheduled for a higher-risk dental procedure such as a surgical extraction, how should their medication be managed?

<p>Delay the morning dose, administering it 4 hours post haemostasis (A)</p> Signup and view all the answers

A patient taking Rivaroxaban once daily in the evening is scheduled for a higher risk dental procedure. Assuming haemostasis is achieved by midday, when should the next Rivaroxaban dose be administered?

<p>The dose should be taken at the usual time in the evening, so long as it is &gt; 4 hours post haemostasis (D)</p> Signup and view all the answers

Under what circumstances might blood transfusions be indicated for a patient, according to the guidelines?

<p>When haemoglobin is under 70 g/l or the patient is symptomatic (D)</p> Signup and view all the answers

When managing dental patients on Warfarin, what is the MOST critical consideration regarding INR (International Normalized Ratio)?

<p>Confirming that the INR is 4 or less, assuming local haemostatic measures are used (B)</p> Signup and view all the answers

A patient presents with microcytic hypochromic anaemia. Further investigation reveals low ferritin levels. Which of the following is the MOST likely underlying cause?

<p>Iron deficiency (B)</p> Signup and view all the answers

Which of the following is NOT a typical cause of iron deficiency anaemia?

<p>Increased red cell production due to haemolysis (A)</p> Signup and view all the answers

A patient is diagnosed with macrocytic anaemia. Which of the following deficiencies or conditions is MOST likely responsible?

<p>Folate deficiency (D)</p> Signup and view all the answers

Pernicious anaemia is characterised by a deficiency of which of the following?

<p>Intrinsic factor, leading to vitamin B₁₂ malabsorption (A)</p> Signup and view all the answers

A patient with suspected B₁₂ deficiency is undergoing diagnostic testing. Which of the following tests would be MOST appropriate to confirm pernicious anaemia as the cause?

<p>Intrinsic factor antibodies (B)</p> Signup and view all the answers

Which of the following factors contributes to the relatively long bodily store (2-6 years) associated with Vitamin B₁₂?

<p>Storage in the liver (D)</p> Signup and view all the answers

A patient presents with macrocytic anaemia and a history of chronic alcoholism. What is the MOST likely underlying cause of their anaemia?

<p>Folate deficiency (D)</p> Signup and view all the answers

A patient's FBC reveals a haemoglobin level of 90 g/l, MCV of 95 fl, and normal white cell and platelet counts. How would you classify this anaemia?

<p>Macrocytic anaemia (C)</p> Signup and view all the answers

A patient develops thrombocytopenia. At what platelet count (x 10^9/l) would this condition typically be diagnosed?

<p>50 (B)</p> Signup and view all the answers

When is a blood transfusion indicated, according to the information provided?

<p>When a patient's haemoglobin is at or below 70 g/l, or when they are symptomatic. (D)</p> Signup and view all the answers

What would an elevated neutrophil count likely indicate?

<p>A bacterial infection. (D)</p> Signup and view all the answers

Which of the following medications can interact negatively with myelodysplasia?

<p>Alcohol (D)</p> Signup and view all the answers

If a patient is taking Dabigatran twice daily and is scheduled for a higher-risk dental procedure such as flap raising, what specific adjustment to their medication schedule is recommended?

<p>Miss the morning dose and administer the evening dose no sooner than 4 hours post-haemostasis. (C)</p> Signup and view all the answers

A patient taking Rivaroxaban once a day in the morning is scheduled for a complex extraction. How should their Rivaroxaban dosage be managed in relation to the procedure?

<p>Delay the morning Rivaroxaban dose and administer it 4 hours post haemostasis. (D)</p> Signup and view all the answers

A patient taking Rivaroxaban once daily in the evening is scheduled for a higher risk dental procedure. Assuming haemostasis is satisfactory by midday, when should the next Rivaroxaban dose be administered?

<p>At the usual time in the evening- so long as it is &gt;4 hours post haemostasis (B)</p> Signup and view all the answers

According to the information, what blood type is considered the 'universal donor' for transfusions?

<p>O Rhesus negative. (C)</p> Signup and view all the answers

A patient presents with fatigue. A full blood count (FBC) reveals a haemoglobin level of 100 g/L and a Mean Corpuscular Volume (MCV) of 98 fl. Which type of anaemia is MOST likely?

<p>Macrocytic anaemia (D)</p> Signup and view all the answers

Which of the following is the LEAST likely cause of iron deficiency anaemia in an adult male?

<p>Menorrhagia (C)</p> Signup and view all the answers

A patient with a history of alcoholism presents with macrocytic anaemia. Which of the following is the MOST likely underlying cause?

<p>Folate deficiency (A)</p> Signup and view all the answers

Which condition is MOST likely associated with an elevated Erythrocyte Sedimentation Rate (ESR)?

<p>Anaemia of chronic disease (B)</p> Signup and view all the answers

A patient's FBC shows a decreased number of platelets. Which term correctly describes this?

<p>Thrombocytopenia (D)</p> Signup and view all the answers

Following a partial gastrectomy, which of the following deficiencies is the patient MOST at risk of developing?

<p>Vitamin B₁₂ deficiency only (A)</p> Signup and view all the answers

A patient is diagnosed with pernicious anaemia. This condition is characterised by antibodies against which of the following?

<p>Intrinsic factor (C)</p> Signup and view all the answers

A patient presents with macrocytic anaemia and neurological symptoms. Which is the most appropriate initial investigation to determine the underlying cause?

<p>Red cell folate and serum vitamin B12 levels (B)</p> Signup and view all the answers

A patient on Rivaroxaban, taken once daily in the evening, requires a complex extraction. Assuming haemostasis is achieved by 2 PM, when should their next dose be administered?

<p>Take the usual evening dose, provided it's at least 4 hours after haemostasis. (C)</p> Signup and view all the answers

Which of the following scenarios would MOST likely warrant a 'blood' transfusion?

<p>A patient with a haemoglobin level of 70 g/l who is symptomatic. (D)</p> Signup and view all the answers

A patient is taking Dabigatran twice daily and is scheduled for a gingival recontouring procedure. According to the SDCEP guidelines, how should their Dabigatran dosage be managed in relation to the procedure?

<p>Miss the morning dose and give the evening dose, provided it's &gt; 4 hours after haemostasis. (C)</p> Signup and view all the answers

A patient's blood test reveals an elevated eosinophil count. Which condition is MOST likely associated with this finding?

<p>Allergic disorder (A)</p> Signup and view all the answers

A 60-year-old female patient has an Erythrocyte Sedimentation Rate (ESR) of 40 mm/hr. How would you interpret this result, considering the age-dependent nature of ESR?

<p>Slightly above the normal range for her age. (B)</p> Signup and view all the answers

Under which of the following circumstances might platelet transfusions be considered?

<p>Rare functional platelet defects requiring intervention. (A)</p> Signup and view all the answers

A patient taking Rivaroxaban once a day in the morning is scheduled for a complex extraction. What adjustment to their medication is advised?

<p>Delay the morning dose and administer it 4 hours post haemostasis. (C)</p> Signup and view all the answers

Which of the following conditions is MOST likely to cause a decreased lymphocyte count?

<p>Steroid treatment. (C)</p> Signup and view all the answers

Why is it crucial to match blood to the patient's blood group before a transfusion?

<p>To prevent the recipient's antibodies from attacking the donor's red blood cells, leading to a transfusion reaction. (A)</p> Signup and view all the answers

A patient with a bacterial infection undergoes a blood test. Which type of white blood cell would MOST likely be elevated in their complete blood count (CBC)?

<p>Neutrophils (B)</p> Signup and view all the answers

How should Dabigatran dosage be managed for a patient taking it twice daily who is scheduled for a gingival recontouring procedure, according to the guidelines?

<p>Omit the morning dose and administer the evening dose, provided it is at least 4 hours after haemostasis. (B)</p> Signup and view all the answers

A patient presents with a suspected allergic reaction. Which type of white blood cell would you expect to see elevated on a full blood count?

<p>Eosinophils (B)</p> Signup and view all the answers

What laboratory findings are most indicative of iron deficiency anaemia according to the information provided?

<p>Low Hb, low MCV, and low ferritin levels. (B)</p> Signup and view all the answers

A patient's FBC reveals a platelet count of 100 x 10^9/l. According to the terminology described, how would you characterise this finding?

<p>Thrombocytopenia (C)</p> Signup and view all the answers

Which type of anaemia is most likely associated with chronic kidney disease, based on the information?

<p>Normocytic anaemia (A)</p> Signup and view all the answers

A patient is diagnosed with pernicious anaemia. Which of the following best describes the underlying mechanism?

<p>Malabsorption of vitamin B₁₂ due to decreased intrinsic factor. (C)</p> Signup and view all the answers

A patient presents with macrocytic anaemia. Which of the following deficiencies or conditions is LEAST likely to be the primary cause?

<p>Iron deficiency (C)</p> Signup and view all the answers

Following a partial gastrectomy, a patient is most at risk of developing which type of anaemia, and why?

<p>Macrocytic anaemia due to reduced gastric acid and intrinsic factor. (B)</p> Signup and view all the answers

A patient presents with fatigue, pallor, and glossitis. Blood tests reveal macrocytic anaemia. Which of the following would be the MOST appropriate next step in diagnosing the cause?

<p>Red cell folate levels and serum vitamin B₁₂ levels, intrinsic factor antibodies. (B)</p> Signup and view all the answers

Considering the information provided, what is the approximate duration of bodily stores for folate and vitamin B₁₂?

<p>Folate: 4 months; Vitamin B₁₂: 2-6 years. (A)</p> Signup and view all the answers

Flashcards

When to transfuse 'blood'?

Avoid unless Hb < 70 g/L or patient is symptomatic; use patient's own blood group if possible.

Normal White Cell Count

4.5-10 x 10^9/l

Neutrophil changes

Increase: bacterial infection, trauma, surgery. Decrease: viral infections, some drugs.

Lymphocyte changes

Increase: viral infections, CLL. Decrease: steroid treatment, SLE.

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Normal Platelet count

Normal: 150-400 x 10^9/l. Concerns arise < 50 x 10^9/l.

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Warfarin target INR

INR needs to be 4 or less (and use local haemostatic measures).

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Dabigatran

Inhibits thrombin. Its effect isn't reflected in INR. It has a linear dose-response.

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Rivaroxaban

Direct Factor Xa inhibitor.

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Anaemia

Low hemoglobin levels due to a decreased red cell mass, typically below 110-180g/l for females and 130-180g/l for males.

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Iron Deficiency Anaemia

Red blood cells appear smaller (microcytic) and paler (hypochromic) than normal. Typically associated with low Hb, low MCV, and low ferritin levels.

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Cytosis

Suffix meaning 'too many'.

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Paenia

Suffix meaning 'not enough'.

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Microcytic Hypochromic Anaemia

Characterized by small, pale red blood cells; often caused by iron deficiency.

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Normocytic Anaemia

Normal-sized red blood cells; can be caused by chronic diseases like RA or chronic kidney disease.

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Macrocytic Anaemia

Large red blood cells, often due to B₁₂ or folate deficiency.

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Pernicious Anaemia

Anaemia caused by malabsorption of vitamin B₁₂ due to a lack of intrinsic factor.

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Haematocrit

A measure of the percentage of your blood that is made up of red blood cells.

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MCV (Mean Corpuscular Volume)

Average volume of a red blood cell.

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MCH (Mean Corpuscular Hemoglobin)

Average amount of haemoglobin in a red blood cell.

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Thrombocytosis

Too many platelets in the blood.

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Thrombocytopaenia

Too few platelets in the blood.

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Folate storage duration

Folate is stored for a shorter period.

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B12 storage duration

Vitamin B12 is stored for a longer period.

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Pernicious Anaemia Cause

Antibodies against parietal cells or lack of intrinsic factor cause malabsorption of B12.

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Methotrexate Considerations

A drug that can cause myelodysplasia (a bone marrow disorder). Avoid alcohol while taking it.

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Universal Donor

O Rh-negative blood can be transfused to almost anyone in emergencies.

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Universal Recipient

AB positive blood type can receive blood from any other blood type.

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Eosinophil Elevation

An increase in eosinophils can be an indicator.

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Aspirin's Impact on Platelets

Aspirin can affect how well platelets work, even with a normal platelet count.

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Platelet Abnormality Management

Work closely with a hematologist, use atraumatic techniques, and consider oral tranexamic acid.

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APTT measures...

Used to monitor heparin therapy.

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ESR Calculation & Meaning

Age divided by 2 (add 10 for women) – non-specific marker of disease; affected by age.

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Myelodysplasia

Bone marrow disorder that can be caused by certain drugs.

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Heparin

Measured by APTT.

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DOACs-Low Risk

Simple extractions and incision and drainages carry a low one.

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DOACs-Higher risk

Complex extractions or biopsies have a high one.

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Dabigatran-Higher risk

If taking twice a day, miss morning dose

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Rivaroxaban-Higher risk

If taking once a day in the morning, delay morning dose.

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ESR (Erythrocyte Sedimentation Rate)

A non-specific indicator of disease presence; age-dependent.

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Dabigatran action

Inhibits thrombin.

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Anaemia Definition

Low haemoglobin due to decreased red cell mass; normal range is 110-180g/l for females and 130-180 g/l for males.

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Iron Deficiency Anaemia Characteristics

Small and pale red blood cells with low Hb and MCV, along with low ferritin levels.

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Iron Deficiency Causes

Can result from dietary deficiency, malabsorption or chronic blood loss, often from the GI tract or menorrhagia.

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Folate Deficiency

Macrocytic anaemia results from a deficiency where the body has limited storage ; found in leafy greens.

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B12 Deficiency Causes

Macrocytic anaemia due to deficiency can result from inadequate intake, low gastric acid, intrinsic factor issues, or absorption problems in the terminal ileum.

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B12/Folate Deficiency Treatment

Identify underlying cause, oral folate replacement or lifelong Vitamin B12 injections every 3 months.

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Folate Deficiency - Causes

Alcoholism, elderly, pregnancy, haemolysis, coeliac disease and drugs like Methotrexate.

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Normal Haemoglobin Levels

Normal range: Male is between 130-180g/l. Female is between 110-180g/l

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Hypochromic Microcytic Anaemia

Anemia characterized by small, pale red blood cells. Common causes include iron deficiency.

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Causes of Iron Deficiency

Possible causes include dietary deficiency, malabsorption, chronic blood loss (GI tract, menorrhagia).

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Functional Platelet Defects

Functional platelet defects affect platelet function despite a normal count, often due to aspirin.

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Liaison with Haemophilia Centre

Used when patients have a platelet abnormality to coordinate their blood clotting care.

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Oral Tranexamic Acid

A medication used to reduce bleeding e.g. post-extraction.

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Warfarin in Dentistry

Requires local haemostatic measures, especially if the INR is elevated (but should be below 4).

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Low-Risk DOAC Procedures

Simple extractions (1-3 teeth), incision and drainage

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High-Risk DOAC Procedures

Complex or adjacent extractions, flap raising, gingival re-contouring, and biopsies

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Dabigatran Dose Adjustment

If taking dabigatran twice a day and undergoing a higher risk procedure, skip the morning dose.

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Elevated ESR Meaning

Indicates the presence of inflammation or infection in the body. Results are age-dependent.

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When to avoid transfusions?

Avoid unless Hb < 70 g/l or symptomatic

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Eosinophil increase

Allergic disorders

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Dabigatran effects?

Inhibits thrombin; not reflected in INR

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Rivaroxaban action

Inhibits Factor Xa.

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Rivaroxaban dose- Higher bleeding risk

Delay the morning dose and give the dose 4 hours post haemostasis

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Rivaroxaban evening dose - higher bleeding risk

Give dose at usual time if it is >4 hours post haemostasis.

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Summary- when to seek help?

Liaise with haematologist

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What is Anaemia?

Low haemoglobin, indicating a decreased red cell mass.

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Iron Deficiency Anaemia signs

Characterized by small (microcytic) and pale (hypochromic) red blood cells.

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Normal Haemoglobin Range

Male: 130-180g/l. Female: 110-180g/l

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What does 'cytosis' mean?

Too many cells.

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What does 'paenia' mean?

Not enough cells.

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Common causes of iron deficiency

Dietary deficiency, malabsorption, or chronic blood loss.

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Causes of Folate Deficiency

Reduced intake, alcoholism, increased requirements, malabsorption, or certain drugs.

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Causes of B12 Deficiency

Inadequate intake, low gastric acid, intrinsic factor issues, or abnormal absorption.

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Dabigatran: Mode of Action

Oral anticoagulant that directly inhibits thrombin.

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Rivaroxaban: Mode of Action

Oral anticoagulant that directly inhibits Factor Xa.

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Tranexamic Acid

Used to prevent excessive bleeding by inhibiting fibrinolysis.

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Aspirin's effect on platelets

Affects platelet function, increasing bleeding risk, even with a normal platelet count.

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APTT Test

Used to monitor the effects of unfractionated heparin.

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ESR Test

To determine if there is inflammation in the body.

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Platelet Transfusions

May be needed to reverse functional platelet defects.

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What indicates Anaemia?

Low haemoglobin due to decreased red cell mass

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FBC - Normal Haemoglobin?

Male: 130-180g/l. Female: 110-180g/l.

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Macrocytic Anaemia cause

B₁₂ or folate deficiency

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Methotrexate effects

Avoid alcohol; can cause Myelodysplasia.

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Platelet Abnormalities

Drug induced functional defect or reduced numbers.

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DOACs - Low Bleeding Risk

Simple extractions (1-3 teeth) and incision and drainage.

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DOACs - High Bleeding Risk

Complex extractions, flap raising procedures or biopsies.

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Rivaroxaban - Morning dose

Delay morning dose, give dose 4 hours post haemostasis.

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Rivaroxaban evening dose

Give at usual time in the evening so long as >4 hours post haemostasis.

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What does 'FBC' mean?

A full blood count; a routine blood test to assess overall blood health, including cell counts and haemoglobin levels.

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What is haematocrit?

The proportion of blood volume occupied by red blood cells.

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What is the MCV?

Average red blood cell size. Helps classify anaemia.

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What is MCH?

Average amount of haemoglobin per red blood cell, useful in anaemia classification.

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Intrinsic Factor Role

Vitamin B12 needs this protein, produced in the stomach, for absorption in the terminal ileum.

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Diagnosing B12/Folate Deficiency

Measured by red cell folate and serum B12 levels; treat with oral folate or B12 injections.

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Where is Folate found?

Leafy vegetables, liver, and fruit

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Where is B12 found?

Animal protein

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