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Medically Compromised Patient Care

Course Number: 628

Platelet Disorders

Normal platelet count (140,000-400,000). Thrombocytopenia is the medical term for a low blood platelet count, which usually occurs at 50,000 and is a dangerously low level for dental providers to treat a patient. Dental considerations for patients with thrombocytopenia include watching for gingival bleeding, petechiae (i.e., small, pinpoint collections of blood under the skin or mucous membrane), ecchymosis (i.e., discoloration of the skin caused by blood within the tissue), jaundice, pallor and ulcers. Aspirin or other NSAIDS are contraindicated for patients with this disorder. If their platelet level falls below 50,000/mm3 a medical consult is required to determine if platelet infusion or a hemostatic agent is needed.

The next platelet disorder is called Von Willebrand Disease, which is an inherited bleeding disorder that is caused by deficiency and/or dysfunction in Von Willebrand factor and factor VIII. There are three types of the disorder (Type 1, 2, and 3). These patients may report increased bleeding (e.g., gums, nose bleeds, menstrual periods, cuts or surgeries, and blood in stool or urine). They may also experience large bruises. Patients with Type 1, have a mild form of the disease and the provider can proceed with dental treatment with caution. However, patients with Type 2 & 3 have a more severe deficiency and are at higher risk for uncontrolled bleeding. Therefore, a medical consult is beneficial before proceeding with treatment when a patient has Type 2 or 3 Von Willebrand Disease.

One of the treatments available for Von Willebrand’s Disease is desmopressin (DDAVP), which is a man-made hormone that is usually taken by injection or nasal spray. It helps the body release more Von Willebrand factor and factor VIII into the bloodstream. Desmopressin works for most people who have Type 1 and for some people who have Type 2 disease. Another treatment option is aminocaproic acid or tranexamic acid, which are antifibrinolytic medicines that help reduce bleeding by slowing the breakdown of blood clots.13