virgola82
Forum Guru
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Posts: 348
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A 31 yo man was sent to your clinic by his dentist to be evaluated for gingival bleeding prior to tooth extraction. For the past 2 months the patient has been experiencing bleeding from his gums while brushing. He admits to several episodes of nosebleeds throughout his lifetime, which were somewhat severe and once required a visit to the ER. He denies melena, hematochezia, joint paint or swelling. His father died at an early age of an unknown cause and the patient recalls that he also had nosebleeds. His vitals in the office are stable. His physical exam is unremarkable. No petechiae or purpura are seen on the skin. The mucosa is normal. The spleen is not palpable and there are no joint deformities. Lab studies shows: WBC 6200; Hematocrit 38%; Plt 360000; PT 11.6; PTT 48; INR 1.3; Smear is normal; Bleeding time is mildly prolonged; the ristocetin cofactor activity is abnormal.
What would you do to make the dental extraction safe?
A. Desmopressin
B. No therapy
C. Aminocaproic acid
D. Factor VIII concentrate infusion
E. Cryoprecipitate
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| elitoki
Forum Guru
Topics: 54
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A. Desmopressin will increase excretion of Factor VIII from endothelial cell.
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Increased PTT, Normal platelet count, Ristocetin assay-Abnormal---->VWD
Mild VWD is treated with desmopressin which causes increase in plasma VWF and FVIII concentrations.
Aminocaproic acid can also be used for temporary prevention of bleeding by inhibiting fibrinolysis
Since this patient is undergoing ONLY tooth extraction and mucous membrane bleeding---> I will go with Aminocaproic acid!
Any inputs are welcomed!
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| Justice
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A. Desmopressin
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| usmlestud
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| dr in trouble
Forum Guru
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Desmopressin shud b given .
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| ssrpk
Forum Fanatic
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its a bleeding problem, not coagulation...
should be desmopressin
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| tolito
Forum Fanatic
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i also agree with desmopressin. he does not have to have the tooth extracted right now and he is not bleeding right now. so we give desmop and check our values again and when normal, he has his tooth extracted.
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| ssrpk
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yes
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