hand book for dental surgeons - Indian Dental Association ...

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Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders
HAEMOSTATIC DISORDERS
Bleeding disorders are conditions that after the ability of blood vessels, platelets and coagulation factors to
maintain haemostasis inherited bleeding disorders are genetically transmitted. Acquired bleeding disorders
occur secondary to diseases affecting vascular wall integrity, platelets of coagulation factors, drugs, radiation or
chemotherapy for cancer. Hemorrhage, intravascular thrombosis and embolism are common clinical
manifestations of abnormal interactions between components of the vessel, circulating platelets and plasma
proteins. However, when disease or trauma damage large arteries and veins, excessive bleeding may occur
despite a normal haemostatic system.
Primary haemostasis: Stops blood loss from capillaries, small arterioles and venules. It occurs within
seconds. During this period, platelet plug is formed at the site of injury. Three critical events occur during this
phase platelet adhesion, granule release and platelet aggregation.
Secondary haemostasis: Completed in several minutes and is important in bleeding from larger vessels.
During this period fibrin is formed it is the activation of clotting process in plasma. Which ultimately results in
the formation of fibrin. Which strengthens primary haemostatic plug. It is a continuous process and there are
approximately 40 substances, which affect clotting. Some promote clotting (procoagulants) and some inhibit
clotting (anticoagulants). Normally there is a fine balance between these factors and blood usually does not
coagulate in the vessel. Whenever there is an injury to the vessel these procoagulants are activated and balance
tilts infavour of coagulation and there is formation of clot.
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Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders