Advertisement

Review of Thrombocytopenia and Perioperative Management in Dentistry

  • Hani F. Braidy
Chapter

Abstract

Thrombocytopenia may be caused by a variety of underlying systemic diseases. Mechanisms resulting in low levels of circulating platelets can be categorized into three categories: decrease in platelet production, an increase in platelet sequestration, or peripheral destruction of platelets. Peripheral platelet destruction may be further classified as immune or nonimmune mediated. The management of thrombocytopenia is based on the severity of the underling systemic disorder and clinical extent of the bleeding. A detailed history and physical exam, review of laboratory values, and scope of the anticipated dental procedure will determine the optimal perioperative management of the thrombocytopenic patient.

Keywords

Thrombocytopenia Low platelet count Congenital thrombocytopenia Thrombocytopenic purpura Platelet transfusions Dental extraction 

References

  1. 1.
    JAL RD-K. Thrombocytopenia. In: Williams hematology [Internet]. 9th ed. New York, NY: McGraw-Hill Education; 2016. p. 1993–2035.Google Scholar
  2. 2.
    Scaradavou A. HIV-related thrombocytopenia. Blood Rev. 2002;16(1):73–6. PubMed PMID: 11914001CrossRefGoogle Scholar
  3. 3.
    Drachman JG. Inherited thrombocytopenia: when a low platelet count does not mean ITP. Blood. 2004;103(2):390–8. PubMed PMID: 14504084CrossRefGoogle Scholar
  4. 4.
    Konkle BA. Disorders of platelets and vessel wall. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson JL, Loscalzo J, editors. Harrison's principles of internal medicine. 19th ed. New York, NY: McGraw-Hill Education; 2015.Google Scholar
  5. 5.
    Nurden AT, Nurden P. Inherited thrombocytopenias. Haematologica. 2007;92(9):1158–64. PubMed PMID: 17768118CrossRefGoogle Scholar
  6. 6.
    Kuter DJ. Managing thrombocytopenia associated with cancer chemotherapy. Oncology. 2015;29(4):282–94. PubMed PMID: 25952492.PubMedGoogle Scholar
  7. 7.
    Visentin GP, Liu CY. Drug-induced thrombocytopenia. Hematol Oncol Clin North Am. 2007;21(4):685–96. vi. PubMed PMID: 17666285. Pubmed Central PMCID: 1993236CrossRefGoogle Scholar
  8. 8.
    Hasserjian RP. Myelodysplastic syndromes. In: Hematopathology [Internet]. Philadelphia, PA: Elsevier; 2017. p. 793–815.Google Scholar
  9. 9.
    Rinder CATHM. Disorders of hemostasis: bleeding. In: Andreoli and Carpenter’s cecil essentials of medicine [Internet]. Philadelphia, PA: Elsevier; 2016. p. 544–63.Google Scholar
  10. 10.
    Manson HGWJIOCLM. Blood disease. In: Davidson’s principles and practice of medicine [Internet]. Philadelphia, PA: Elsevier; 2014. p. 989–1056.Google Scholar
  11. 11.
    Rand ML, Wright JF. Virus-associated idiopathic thrombocytopenic purpura. Transfus Sci. 1998;19(3):253–9. PubMed PMID: 10351137CrossRefGoogle Scholar
  12. 12.
    Toltl DMACPLJ. Diseases of platelet number: immune thrombocytopenia, neonatal alloimmune thrombocytopenia, and posttransfusion purpura. In: Hematology: basic principles and practice [Internet]. Philadelphia, PA: Elsevier; 2013. p. 1883–94.Google Scholar
  13. 13.
    Leung WH, Wong KL, Lau CP, Wong CK, Liu HW. Association between antiphospholipid antibodies and cardiac abnormalities in patients with systemic lupus erythematosus. Am J Med. 1990;89(4):411–9. PubMed PMID: Medline: 2121029. EnglishCrossRefGoogle Scholar
  14. 14.
    Macchi L, Rispal P, Clofent-Sanchez G, Pellegrin JL, Nurden P, Leng B, et al. Anti-platelet antibodies in patients with systemic lupus erythematosus and the primary antiphospholipid antibody syndrome: their relationship with the observed thrombocytopenia. Br J Haematol. 1997;98(2):336–41. PubMed PMID: Medline: 9266930. EnglishCrossRefGoogle Scholar
  15. 15.
    Aster RH, Bougie DW. Drug-induced immune thrombocytopenia. N Engl J Med. 2007;357(6):580–7. PubMed PMID: 17687133CrossRefGoogle Scholar
  16. 16.
    Greinacher A. Clinical practice. Heparin-induced thrombocytopenia. N Engl J Med. 2015;373(3):252–61. PubMed PMID: 26176382CrossRefGoogle Scholar
  17. 17.
    Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M, Scientific Subcommittee on Disseminated Intravascular Coagulation of the International Society on T, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86(5):1327–30. PubMed PMID: Medline: 11816725. EnglishCrossRefGoogle Scholar
  18. 18.
    Boral BM, Williams DJ, Boral LI. Disseminated intravascular coagulation. Am J Clin Pathol. 2016;146(6):670–80. PubMed PMID: 28013226CrossRefGoogle Scholar
  19. 19.
    Andreoli T, Benjamin I, Griggs R, Wing E. Andreoli and Carpenter’s cecil essentials of Medicine: Elsevier Health Sciences; 2010. Available from: http://www.r2library.com/Resource/Title/1416061096.
  20. 20.
    Blombery P, Scully M. Management of thrombotic thrombocytopenic purpura: current perspectives. J Blood Med. 2014;5:15–23. PubMed PMID: 24523598. Pubmed Central PMCID: 3921093PubMedPubMedCentralGoogle Scholar
  21. 21.
    Balduini CL, Gugliotta L, Luppi M, Laurenti L, Klersy C, Pieresca C, et al. High versus standard dose methylprednisolone in the acute phase of idiopathic thrombotic thrombocytopenic purpura: a randomized study. Ann Hematol. 2010;89(6):591–6. PubMed PMID: 20033409CrossRefGoogle Scholar
  22. 22.
    Swisher KK, Terrell DR, Vesely SK, Kremer Hovinga JA, Lammle B, George JN. Clinical outcomes after platelet transfusions in patients with thrombotic thrombocytopenic purpura. Transfusion. 2009;49(5):873–87. PubMed PMID: 19210323CrossRefGoogle Scholar
  23. 23.
    Mustafa R, Ahmed S, Gupta A, Venuto RC. A comprehensive review of hypertension in pregnancy. J Pregnancy. 2012;2012:105918. PubMed PMID: 22685661. Pubmed Central PMCID: 3366228CrossRefGoogle Scholar
  24. 24.
    Pourrat O, Coudroy R, Pierre F. Differentiation between severe HELLP syndrome and thrombotic microangiopathy, thrombotic thrombocytopenic purpura and other imitators. Eur J Obstet Gynecol Reprod Biol. 2015;189:68–72. PubMed PMID: Medline: 25879992. EnglishCrossRefGoogle Scholar
  25. 25.
    Erkurt MA, Berber I, Berktas HB, Kuku I, Kaya E, Koroglu M, et al. A life-saving therapy in class I HELLP syndrome: therapeutic plasma exchange. Transfus Apher Sci. 2015;52(2):194–8. PubMed PMID: 25595543CrossRefGoogle Scholar
  26. 26.
    Johnsen J. Pathogenesis in immune thrombocytopenia: new insights. Hematology Am Soc Hematol Educ Program. 2012;2012:306–12. PubMed PMID: 23233597PubMedGoogle Scholar
  27. 27.
    Saulsbury FT. Clinical update: Henoch-Schonlein purpura. Lancet. 2007;369(9566):976–8. PubMed PMID: 17382810CrossRefGoogle Scholar
  28. 28.
    Khair K, Liesner R. Bruising and bleeding in infants and children—a practical approach. Br J Haematol. 2006;133(3):221–31. PubMed PMID: 16643424CrossRefGoogle Scholar
  29. 29.
    O’Reilly RA. Splenomegaly in 2,505 patients in a large university medical center from 1913 to 1995. 1913 to 1962: 2,056 patients. West J Med. 1998;169(2):78–87. PubMed PMID: 9735688. Pubmed Central PMCID: 1305176PubMedPubMedCentralGoogle Scholar
  30. 30.
    George JN. Approach to the adult with unexplained thrombocytopenia. In: Post T, editor. UpToDate, UpToDate. Waltham, MA; 2017.Google Scholar
  31. 31.
    Stasi R. How to approach thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2012;2012:191–7. PubMed PMID: Medline: 23233580. EnglishPubMedGoogle Scholar
  32. 32.
    Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190–207. PubMed PMID: Medline: 21325604. EnglishCrossRefGoogle Scholar
  33. 33.
    Israels S, Schwetz N, Boyar R, McNicol A. Bleeding disorders: characterization, dental considerations and management. Journal. 2006;72(9):827. PubMed PMID: 17109803Google Scholar
  34. 34.
    Slichter SJ. Evidence-based platelet transfusion guidelines. Hematology Am Soc Hematol Educ Program. 2007:172–8. PubMed PMID: 18024626Google Scholar
  35. 35.
    British Committee for Standards in Haematology General Haematology Task F. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol. 2003;120(4):574–96. PubMed PMID: 12588344CrossRefGoogle Scholar
  36. 36.
    Rumjantseva V, Hoffmeister KM. Novel and unexpected clearance mechanisms for cold platelets. Transfus Apher Sci. 2010;42(1):63–70. PubMed PMID: 19932055. Pubmed Central PMCID: 4303245CrossRefGoogle Scholar
  37. 37.
    Thiagarajan P, Afshar-Kharghan V. Platelet transfusion therapy. Hematol Oncol Clin North Am. 2013;27(3):629–43. PubMed PMID: 23714315CrossRefGoogle Scholar
  38. 38.
    Yuan S. Clinical and laboratory aspects of platelet transfusion therapy. In: UpToDate [Internet], UpToDate. Waltham, MA; 2016.Google Scholar
  39. 39.
    Goldfinger D. Refractoriness to platelet transfusion therapy. In: UpToDate [Internet]. Waltham, MA: UpToDate; 2016.Google Scholar
  40. 40.
    Fillmore WJ, Leavitt BD, Arce K. Dental extraction in the thrombocytopenic patient is safe and complications are easily managed. J Oral Maxillofac Surg. 2013;71(10):1647–52. PubMed PMID: 23932116CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Hani F. Braidy
    • 1
  1. 1.Department of Oral and Maxillofacial SurgeryRutgers University School of Dental MedicineNewarkUSA

Personalised recommendations