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Table 3. Management Guidelines Relative to Invasive Dental Procedures

Medical Status  Guideline  Comments 
Patients with chronic indwelling venous access lines (e.g., Hickman).AHA prophylactic antibiotic recommendations (low risk).There is no clear scientific proof detailing infectious risk for these lines following dental procedures. This recommendation is empiric.
Neutrophils Order CBC with differential.
>2,000/mm3No prophylactic antibiotics.
1,000–2,000/mm3AHA prophylactic antibiotic recommendations (low risk).Clinical judgment is critical. If infection is present or unclear, more aggressive antibiotic therapy may be indicated.
<1,000/mm3Amikacin 150 mg/m2 1 h presurgery; ticarcillin 75 mg/kg IV ½ h presurgery. Repeat both 6 h postoperatively.If organisms are known or suspected, appropriate adjustments should be based on sensitivities.
Plateletsa Order platelet count and coagulation tests.
>60,000/mm3No additional support needed.
30,000–60,000/mm3Platelet transfusions are optional for noninvasive treatment; consider administering preoperatively and 24 h later for surgical treatment (e.g., dental extractions). Additional transfusions are based on clinical course.Utilize techniques to promote establishing and maintaining control of bleeding (i.e., sutures, pressure packs, minimize trauma).
<30,000/mm3Platelets should be transfused 1 h before procedure; obtain an immediate postinfusion platelet count; transfuse regularly to maintain counts >30,000–40,000/mm3 until initial healing has occurred. In some instances, platelet counts >60,000/mm3 may be required.In addition to above, consider using hemostatic agents (i.e., microfibrillar collagen, topical thrombin). Aminocaproic acid may help stabilize nondurable clots. Monitor sites carefully.

CBC = complete blood cell count; IV = intravenous.
aAssumes that all other coagulation parameters are within normal limits and that platelet counts will be maintained at or above the specified level until initial stabilization/healing has occurred.