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/mm3 | No prophylactic antibiotics. | |
| 1,000–2,000/mm3 | AHA prophylactic antibiotic recommendations (low risk). | Clinical judgment is critical. If infection is present or unclear, more aggressive antibiotic therapy may be indicated. |
| <1,000/mm3 | Amikacin 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/mm3 | No additional support needed. | |
| 30,000–60,000/mm3 | Platelet 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/mm3 | Platelets 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. |
