Coumadin/Warfarin and Other Blood Thinners:

All patients taking Coumadin MUST have a medical consult signed by a physician prior to receiving treatment. Consult should request Patient’s INR count. Multiple drug interactions should be carefully reviewed for possible emergencies due to their anticoagulation properties.

INR Guidelines

If the INR value is less than or equal to 2.5- 3.0 -- proceed

If it is higher than 3.0 – may not treat—medical consult needed

If the INR is unknown – must acquire a med consult

All patients on Coumadin must have a med consult annually.

Patients taking Plavix or other antiplatelet medication should send a Medical Consult to the patient’s physician post treatment indicating patient’s response to treatment (and what services were provided) and bleeding complications if any. PLEASE be sure to check patient charts prior to scheduling appointments so this can be taken care of BEFORE they report for their appointments. Document their current INR whenever possible.

Blood Disorders/HIV

Medical clearance must be obtained prior to treatment of any patient with an uncontrolled bleeding disorder or irregularities that would severely compromise the patient’s immune system. HIV Medical clearance and/or premed may be necessary if the current blood work shows any of the following. If you have any specific questions, please consult with the PLUS clinic. All lab values must be within a year of treatment at the Dental School.

WBC: if under 2,000 will need antibiotics to treat	Platelet count: must be at least 60,000
Neutrophils: if < 500 need antibiotics to treat	CD4: should be over 200

Total CD4+ count

Normal:

CD4+ cell counts in people who are not infected with HIV usually range from 600 to 1,500 cells per microliter.

Abnormal:

A CD4+ cell count greater than 350 but less than 500 cells/mcL means that the immune system is beginning to weaken.

A CD4+ cell count of fewer than 350 cells/mcL indicates a weak immune system and an increased risk for opportunistic infections.

A CD4+ cell count of fewer than 200 cells/mcL indicates acquired immunodeficiency syndrome (AIDS) and a high risk for opportunistic infections.

Source: http://www.webmd.com/hiv-aids/cd4-count

Patients may also report the Viral Load (VL) number:

What HIV Viral Load Test Results Mean

The HIV viral load test measures the number of HIV copies in a milliliter of blood.

If the HIV viral load is high, HIV is reproducing and the disease may progress more quickly. A high HIV viral load is 50,000 to 100,000 copies. It can be as high as 1 million or more.
If the HIV viral load is low, HIV may not be actively reproducing and the disease may progress more slowly. A low viral load is between 20 and 500 copies. However, what you want is an undetectable viral load
If the HIV viral load can't be detected, this does not mean it is cured. The level of HIV virus may be so low that the test can't pick it up. A more sensitive test may be able to detect it. It's important to also know that the HIV viral load test does not measure HIV in other parts of the body where HIV may be present. Only about 2% of HIV is in the blood. For most patients, the goal of treatment is to reach an undetectable viral load, which is currently defined as less than 20 copies.

Remember: Even if the HIV viral load is undetectable, HIV positive patients can still infect others.

Source: http://www.webmd.com/hiv-aids