16. Hematologic disorders

Question 1

What is anemia?

Answer 1

When there is a decrease in volume of RBC or a decreased concentration of hemoglobin

Question 2

What is a hematocrit?

Answer 2

It is the percentage of RBC
men: 40-54%
women: 35-45%
newborns: 44-64%

Question 3

What are the causes of anemia?

Answer 3

1.) Excessive bleeding: acute or chronic
2.) Increased erythrocyte destruction: hemolytic anemia
3.) Decreased erythrocyte production

Question 4

What are some signs & symptoms of anemia?

Answer 4

1.) Shortness of breath
2) Low blood pressure
3.) Heart palpitations
4.) Chest pain
5.) Increased risk of angina & heart attacks
6.) Enlargement of spleen

Question 5

What is the role of the spleen?

Answer 5

It is the production of RBC’s

Question 6

What are some of the head & neck manifestations of anemia?

Answer 6

1.) Mucosal pallor: when the tissue is lighter in colour
2.) When it’s smooth, burning tongue
3.) Angular cheilitis: corner commissure of lips
4.) Xerostomia: dry mouth

Question 7

What is iron deficiency anemia?

Answer 7

When there is the presence of low iron, meaning there results of a hypochromic (pale), microcytic (small) anemia

• accounts for half of all anemias world wide

Question 8

What can patients exhibit with iron deficient anemia?

Answer 8

1.) brittle nails
2.) Pale skin
3.) Sore muscles

Question 9

What is sickle cell anemia?

Answer 9

When there is the presence of abnormal hemoglobin in RBC, which leads to sickling of RBCs

when there is one gene affected = 50% of RBCS sick cell trait
when there is two genes affected = 100% sickle cell disease

Question 10

What are the clinical features of sickle cell anemia?

Answer 10

1.) Results in blood clots & pain
2.) “Hair-on-end” skull
3.) Anemia
4.) Hypoxia
5.) Sickle cell crisis

Question 11

What are thrombocytopenia?

Answer 11

They are a decreased number of platelets:
1.) A normal count would be around 150,000 - 450, 000 per microlitre
2.) Severe form: < 10,000 per microlitre

Question 12

What can thrombocytopenia cause?

Answer 12

1.) It may increase the destruction
2.) Decrease the production
3.) Sequestration in the spleen

Question 13

What are some of the clinical features of thrombocytopenia?

Answer 13

1.) It has increased petechia & ecchymosis
2.) There are larger hematomas (large bruising)
3.) Gingival bleeding with little manipulation
4.) Epistaxis

Question 14

What is leukemia?

Answer 14

It is a cancer originating in the bone marrow in which has an INCREASED NUMBER of white blood cells.

Question 15

How can leukemia be classified?

Answer 15

1.) Myeloid or lymphoid
2.) Acute or chronic

Question 16

What does acute leukemia encompass?

Answer 16

A build-up of immature cells

Question 17

What does chronic leukemia encompass?

Answer 17

A slower build up of mature of cells

Question 18

What does myeloid leukemia encompass?

Answer 18

Has the progenitor cells of granulocytes, monocytes, erythrocytes or platelets

Question 19

What does the lymphoid leukemia encompass?

Answer 19

Has the progenitor cells of lymphocytes: B-cells, T- cells.

Question 20

What variation of leukemia is more relevant to dentistry?

Answer 20

Acute myeloid leukemia

Question 21

What are the oral manifestations of leukemia?

Answer 21

1.) Leukemic gingivitis: more common in acute leukemia (AML)
2.) Deep ulcers: increased infections due to a decrease in functioning WBCs
3.) Hemorrhage: Due to thrombocytopenia

Question 22

What is Langerhans cell histiocytosis?

Answer 22

It is a proliferation of Langerhans cells (which are antigen presenting cells found in a variety of tissues)

*They can result in a wide spectrum of diseases (which can affect bone, skin, organs)

Question 23

In what general population is Langerhans cell histiocytosis more prevalent?

Answer 23

equal in both males & females, but more prevalent in 50% of cases in patients < 15 years of age.

Question 24

What are some of the clinical features in bone of the langerhans cell histiocytosis?

Answer 24

1.) It has well-demarcated punched out lesions & can mimic periodontal disease

Question 25

What are some of the clinical features in the skin of the langerhans cell histiocytosis?

Answer 25

1.) It has a pruritic (itchy) erythematous lesions & has ulcerations

Question 26

What are some clinical features in the viscera relative to the langerhans cells histiocytosis?

Answer 26

They can affect the spleen, liver, & small & large intestines.

Question 27

What is multiple myeloma?

Answer 27

• It is a malignancy of plasma cells:
  1.) Monoclonal proliferation
  2.) All of the cells are either kappa or lambda cells

*Originates within the bone

Question 28

Where is multiple myeloma more commonly found in ?

Answer 28

More common in males, in older populations & in black populations > white populations

Question 29

What are the clinical features of multiple myeloma?

Answer 29

1.) Has severe bone pain: lower back is a common location
2.) Punched out radiolucencies on radiographs noted
3.) Increased risk of pathologic fracture
4.) Hypercalcemia due to the bone destruction

Question 30

How can we differentiate multiple myeloma?

Answer 30

If they are younger; Langerhans Histiocytosis
If they are older; multiple myeloma

Question 31

What are some of the clinical features of multiple myeloma?

Answer 31

1.) They are noted both equally or radiographically. There is a radioluscent appearance in the area.

Question 32

What can multiple myeloma result in clinically?

Answer 32

1.) have these amyloidosis (deposition of amyloid) in the tongue. Can cause macroglossia