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C M S 1 > Blood 1 > Flashcards

Blood 1 Flashcards

1
Q

What does plasma consist of?

A

Water (96%)
Ions
Proteins
Nutrients
Wastes
Gases
Sugar, fat, electrolytes

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2
Q

What are red blood cells?

A

Most abundant cell in blood - accounts for around 45% of volume

No nucleus, able to easily change shape

No nucleus therefore, short lifespan - 120 days

Contains Hb which carries oxygen and carbon dioxide

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3
Q

What are the two types of haematopoietic stem cells?

A
  1. Myeloid stem cell e.g. red blood cell and platelets
  2. Lymphoid stem cell e.g. T-cells and B-cells
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4
Q

What is leukaemia?

A

Cancer of a particular line of stem cells causing unregulated production of certain types of blood cells.

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5
Q

What are the 4 main types of leukaemia?

A

Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia

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6
Q

What causes pancytopenia?

A

Mutation which causes excessive production of a single type of abnormal white blood cell. This excessive production comes at the expense of other cell types, causing pancytopenia (combination of anaemia, leukopenia and thrombocytopenia).

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7
Q

What age groups are the four different types of leukaemia susceptible to?

A

Under 5 and over 45 - acute lymphoblastic leukaemia (ALL age groups)

Over 55 – chronic lymphocytic leukaemia (CeLL)

Over 65 – chronic myeloid leukaemia (CoMmon)

Over 75 – acute myeloid leukaemia (AMbitions)

ALL CELLMATES HAVE COMMON AMBITIONS

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8
Q

What is acute lymphoblastic leukaemia?

A

Acute proliferation of a single type of lymphocyte, usually B-lymphocytes, causing replacement of other cells created in bone marrow, leading to pancytopenia

The most common cancer in children, peaks around 2-4 years. Can also affect adults over 45 years. Often associated with Downs syndrome

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9
Q

What is chronic lymphocytic leukaemia?

A

Chronic proliferation of usually B-lymphocytes

Usually affects adults over 55 years.

Often asymptomatic but it can present with infections, anaemia, bleeding and weight loss

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10
Q

What is chronic myeloid leukaemia?

A

Three phases:

Chronic phase – can last 5yrs, is often asymptomatic, patients are diagnosed incidentally with a raised white cell count

Accelerated phase – abnormal blast cells take up a high proportion of bone marrow and blood (10-20%). Patients develop anaemia, thrombocytopenia and become immunocompromised

Blast phase – follows accelerated phase and involves even higher proportion of blast cells (>30%). Has severe symptoms and pancytopenia. Is often fatal.

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11
Q

What is acute myeloid leukaemia?

A

Most common acute leukaemia in adults
Many different types of acute myeloid leukaemia with different presentations
Can present at any age but usually from middle age onwards

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12
Q

What are the oral signs and symptoms of leukaemia?

A

Compared to other types of leukaemia, oral manifestations are ordinarily seen in AML
Oral exam may show mucosal pallor related to anaemia; spontaneous bleeding, and gingival hyperplasia caused by leukemic infiltration
The most prevalent oral signs and symptoms are gingival bleeding, oral ulceration and gingival hyperplasia

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13
Q

How is leukaemia diagnosed?

A

Simple test initially – FBC indicates anaemia
Blood film shows shape/features of blood cells under microscope

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14
Q

How is leukeamia treated?

A

Treatment will be coordinated by an oncologymulti-disciplinary team.
Leukaemia is primarily treated withchemotherapyandsteroids

Other therapies include:
- Radiotherapy
- Bone marrow transplant
- Surgery

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15
Q

Define the term lymphoma?

A

Umbrella term encompassing a broad range of cancers derived from lymphocytes.

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16
Q

What are the two divisons of lymphoma? Briefly describe the differences between the two

A

1) Non-Hodgkin lymphoma
Approx 85% of lymphomas
Usual onset 65-75yrs
Risk factors: poor immune function, autoimmune diseases, Helicobacter pylori infection, Hep C, Obesity, EBV infection.

2) Hodgkin lymphoma
Approx 15% of lymphomas
Recognised histologically by presence of Reed-Sternberg cells (multinucleated cells in lymph nodes)
Any age
Risk factors: EBV, Family history, HIV/AIDS
Good prognosis. 5yr survival up to 98% (85% with unfavourable features)
Often treated by radiotherapy along as long as it is localised

17
Q

How is lymphoma diagnosed and treated?

A

Diagnosed via lymph node biopsy.

Treatment and management depends on grade of disease
Low grade inactive may be a period of observation only, with no active intervention
May see combinations of local radiotherapy and chemotherapy as the grade increases

18
Q

What is a myeloma?

A

Myeloma is a blood cancer arising from plasma cells (B lymphocytes that produce specific antibodies)

Mainly affects > 65yrs. However it has been diagnosed in people much younger. M > F = 2:1
Myeloma develops when DNA is damaged during the development of a plasma cell. This abnormal cell then starts to multiply and spread within the bone marrow. The abnormal plasma cells release a large amount of a single type of antibody – known as paraprotein – which has no useful function.

Treatable but incurable. 5yr survival is 52%.
Risk factors: obesity, family Hx, EBV, certain chemical exposures, radiation

19
Q

Describe the signs symptoms of myeloma along with the diagnosis?

A

Bone pain
Bleeding
Anaemia
Impaired kidney function
Frequent infection
Neurological symptoms
Amyloidosis
Plasmacytomas in soft tissue – can be intra-oral, usually presents as a mass. May appear as a ulcerated lesion.

Diagnosis is via the following:
- Tests: Protein electrophoresis (shows paraprotein collection – monoclonal peak on electrophoresis (with or without reduction in other immunoglobulins)

Additional findings: elevated calcium (osteoclasts breaking down bone)
raised creatinine due to reduced kidney function

Bone marrow biopsy – estimate percentage of bone marrow occupied by plasma cells

pepper pots appearance skull - bone dissolved by osteoclasts -shown as lytic patches along bone

20
Q

Key features of myeloma

A

CRAB
hyperCalcemia
Renal failure
Anaemia
Bone disease

21
Q

What is oral plasmacytoma

A

Lesion packed with plasma cells
leads to pathological fracture of bone/jaw due to bone being replaced by plasma cells

22
Q

Dental implications of Myeloma

A
  1. Hyperviscocity of blood p spontaneous bleeding from mucous membranes
    2.Renal failure due to kidney damage from abnormal antibodies - THINK ABOUT WHAT TYPE/HOW MUCH DRUGS YOU CAN PRESCRIBE
  2. bisphosphonates used alongside steroids for txt - reduces bone turnover therefore less risk of pathological fracture (dont forget MRONJ risk)
  3. chemotherapy, thalidomide, stem cell transplant, radiotherapy : can bring about remission
23
Q

Graft vs Host disease - what Is it

A

A common but fatal complication of stem cell transplant - can be acute or chronic
Acute : fatal, typically affects skin, GI and liver
Chronic: affects different organs, including oral cavity

24
Q

Oral implications of Graft vs Host disease

A
  1. Lichenoid lesions- ulcers and striations
  2. Hyperkeratotic plaques
  3. Limited opening secondary to sclerosis - think about less OH and dental work being done
  4. Mild/moderate/severe erosive lesions can be seen

MUST TEACH PT TO SELF EXAMINE IF THEYVE HAD A Bone marrow transplant bc higher risk of hyperplasia

25
Q

Effects of blood disorders on oral health

A
  1. Infections due to lack of normal white blood cells
  2. Infections more likely and severe
  3. Purpura - small bruises in skin, nosebleeds, bleeding gums
  4. Bleeding and bruising due to lack of platelets
  5. Meds have side effect of oral ulcerations - but dont always assume its the meds that have caused the ulcer, always investigate
  6. Bisphosphonates, immunosuppressants,steroids - likely to cause immuno compromised patients
  7. Side effects of chemo- infection, delayed dental development in children

C M S 1 (23 decks)

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