Blood 2 Flashcards
what are the 3 main components of rbc?
rbc - erythrocytes
plasma
wbc - leukocytes
what is plasma?
- makes up 55% of blood
- mostly water 96%
- contains water, ions, nutrients, gases, waste, proteins (immunoglobulins, electrolytes, sugars and fat
what are red blood cells?
fill in the gaps
what are the myeloid stem cells responsible for?
rbc platelets and others
what are the lymphoid stem cells responsible for?
producing specific immune response cells:
lymphoblast to
t and b cells and natural killer cells
fill in the blanks
what is leukaemia ?
cancer of a particular type of stem cells in bone marrow causing unregulated production of certain types of blood cells
how is leukaemia classified ?
depending on how rapidly they progress and the cell line that is affected (myeloid or lymphoid)
what do we call a slowly progressing leukaemia ?
chronic leukaemia
what do we call a fast growing leukaemia
acute leukaemia
what are the 4 main types of leukaemia ?
acute myeloid
acute lymphoblastic
chronic myeloid
chronic lymphocytic
what does a mutation in precursor cells in the bone narrow lead to?
an excessive production of a slightly abnormal WBC
what is pancytopenia?
the excessive production of a single type comes at the expense of other cell types
what problems does pancytopenia cause?
combination of anemia, leukopenia and thrombocytopenia
what are the symptoms of an acute marrow failure (anaemia symptoms) ?
breathlessness - due to blood doesn’t have enough capacity to carry gases of respiration
dizziness
pallor of oral mucosa and membrane and conjunctiva of eye
apthous ulceration
oppurtinsitc infections eg. angular chelitis
what are some symptoms of thrombocytopenia ?
- coagulation defects eg. bruise easily or bleed easily
what is a pneumonic to easily remember the different types of leukaemia
what is acute lymphoblastic aneamia ?
acute proliferation of a single type of lymphocyte usually b lymphocytes causing replacement of other cells created in bone marrow leading to pancytopenia
he most common type of cancer in children?
acute lymphoblastic leukaemia
peaks around 2-4 yrs
can also affect adults over 45ys
what condition is acute lymphoblastic aneamia linked to?
downs syndrome
what is chronic lymphocytic leukaemia ?
chronic proliferation of b lymphocytes usually
affects 55yrs+ old
what are the symptoms of chronic lymphocytic luekamia
often asymptomatic
but can present with increased susceptibility to infections, anaemia, bleeding an weight loss
what can chronic lymphocytic leukaemia lead to ?
high grade lymphoma
which age group tends to get chronic myeloid ?
65 yrs and older
what are the three phases of chronic myeloid leukaemia ?
chronic
accelerated
blast
describe the chronic phase of chronic myeloid leukaemia
- can last 5 yrs
- often asymptomatic
- pts are diagnosed incidentally via a blood test with a raised white cell count
describe the accelerated phase of chronic myeloid leukaemia
- abnormal blast cells take up a high proportion of bone marrow and blood (10-20%)
- pts therefore suffer symptoms of anaemia, thrombocytopenia and become immunocompromised
describe the blast phase of chronic myeloid leukaemia
- follows accelerated phase and involves even higher proportion of blast cells = 30%
- severe symptoms stemming from pancytopenia
- fatal
what is the most common acute leukamia in adults ?
acute myeloid leukaemia
can present at any age but usually from middle age onwards
peak after 75 yrs
how many types of acute myeloid leukaemia are there?
many types with different presentations
what are the signs and symptoms of acute myeloid leukaemia?
what are some oral signs and symptoms of AML?
- compared to other leukaemia’s, oral manifestations are ordinary seen in AML
- mucosal pallor related to anaemia
- spontaneous bleeding and petechial haemorrhage of gingivae, palate, tongue or lips arising from thrombocytopenia
- gingival hyperplasia caused by leukaemia infiltration
most prevalent oral signs and symptoms = gingival bleeding, oral ulceration and gingival hyperplasia, bruising or mobility = REFER
what may we see if a pt is under chemo in their acute phase AML?
mucositis - swelling, ulceration, discomfort along GIT
oral mucosal ulceration after induction phase
dryness if saliva gland involved in disease or side effect of medication is xerostomia
trismus - when leukaemic cells directly invade TMJ
label the signs of leukaemia
A= inappropriate bleeding and submucosa; bruising
B= gross swelling
C= oral ulceration on lip due to neutropenia
D and E= gingival swelling from gingivae packed with leukaemic infiltration also swelling bruising and bleeding
*swollen lymph nodes too (not in pics)
what is this ?
chronic ulceration
- could be secondary to chemotherapy
- could be mucositis if in acute phase
- can see this ulceration due to longer lasting consequence of treatment
how do we diagnose leukaemia
- blood film = look at shape and type of blood cells
- bone marrow biopsy = needle passed thru cortex of bone into marrow and investigate
how do we treat leukaemia ?
- m. team = oncologist, dietician, haematologist
- chronic forms of leukaemia arent treated but monitored
- acute forms (2 forms) : induction phase (aggressive) = pt suffers from severe side effects of chemo eg. mucocitis, suppressed immune system, once primary stage suppressed this stage is called consolidation phase = chemo used long term
- bone marrow transplant = young and fit pts
what is lymphoma ?
umbrella term encompassing a broad range of cancers derived from lymphocytes
how does lymphoma differ from leukaemia ?
abnormal cells develop in lymph nodes and not bone marrow
what are the 2 subtypes of lymphoma?
non Hodgkin and Hodgkin
what do both of these lymphomas have in common?
both of these types are more common in men than women
what is non Hodgkin lymphoma
- 85% of lymphomas
- onset = 65-75 yrs
- 5th highest cause of cancer in young adults
what is Hodgkin lymphoma?
- 15% of lymphomas
- has bimodal incidence = first as a young adult and then again later in life
- occurs in cervical lymph nodes
what are the risk factors for Hodgkin lymphoma?
EBV, family history, HIV/AIDS
half cases are due to EBV
what is the prognosis of Hodgkin lymphoma?
good = 5 yr survival up to 98% (85% unfavourable feautres
how do we treat Hodgkin
localised radiotherapy
what do a third of Hodgkin pts have?
B symptoms - fever, night sweats and weight loss which is greater than 10% of Their body weight in a 6 month period
what is the main difference between Hodgkin an non Hodgkin ?
in hodgkin there are reed Sternberg cells (multinucleate cells in lymph nodes)
what are the risk factors for non hodgkin lymphoma ?
poor immune system function, autoimmune diseases, H pylori infection, Hep C, obesity, EBV
what is the percentage of lymphomas that appear in the oropharynx ?
10%
- may see a persistent painless ulcer or enlargement in mouth usually in palate
what symptoms relating to dentistry do ppl with non Hodgkins show?
facial asymmetry
visible swelling in neck
mobility in teeth
change in fit of denture
longer down the line - pain or paraesthsia in nerve = perinural invasion
ulceration of overlying mucosa
what are some signs and symptoms of lymphoma
- lymphademopathy= WBC proliferate in nodes
what does a lymph node biopsy look like?
abnormal lymphocytes
what does a reed Sternberg cell look like under a microscope ?
multinucealted (Hodgkin)
how do we treat lymphoma
- surgical
- mix of chemo and localised radio
what is myeloma?
blood cancer that arises from plasma cells (b lymphocytes that produce specific antibodies )
15% of blood cancers and 2% of all cancer
mainly affects over 65yrs
M:F 2:1
how does myeloma develop?
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 aboral cell realises a large amount of a single type of antibody = paraprotein - which is has no useful function
what is the survival rate of myeloma?
5 yrs survival is 52%
treatable but incurable
what are the risk factors for myeloma ?
obesity
family hx
EBV
certain chemical exposures
radiation
what are paraproteins ?
plasma cell proteins that produce cytokines which cause damage
what damage can paraproteins cause?
osteoporosis
lytic lesions in bone
antibodies that are produced by the plasma clones are deposited in various organs eg. nephrons in kidney can cause kidney failure or polyneuropathy = weakness numbness and pain all around body
what are some signs and symptoms of myeloma ?
amyloidosis= deposition of para proteins in tissue around the body eg. in mouth = red purple swelling sides of tongues
what pneumonic can help us remember the key features of myeloma ?
how do we diagnose myeloma?
multiple myeloma x rays
what does an oral plasmacytoma look like ?
packed full of plasma cells can move to jaw (30% of cases)
what are some dental implications of myeloma
- impaired kidney func= may affect certain LA usage or drug interactions
what is graft vs host disease ?
- results from a bone marrow transplant which is a common treatment for many haematological malignancies
- occurs if there is an allergenic bone marrow transplant (transplanting the bone marrow of one person into the person to the disease) and GVHD is the immune response to this foreign bone marrow
what are the 2 types of GVHD?
acute or chronic
what is acute GVHD ?
- potentially fatal
- affects GIT skin and liver
what is chronic GVHD ?
number of organs are affected including oral cavity
what are the oral manifestation of GVHD?
head neck salivary glands = lichenoid lesions, persistent recurrent facial infections , xerostomia , ulceration, fibrous bands in mucosa of cheek= trismus, altered taste sensation, white striae around tongue (immunosuppressed pts), pts with bone marrow or stem cells or GVHD = increased risk of dysplasia of oral tissues and oral cancer= meed to be vigilant
the determinate effects on oral health and how these are managed
what is our role ?
