Blood Disorders 2

Question 1

thalassemia

Answer 1

a hemoglobin disorder that has some effect on the bones and patients present with a range of anemic symptoms

Question 2

thalassemia pathogenesis

Answer 2

a-chain: high affinity for oxygen and will not release O2 to cells
b-chain: interferes with normal maturation of RBCs and contributes to early destruction

Question 3

extraoral characteristics thalassemia

Answer 3

a-thalassemia: mild to moderate signs of anemia
b-thalassemia: minor, intermedia, major (bone malformations and stunted growth)

Question 4

radiographic bone changes thalassemia

Answer 4

jaw: honeycomb trabecular pattern
skull: hair-on-end trabecular pattern

Question 5

megaloblastic anemia is caused by

Answer 5

Vitamin B12 deficiency
folic acid deficiency

Question 6

megaloblastic anemia pathogenesis

Answer 6

normal RBCs have a nucleus while maturing, but once the maturation process is complete the nucleus is ejected

Question 7

perioral characteristics megaloblastic anemia

Answer 7

glossitis “beefy red,” smooth, sore appearance
pale ulcerated mucosa
possible cleft lip and/or palate

Question 8

megaloblastic anemia dental implications

Answer 8

abnormal vital signs
refer for medical evaluation
female patients of childbearing age

Question 9

what are the two anemias with bone changes

Answer 9

sickle cell disease and thalassemia

Question 10

sickle cell crisis

Answer 10

episodic exacerbations brought on by cold, stress, physical exertion, dehydration, acidosis, infectious agents, hypoxia or a low level of oxygen

sickling of many RBC, occluding the microvasculature in many areas, such as the chest, abdomen and bones, causing extreme pain

Question 11

sickle cell disease perioral/intraoral characteristics

Answer 11

bone trabecular changes: skull “hair-on-end” trabecular pattern caused by bone marrow expansion similar to the thalassemias

periapical “step-ladder” trabecular pattern between posterior teeth

Question 12

sickle cell disease dental implications

Answer 12

use local anesthetics with little or no vasoconstrictors (avoid epi)

Question 13

anemia associated with chronic disease or disorders

Answer 13

treatment of these conditions usually eliminates the anemia
cancer, chronic inflammatory disease, renal disease, hypertension, prosthetic heart valves, turbulent blood flow

Question 14

aplastic anemia

Answer 14

bone marrow fails to produce any of the blood cells usually due to destruction of pluripotential stem cells

Question 15

extraoral characteristics of aplastic anemia

Answer 15

classic symptoms of anemia
bleeding tendencies
infections
severe perio infections
spontaneous gingival bleeding

Question 16

polycythemia

Answer 16

excess RBCs, can impair flow

Question 17

three forms of polycythemia

Answer 17

relative polycythemia
secondary polycythemia
primary: caused by proliferative neoplastic disease, clinical manifestations

Question 18

lymphoid stem cell

Answer 18

lymphocytes

Question 19

myeloid stem cell

Answer 19

monocytes
granulocytes
platelets
erythrocytes

Question 20

disease of WBCs can be broken into two categories

Answer 20

diseases of the leukocytes (Neutropenia, agranulocytosis, cyclic neutropenia)
lymphomas: Hodgkin Lymphoma, Non-Hodgkin Lymphoma, Leukemia, Multiple Myeloma

Question 21

neutropenia etiology

Answer 21

adverse reaction to a drug
many types

Question 22

neutropenia pathogenesis

Answer 22

genetic of caused as reaction to infection
results in increased susceptibility to infections

Question 23

neutropenia extraoral characteristics

Answer 23

fatigue, fever, malaise, extreme weakness
vital signs
skin infections (will not have exudate or erythema present)
upper respiratory infections
genitourinary tract infection

Question 24

neutropenia perioral/intraoral characteristics

Answer 24

oral infections
oral ulcers
perio infections
rapid, progressive loss of periodontal attachment
can lead to premature loss of dentition

Question 25

neutropenia dental implications

Answer 25

focus on prevention of infections and preserving dentition patient education

Question 26

lymphomas

Answer 26

Hodgkin lymphoma: involves an atypical form of B lymphocyte Non-Hodgkin lymphoma involves: B lymphocytes, T lymphocytes, Natural killer cells

Question 27

hodgkin lymphoma pathogenesis

Answer 27

presence of an abnormal tumor cell as disease progresses the individual becomes highly susceptible to infection because of the associated immune system dysfunction

Question 28

hodgkin lymphoma dental implications

Answer 28

head and neck eval cervical and supraclavicular nodes importatn

Question 29

non-hodgkin lymphoma describes

Answer 29

various B and T cell malignant neoplasms

Question 30

non-hodgkin lymphoma perioral/intraoral characteristics

Answer 30

soft tissue mass in Waldeyer ring area hard palate is common location tumors within bone may present as ill-defined radiolucencies that can progress to expansion of the bone

Question 31

non-hodgkin lymphoma dental implications

Answer 31

EO/IO importnat intraoral swelling

Question 32

burkitt lymphoma

Answer 32

aggressive form of non-hodgkin lymphoma most rapidly growing cancer EBV three forms: endemic, sporadic, immune def

Question 33

leukemia

Answer 33

a group of malignant neoplasms involving leukocytes lymphoid or myeloid

Question 34

leukemia pathogenesis acute vs chronic

Answer 34

acute form: days to several weeks, overgrowth of blastic cells chronic form: gradual progression, production of stem cells that do not respond to body's attempts to regulate proliferation

Question 35

both forms of leukemia

Answer 35

have extremely high numbers of the abnormal white cells overwhelms the bone marrow, and not enough stem cells to make other blood products so other blood issue are usually present

Question 36

the symptoms of leukemia are associated with

Answer 36

the disorders produced by the decrease in the numbers of these cells, specifically anemia, neutropenia, thrombocytopenia

Question 37

extraoral characteristics leukemia

Answer 37

Acute and Chronic differ bone pain headache, nerve dysfunction, nausea, vomiting, seizures Chronic Lymphoid (bone pain) and Chronic Myeloid (three phases) differ

Question 38

leukemia perioral/intraoral characteristics

Answer 38

increased periodontal infections and gingival bleeding petechiae/purpura in oral soft tissues

Question 39

leukemia dental implications

Answer 39

determine WBC level and coagulation status stress good oral hygiene

Question 40

multiple myeloma etiology

Answer 40

overproduction of plasma cells

Question 41

multiple myeloma pathogenesis

Answer 41

excessive production of M protein, causing immunosuppression bone resorption Bence Jones protein causes renal failure

Question 42

two additional forms of myeloma

Answer 42

solitary plasmacytoma: single area of bone destruction extramedullary plasmacytoma: soft tissues, exophytic red masses

Question 43

multiple myeloma perioral/intraoral characteristics

Answer 43

increases risk of periodontal infection

Question 44

multiple myeloma dental implications

Answer 44

determine white cell levels clotting time patients treated with bisphosphonates must be monitored closely for osteonecrosis of the jaw