Blood Disorders Exam 5 Flashcards
What is plasma composition?
90% water
10% plasma proteins, inorganix salts , gases and transported substances
What are the normal blood componets
Plasma Compositon
Origin (Formes elements)
What are the origin (Formed elements) composition?
- Bone marrow
- Hemocytoblast (Stem cell)
What are stem cell made up of?
Erythrocytes
Leukocytes
What are erythrocytes?
Red Blood cells.
- No nuclei
- Biconcave discs
What does erythrocytes: Red blood cells contain?
Hemoglobin
What is the function of Erythrocytes (RBC)
Carry oxygen to cells
Carbon dioxide from cells
What is anemias?
- Reduction of hemoglobin concentration, hematocrit, or
number of red blood cells - Oxygen carrying capacity decreases
What are the signs and symptoms of anemia?
Pale thin skin and mucosa
Weakness, fatigue
Dyspnea when exerted
Headache, vertigo, tinnitus
vision dimness
Spots in eyes
brittle nails
What are the cause of anemias?
- Blood loss- acute or chronic (slow bleeding) = iron deficiency anemia.
-
Dimished RBC Production= nutritional deficiency- pernicious anemia( B12), Iron deficiency anemia (pregnancy, growth spurt),
Bone marrow failure= Aplastic anemia (inherited) - Hemolysis
- Genetic Blood Disorders
What is hemolysis?
- Destruction of RBCs “hemolytic anemia”
- Heredity: Sickle cell disease
- Acquired: Erythroblastosis fetalis- Rh negative mother develops antibodies against Rh positive fetus
What is Genetic Blood Disorders?
- Thalassemia: Decreased production of normal hemoglobin
Middle eastern, Mediterranean, African, or Southeast Asian descent
What is Iron Deficiency Anemia?
Small RBC
- RBC Smaller= deficient in hemoglobin
- More in younger individuals
- More in Females than males
What are the causes of iron deficiency anemia?
- Malnutrition or malabsorption
- Chronic infection
- Increased body demand for iron above daily intake
- Chronic blood loss :Internal bleeding, Excessive menstruation, Frequent blood donations.
What are the medical management for Iron Deficiency anemia?
-Oral ferrous iron tablets: Liquid preparations that may stain teeth
-Dietary changes
What are the oral manifestations of Iron deficiency anemia?
- Atrophic glossitis (smooth and shiny)
- Angular chelitits
- Secondary irritations like Smoking, mechanical trauma, & hot, spicy foods
What are megaloblastic Anemia?
- Abnormally large RBCs
- Result as a vitamin B12 (pernicious anemia) or folate
deficiency (folate deficiency anemia) or both
What is the cause of pernicious anemia?
- Decrease intake of B12
- Impaired absorption of B12
What is the medical management for Pernicious Anemia?
B12 injections
Dietary Modifications
What is the cause of Folate deficiency anemia?
Decreased intake of folate
Increased requirement of folate
What are the sources of folate?
Liver, kidney
Fruits, green leafy and cruiferous veggies
Dairy products, whole grains cereals
Folate Deficiency Anemia can lead to ?
Fetal development deficiency such as neural tube defects (Spina bifida)
What are the signs and symptoms of megablastic anemias?
- Tingling or numbness of fingers and toes
- Palpitations, weight loss and syncope
- Difficulty walking, lack of coordination, mental confusion
*
Neurology symptoms are specific to ?
Pernicious Anemia
What are the oral manifestations of megablastic anemia?
Atrophic glossitis
Sensitivity to hot or spicy foods
Painful swallowing
What is sickle cell disease?
Heredity hemolytic disease resulting
in defective hemoglobin molecule
causing sickle shaped erythrocytes
Most common in African Americans and mediterranean
What is the test for sickle cell disease?
Hemoglobin electrophoresis test
What does sickle cell do to the body and when is it detected?
Impairs growth and development during youth and detection is possible before birth but signs show up around 6 months
If a person has sickle cell disease what are they losing or gaining?
Hemogloblin loses oxygen = RBC distorts
Increase fluid viscosity= Thrombosis, infraction
What is sickle cell crisis?
- Acute form of disease
- Clinical exacerbations with remission periods
- Appearance with or without stimuli
- Viral or bacterial infections, systemic disease
- Hypoxia, dehydration, sudden temperature changes
- Physical activity, extreme fatigue, acidosis
- Stress/anxiety, physical burden (pregnancy), trauma
What are the signs and symptoms of sickle cell disease?
Pain in extremities, head back, chest, abdomen
Infarctions in various tissues and organs
Symptoms of seizure, stroke, coma Infections reduce red blood cell production
What are the systemic changes within sickle cell disease?
- Enlargement of heart, murmurs, coronary insufficiency
- Ocular disturbances, even blindness
- Organs affected
Major: kidney
Minor: lungs, liver, spleen, bones
What is the mortality rate with sickle cell disease?
- increase rate in young children due to infections and crisis
- Children less than 3 are more at risk for fatal sepsis and meningitis
What is the medical management for sickle cell?
- Folate supplements
- Treat infections promptly
- Stem-cell transplantation
- Daily penicillin to prevent infections (≤ 6 years old)
- Pain relief medications
- Oxygen therapy and blood transfusions
What is the dental management for Sickle cell disease?
- Antibiotics prophylactically
- Use local anesthesia without epinephrine
- Avoid long complicated dental appointments
What are the oral manifestations of sickle cell disease?
- Jaundice color
- Decreased radiodensity; osteoporosis
- Coarse trabecular pattern “step-ladder”
- Periodontal involvement → sickle cell crisis
- Significant bone loss in children → perio
What is Polycythemias
The increase of the number of RBCs above the normal level
What are the three types of polycythemias?
- Relative
- Primary
- Secondary
What is the relative type of polycythemias
Loss of plasma without loss of RBCs
Dehydration, diarrhea, vomiting, sweating, burns
What is the Primary type of polycythemias
- ↑ RBC count and hemoglobin level
- Affects oxygen transport to tissues due to blood viscosity
What is the Secondary type of polycythemias?
- ↑ number RBCs from hypoxia (high altitude), pulmonary / heart disease, smoking
What is the oral manifestations of polycythemias?
Gingival bleeding
Difficulty controlling bleeding
Numerous petechiae
Pale mucous membranes
Atrophy of tongue papillae
Painful tongue (glossodynia)
Acute or chronic infections
Severe ulcerations not responding to treatment
Exaggerated response to irritants
What are the Erythrocytes/Red blood cell disorders?
Anemias (Iron deficiency and megaloblastic)
Sickle Cell Disease
Polycythemias
What is Leukocytes/ white blood cells?
- Granulocytes: neutrophils, eosinophils, basophils
- Agranulocyctes: lymphocytes, monocytes
What is the function of leukocytes?
- Phagocytic, immunologic, inflammatory process functions
- Cell count used in detection and monitoring of disease
states
Neutrophils are?
PMNs
* Most numerous of all WBCs
* Phagocytosis function
* Arrive 1st at injury
Eosinophils are?
Few in number
Prominent in allergic conditions
Basophils are?
↑ vascular permeability during inflammation → phagocytic cells entry
Lymphocytes are?
- Can revert to blast-like cell
- Differentiate into β, T, NK cells
- Plasma Cell
Monocytes are?
- 2nd cell to participate in inflammatory response
- Phagocytosis function
- Differentiate into macrophages
What is** Leukopenia**?
Decrease in total of white blood cells
What is the cause of leukopenia?
Conditions
-Specific
▪ HIV-AIDS, typhoid fever, measles, malaria, influenza
-Disease or Intoxification of Bone Marrow
▪ Chronic drug poisoning, radiation, autoimmune reactions, drug-induced immune
reaction
What are Lymphoma?
Abnormal Lymphocytes
Cancer: Non-hodgkins, Hodgkin
What is the treatment for lymphoma?
Chemotherapy and stem cell transplant
**What is Agraulocytosis (malignant neutropenia)
Destruction of the bone marrow, rare
↑ infection susceptibility (oral ulceration)
What is the cause of Agraulocytosis?
Drug and chemical toxicity, antipsychotic, autoimmune reactions
What is Leukocytosis?
↑ in circulating WBCs
What causes Leukocytosis?
Inflammatory or infectious states, trauma, exertion, leukemia
What are the white blood cell disorders?
Leukopenia
Lymphoma
Agraulocytosis
Leukocytosis
What is the function of platelets?
- Blood clotting mechanism
- Maintain integrity of the blood capillaries → closes when injured
- Dissolve clot after healing
What are the two types of coagulation diseases?
Acquired disorders and Hereditary
What is the acquired disorders for coagulation diseases?
- Vitamin K deficiency
- Liver disease
- Thrombocytopenia
- Anticoagulation drugs
What is the Hereditary Disease
- Hemophilia A
- Hemophilia B
- von Willebrand’s disease
What is thrombocytopenia?
Decrease in production = decrease of platets
What are the causes of thrombocytopenia?
Invasive disease (leukemia), Folate or pernicous
What does the anticoagulation drugs do?
Blood clotting mechanism interference → ↑ bleeding
Etiologies
▪ Heparin, Coumadin, Aspirin
What is Heophilias?
Congenital disorders resulting in defective blood clotting
mechanism
What are the types of hemophilias?
1) Hemophilia A (classic)
Hereditary disorder of the platelet function
▪ Factor VIII deficiency
85% hemophiliacs have this form
2)** Hemophilia B (Christmas Disease)**
Deficient plasma protein (factor IX) → clots
3) von Willebrand’s disease
Prolonged bleeding time with normal platelet count
3 types based on how inherited
Hemophilias
What are effects and long term complications of hemophilias?
- Minor trauma → bleeding and bruising
- Bleeding into joint soft tissue (hemarthroses)
- Joint deformity, crippling
- Intramuscular hemorrhage
What are the types of oral bleeding seen with hemophilias/
- Gingival bleeding common
- Fear of bleeding → decrease oral hygiene → increased biofilm and inflammation
What is the dental/medical management of hemophilias?
Medical History- Type, severity, treatment, medications, family history
Consultation- Physician / Hemotologist
Signs of leukemia, lymphoma (WBC disorders) {lots of bleeding}
Premedication requirement?
factor replacement therapy prior to dental appointment
What are the clinical procedures for hemophilias?
- Thorough EO to palpate lymph nodes
- Prevent infection (i.e., gingival, caries)
- Educate and reinforce oral hygiene; daily biofilm removal
- scaling in small segments
- Avoid mucous membrane laceration
What is used for pain control for hemophilia patient?
Advice acetaminophen and avoid aspirin
