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Diseases of human systems > Diseases of the blood > Flashcards

Diseases of the blood Flashcards

1
Q

What are the four main components of blood

A

Plasma
WBC’s
RBC’s
Platelets

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2
Q

What makes up plasma

A

Proteins
ions
water
nutrients
wasres
gases

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3
Q

What do these mean:
Leuko

Erythro

Thrombocyto

Pan / poly

A

Leuko – white blood cell​

Erythro – red blood cell​

Thrombocyto – platelet​

Pan / poly – all blood cells

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4
Q

What indicates excess of

A

Cytosis

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5
Q

What does the ending penia mean

A

Lack of

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6
Q

How can cell sizes be written

A

Microcytic – small cell size​

Normocytic - normal cell size​

Macrocytic – large cell size

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7
Q

What is the purpose of blood

A

Transportation (oxygen from lungs to tissues, hormones, nutrients, waste to liver and kidneys)​

Clotting (more in Coagulation lecture)​

Immune (B cells, T cells…)​

Temperature regulation

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8
Q

What are the two origin sites of blood cells

A

Myeloid
Lymphoid

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9
Q

What is the life span of rbc

A

120 days

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10
Q

What is anaemia

A

Low haemoglobin in the blood

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11
Q

How many haem molecules does each RBC have

A

270 million

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12
Q

What are the causes of anaemia

A

Impaired production
Increased breakdown (haemolysis)
Increased demand
Increased blood loss

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13
Q

How does impaired production cause anaemia

A

Issue with the marrow:​
-Congenital aplasia​
-Medication side effects ​

Lack of EPO​
-Severe CKD​

Lack of “raw materials”​
-Iron ​
-Vitamin B12​
-Folic acid​

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14
Q

How does haemolysis cause anaemia

A

Issue with the RBC​
-G6PD deficiency​
-Hereditary spherocytosis​

Issue with haemoglobin​
-Thalassaemia​
-Sickle cell disease​

Immune driven​
-Autoimmune haemolysis​

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15
Q

What causes increased demand leading to anaemia

A

Pregnancy
Growth phases (children)

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16
Q

Why can acute bleeding , menstrual bleeding and gastrointestinal losses (cancer) all cause anaemia

A

increased blood loss

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17
Q

What are symptoms of anaemia

A

Tiredness​

Shortness of breath​

Dizziness​

Palpitations (angina if severe)

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18
Q

What are visual indicators of anaemia

A

Pale skin
Conjunctival pallor

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19
Q

What classical signs of anaemis can we see as dentists

A

Angular cheilitis
Koilonchyia (spoon shaped nails-iron deficiency)

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20
Q

What subsequent deficiencies can anaemia cause

A

Iron
Folate
Vit B12

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21
Q

What are the causes of iron deficiency anaemia

A

Reduced dietary intake​

Impaired absorption – in duodenum​

Increased loss – menstrual, GI bleeding etc.​

Increased demands – pregnancy, growth

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22
Q

What can cause reduced iron absorption

A

Inflammation in duodenum ​
-Coeliac disease**​

Lack of stomach acid​
-Proton pump inhibitor (omeprazole)

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23
Q

Where is the main site of iron absorption

A

Duodenum

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24
Q

What causes a Vit B12 deficiency

A

Reduced intake​

Impaired absorption​

Medication side effect (metformin)

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25
Q

What are the symptoms of Vit B12 deficiencies

A

Anaemia symptoms​

Peripheral neuropathy​

Visual changes
Results in a macrocytic anaemia

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26
Q

How can most deficiencies be managed/treated

A

Oral supplementation
IV supplementation
Intra-muscular supplementation

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27
Q

What is required for Vit B12 absorption

A

Intrinsic factor

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28
Q

Where is Vit B12 absorbed

A

Ileum

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29
Q

Why might Vit B12 absorption be impaired

A

Pernicious anaemia ***​

Gastrectomy​

Crohn’s disease (inflammation in ileum)​

Following bowel surgery

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30
Q

What is pernicious anaemia

A

Autoimmune condition​

Commonly middle-aged patient​

Antibodies destroy parietal cells in stomach​

Can also target intrinsic factor itself​

No intrinsic factor ​

No absorption of vitamin B12 in ileum​

​

IM supplementation (3 monthly)​

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31
Q

Where is folic acid absorbed

A

Jejunum

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32
Q

What can cause folic acid deficiency

A

Dietary (found in leafy vegetables)​

Medications (methotrexate, phenytoin)​

Alcohol excess​

Bowel inflammation

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33
Q

What do we need folic acid for

A

folic acid has important role in foetal development​

Spina bifida

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34
Q

What is ferritin

A

the molecule in which iron is stored in cells​

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35
Q

How can anaemia be tested for

A

Blood tests​

Full blood count​

Haematinics (ferritin, folate, B12)​

May consider endoscopy/colonoscopy if suspicious of GI bleeding​

Blood in stool, weight loss, older patient

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36
Q

When will the mean red blood cell volume be <80 (microcytic)

A

-Iron deficiency​

-Thalassaemia​

-Lead poisoning

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37
Q

When are RBCs often normocytic (80-100)

A

-Bleeding​

-Kidney disease​

-Anaemia of chronic disease

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38
Q

What size of RBC’s would often be present with B12 deficiency and folic acid deficiency

A

Macrocytic (>100)

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39
Q

What is thalassaemia

A

Genetic defect in the protein chains which make up haemoglobin (autosomal recessive)​

Alpha globin (x2)​

Beta globin (x2)

Meaning there is alpha or beta thalassaemia

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40
Q

What effect does thalassaemia have on RBCs

A

RBCs are more fragile, therefore the spleen detects and destroys damaged RBCs

Microcytic anaemia

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41
Q

How is thalassaemia managed

A

Monitoring (minor)​

Blood transfusions​

Splenectomy ​

Bone marrow transplant

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42
Q

What are the properties of sickle cell anaemia

A

Genetic condition, results in crescent-shaped RBCs​

Autosomal recessive

Crescent shape = more fragile and easily destroyed

Screening – newborns

Reduced severity of Malaria​

Higher incidence in African, Caribbean populations

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43
Q

How is sickle cell anaemia managed

A

Avoid triggers​

Antibiotic prophylaxis​

Specialist medications​

Blood transfusions​

Bone marrow transplant

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44
Q

How can anaemia manifest within the oral environment

A

Angular cheilitis
Mucosal atrophy
Glossitis - smooth or ‘beefy’ (tongue)
Recurrent aphthous stomatitis (ulcers)
Candidal infections
Oral dysaesthesia​

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45
Q

What is the universal donor

A

Group O

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46
Q

What is the universal recipient

A

Group AB

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47
Q

How long does a blood transfusion take

A

3-4 hours

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48
Q

What is cross-matching

A

Sample taken from recipient and tested against donor’s blood

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49
Q

What are the complications of blood transfusions

A

Transfusion associated fever​
-Benign

Incompatible blood (e.g. giving Group B blood to a Group A recipient)​
-Haemolysis

Fluid overload -> heart failure​
-TACO (transfusion associated circulatory overload)

Anaphylaxis

Infection (rare)

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50
Q

What are the normal ranges of Haemoglobin g/L in adults blood

A

Male: 135-180
Female: 115-160

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51
Q

What are the normal adult ranges of WBCs in blood x10^9/L

A

4-11

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52
Q

How many platelets should adults have in their blood x10^9/L

A

150-400

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53
Q

What is the normal MCV (mean cell volume) within adult blood

A

78-100

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54
Q

What is leukaemia

A

A group of blood cancers​
-particular line of stem cells in the bone marrow​
-unregulated production​

Bone marrow produces high amount of immature “-blast” cells​
-Loss of marrow function

Blast cells propagate, displace normal cell development

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55
Q

What is caused by platelet deficiency

A

Easy bleeding

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56
Q

What is caused by WBC deficiency of dysfunction

A

Impaired immunity

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57
Q

What are the subtypes of leukaemia

A

Acute lymphoblastic – most often kids <5years old ​

Down syndrome = risk factor​

​

Acute myeloid leukaemia – in adults​

​

Chronic lymphocytic leukaemia – older adults, slow proliferation​

​

Chronic myeloid leukaemia – Philadelphia chromosome

58
Q

What are some non-specific symptoms of leukaemias

A

Fatigue ​

Fever​

Weight loss​

Easy bruising​

Easy bleeding​

Abnormal infections​

Lymphadenopathy

59
Q

How is leukaemia diagnosed

A

via blood tests, bone marrow biopsy and scans​

60
Q

What are the main managment methods of leukaemia

A

Mainly chemotherapy​

Targeted therapies (monoclonal antibodies e.g. Rituximab)​

Bone marrow transplant (immunosuppression +++)

61
Q

    What does this blood test indicate 

	 Result  Normal range​

Hb    107    115 - 160​

WCC    6.8    4.0 - 11.0​

Platelets  378    150 - 400​

MCV    105    78 - 100​

​

Ferritin    67    10 - 300​

Folate    10.4    >4.0​

B12     98    180 - 1000

A

Macrocytic anaemia secondary to B12 deficiency

62
Q

What cells will chemotherapy target aside from Fast-growing cancer cells

A

Oral mucosa​

Gut mucosa​

Hair cells

63
Q

Why is chemotherapy used

A

Halts or slows the growth of cancer cells, which grow and divide quickly

64
Q

What are the general side effects of chemotherapy

A

Hair loss​

Nausea, vomiting, diarrhoea​

Infertility​

Bone marrow suppression ​

Immunosuppression​

Cardiac toxicity​

Oral mucositis ​

Depression / anxiety

65
Q

What is lymphoma

A

Cancer affecting the white blood cells in the lymphatic system​

​

The lymph nodes become abnormally large (painless)

66
Q

What are the two main types of lymphoma

A

Hodgkin’s lymphoma (20-40 year old)​

Non-Hodgkin lymphoma (most common)

67
Q

What is the key presenting symptoms of lymphoma

A

Lymphadenopathy
-Non-tender​
-Rubbery​
-Pain with alcohol

68
Q

What is the difference between acute and chronic leukaemia

A

Acute - raid and more severe
Chronic - slow less treatment required

69
Q

What are common constitutional/Bsymptoms of lymphadenopathy

A

Fever​

Night sweats ​

Weight loss

Fatigue​

Itching​

Cough​

Shortness of breath​

Abdominal pain​

Recurrent infections​

70
Q

How is lymphoma diagnosed

A

Lymph node biopsy***​

Reed-Sternberg cells (in Hodgkin’s lymphoma)​
-“Owl’s eyes”​

Scans (CT, MRI, PET)

71
Q

How can lymphoma be managed

A

Chemotherapy​

Radiotherapy​

Targeted therapy​
-Rituximab – targets B cells (CD 20)​

Stem cell transplant

72
Q

What is myeloma

A

Cancer affecting the plasma cells​

B cells which produce antibodies

73
Q

What protein is overproduced with myeloma

A

“paraprotein”

causes organ/tissue impairment​

present in urine (Bence-Jones protein)

74
Q

In whom is myeloma most common

A

70+ year olds

74
Q

What are the key symptoms/affects of myeloma

A

Calcium (increased) ​

Renal impairment​

Anaemia​

Bone lesions​
-Pathological fractures

75
Q

How does myeloma present

A

Unexplained fever​

Weight loss​

Fatigue​

Anaemia​

Renal impairment​

Bone pain (back pain)​

Pathological fractures**​

Very rarely can present in mouth

76
Q

What is the management of myeloma

A

No cure​

​

Management focuses on disease control​

Chemotherapy​

Stem cell transplant​

Bisphosphonates ***

77
Q

What are the Oral manifestations of haematological malignancy

A

Easy bleeding (Platelets - thrombocytopenia)​
-Petechiae​
-Haemorrhage (e.g. after extraction)​
-Spontaneous gingival bleeding

Low immunity (WBC – leukopenia/neutropenia)​
-Candidosis​
-Herpes simplex virus

Anaemia (RBC)​
-Pallor

Gingival swelling ​
-Acute myeloid leukaemia

Presentation of myeloma in mandible (rare

78
Q

What are the stages of lymphoma

A

Stage 1 - one lymphadenopathy
Stage 2 - two on once side of diaphragm
Stage 3 - groups across diaphragm
Stage 4 - widespread metastasis

79
Q

What are oral side effects of chemotherapy

A

Mucositis​

Dry mouth – caries risk, taste disturbance, dysphagia​

Infection (fungal, viral) – vulnerable**​

Easy bleeding (thrombocytopenia)

80
Q

Within the oral cavity what can radiotherapy cause

A

Dry mouth​

Osteoradionecrosis of jaw (if in way of beam)​

Fibrosis = trismus

81
Q

What are the main side effects of treatment for cancers

A

Fungal infections (reduced salivary flow and immunosuppression)
Xerostomia (reduced salivary flow)
Caries (high calorie dietary supplements and reduced salivary flow)
Osteonecrosis (anti-resorptives, anti-angiogenics and immunosuppressive effects)
Bleeding tendencies (Thrombocytopenia)

82
Q

How can dental health be optimised prior to the patient starting of chemotherapy

A

Dental assessment​

OPT radiograph​

Removal of hopeless teeth / teeth that may cause issues / infection​

Removal and stabilisation of caries​

Removal of traumatic edges​

Toothbrushing instruction​

Fabrication of mouthguard​

High fluoride toothpaste​

Fluoride varnish​

Dietary advice​

Prepare patient for expected oral side effects​

Completion of treatment at least 10 days before chemotherapy

83
Q

How long before starting chemotherapy should dental work be completed

A

At least 10 days

84
Q

When a patient is undergoing chemotherapy how can oral health be optimised

A

Hygienist support​

Maintenance of oral hygiene​

Ongoing caries prevention​

Assess and manage mucositis​

Provision of saliva substitutes​

Avoid any elective dental treatment

85
Q

What is the common name for candidosis

A

Thrush

86
Q

What is mucositis

A

Ulceration of mucosal cells

87
Q

What are the steps in clotting

A

Injury​

​

Vascular phase​

​

Platelet phase (primary haemostasis)​

​

Coagulation phase (secondary haemostasis)​

​

Clot formation and stabilisation​

​

Clot dissolution​

88
Q

What factors are released from the vessel lining after injury

A

ADP (platelets)
Tissue factor
Endothelins

89
Q

What specifically aside from injury attracts platelets

A

Exposed collagen, ADP and endothelins

90
Q

What is fibrinolysis

A

Clot breakdown

91
Q

What is the difference between intrinsic and extrinsic coagulation cascade

A

Intrinsic - in bloodstream
Extrinsic - in vessel wall

92
Q

What is the result of both intrinsic and extrinsic coagulation cascade

A

Fibrin clot

93
Q

What medications affect platelets (clotting)

A

Aspirin​

Clopidogrel​

Dipyridamole​

Ticagrelor

94
Q

What medications affect anticoagulants (clotting)

A

Warfarin​

Edoxaban​

Rivaroxaban​

Apixaban​

Dabigatran

95
Q

What injectable medication affects clotting

A

Heparin

96
Q

Why are patients prescribed blood thinners

A

Coronary disease – to prevent an MI or stroke​

​

Peripheral artery disease – to reduce symptoms​

​

Prosthetic heart valves – to prevent a clot​

​

Atrial fibrillation – to prevent a stroke​

​

Pulmonary embolism/Deep vein thrombosis – to treat or prevent​

​

Following surgery or pregnancy

97
Q

What is the lifespan of platelets

A

7-10 days

98
Q

How does aspirin reduce platelet aggregation

A

inhibits COX enzyme, to reduce production of thromboxane A2, thereby reducing platelet aggregation

99
Q

When would a patient be taking 75mg of aspirin daily

A

Coronary artery disease (secondary prevention)​

Transient ischaemic attack (secondary prevention)

100
Q

What is a 300mg dose of aspirin prescribed/given for

A

Given in acute MI/stroke

101
Q

How does Warfarin affect clotting

A

inhibits the production of vitamin K, which is essential in formation of coagulation factors II, VII, IX, X (2, 7, 9, 10)

102
Q

What substances will warfarin interact with

A

Metronidazole​

Fluconazole​

NSAIDs​

Alcohol​

Grapefruit

103
Q

What should be continuously monitored when taking warfarin

A

INR – International Normalised Ratio

104
Q

What doesDOAC stand for

A

Direct Oral Anticoagulants

105
Q

What are some examples of DOACs

A

Edoxaban, rivaroxaban, apixaban​

Dabigatran ​

106
Q

How do DOACs affect clotting

A

inhibits factor Xa
Dabigatran also inhibits free thrombin

107
Q

Why are DOACs preferable over warfarin

A

Do not require monitoring
Less interactions
Faster onset
Fixed dosage
Shorter offset

108
Q

Do direct oral and injectable anticoagulants have the same affact on clotting

A

Yes both affect formation offactor Xa and thrombin

109
Q

What procedures pose a high risk for post op bleeding complications

A

Complex extractions (adjacent extractions or more then 3 at once)
Gingivalrecontouring
Biopsies
Flap raising surgery:
Periodontal surgery
Preprosthetic surgery
Perriradicular surgery
Dental implant surgery

110
Q

What should you doif a patient on blood thinners needs dental surgery/procedures

A

Consult with patient’s prescribing specialist/GP if unsure***​

Consult with more senior dentist if unsure***​

Delay dental treatment until anticoagulant finishes (if planned)​

Plan treatment for early in the week​

Plan treatment for early in the day​

“Atraumatic” surgery, staged​

Consider packing and suturing​

Ensure bleeding has stopped ​

Give excellent post-operative instructions​

Advise the patient to take paracetamol, unless contraindicated, for pain relief rather than NSAIDs such as aspirin, ibuprofen, diclofenac or naproxen

111
Q

What should be done if the patients INR is below 4 on warfarin within the 24 hrs before procedure

A

Treat without interrupting medication

112
Q

What is the recommendation if the patient’s INR levels are 4 or above on warfarin

A

Delay invasive treatment or refer if urgent

113
Q

What DOACs require the morning dose to be delayed or missed prior to dental treatment

A

Apixaban or dibigatran (miss)
Rivaroxaban (delay)

114
Q

What are inherited bleeding disorders

A

Von Willebrand disease​

Haemophilia A​

Haemophilia B

115
Q

What are acquired bleeding disorders

A

`Liver disease​

Thrombocytopenia

116
Q

How does liver disease result in bleeding disorder

A

Reduced platelet number and function​
-Thrombopoeitin (TPO) hormone which stimulates platelet production is produced in liver​

Impaired production of coagulation factors​

I, II, V, VII, IX, X, XI, and XIII

117
Q

What is the meaning of thrombocytopenia (breakdown)

A

Thrombo - clot
cyto - cell
penia - low

118
Q

What is thrombocytopenia

A

Low platelets

119
Q

What diseases cause reduced production of platelets (thrombocytopenia)

A

B12 deficiency​

Folic acid deficiency​

Liver disease​

Leukaemia​

Chemotherapy

120
Q

What is the most common inherited cause of abnormal and prolonged bleeding

A

Von Willebrand Disease
​

Autosomal dominant inheritance - familial

121
Q

What are the differences between types of von willebrand disease

A

Type 1(autosomal dominant) involves a partial deficiency of VWF and is the most common and mildest type​

Type 2 (autosomal dominan) tinvolves the reduced function of VWF​

Type 3 (autosomal recessive) involves a complete deficiency of VWF and is the most rare and severe type

122
Q

What causes the abnormal bleeding with Von willebrand disease

A

Impaired platelet aggregation​

Impaired transport of factor VIII to wound

123
Q

How does DDAVP/desmopressin act to reduce bleeding

A

Works by increasing vWF production and factor VIII production

124
Q

What treatments can be used to carry out dental procedures on Von Willebrand patients

A

tranexamic acid oral/mouthwash (if mild disease and low risk procedure)​

DDAVP/desmopressin (if more likely to cause bleeding)​

Von Willebrand factor concentrate (if severe disease and high risk procedure)

125
Q

What is haemophilia

A

X-linked recessive (primarily affects males)​
Rare

Haemophilia A – deficiency factor VIII
Haemophilia B – deficiency factor IX

Spontaneous bleeding (into joints) and significant bleeding following minor trauma​

126
Q

What separates mild, moderate and severe haemophiliacs

A

mild (6-40% factor)
moderate (2-5%)
severe (<1%)

127
Q

What blood products are given before treatments of haemophiliacs

A

Haemophilia A – use of DDAVP/desmopressin (mild) or factor VIII concentrate (moderate/severe)​

Haemophilia B – requires use of factor IX concentrate (DDAVP not effective)

128
Q

How long before a procedure should blood products be given to patients with bleeding disorders

A

within 30 mins to an hour of treatment

129
Q

When are those with haemophilia prone to bleeding

A

Severe - frequent spontaneous bleeds (should have all treatments carried out at a hospital)
Moderate - may have spontaneous bleeds (managed same as severe)
Mild - bleed after trauma or surgery

130
Q

When administering local anaesthetic to those with bleeding disorders what should be avoided where possible

A

try to avoid inferior alveolar nerve block = risk of bleeding from muscle – haematoma, airway compromise​

buccal infiltration, intra-papillary injections and intra-ligamentary injections preferred​

131
Q

What blood tests are related to clotting

A

Full blood count
Liver function test (Most coagulation factors are made in liver)
INR (Compares how long it takes patient’s blood to clot compared to a laboratory standard)
Coagulation screen

132
Q

What are the variation of results seen from an INR blood test

A

Higher number = longer to clot​

Healthy person on no medication = 1​

Usual range for patients on warfarin = ~2 – 4​

Normally should be <4 for dental treatment​

133
Q

What is the name for clotting too much

A

Thrombophilia

134
Q

What elements of the clotting cascade prevent ‘over-clotting’

A

Protein C​

Protein S​

Antithrombin

135
Q

What diseases/disorders are associated with clotting too much

A

Antiphospholipid syndrome​

Protein C / Protein S deficiency

136
Q

What is a pulmonary embolism

A

Blood clot in lung

137
Q

What is a deep vein thrombosis

A

Blood clot in limbs (often leg)

138
Q

What are symptoms of a deep vein thrombosis

A

Calf swelling and tenderness
Dilated superficial veins
Colour change
Oedema

139
Q

What are the risk factors of thrombophilia

A

Previous DVT/PE​

Prolonged immobility (long haul flight, long hospital stay)​

Plaster cast​

Combined oral contraceptive pill / HRT​

Surgical operation (particularly orthopaedic)​

Acutely unwell (sepsis)​

Cancer​

Dehydration​

Pregnancy

140
Q

Why do most thrombophiliacs become bleeding risks for dentists

A

Treated with anticoagulants

Diseases of human systems (7 decks)

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