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Dentistry Human Disease > Haematological Disease > Flashcards

Haematological Disease Flashcards

1
Q

What are the three main functions of the blood?

A
  1. Transport nutrients
  2. Removal of waste
  3. Transport host defences
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2
Q

What is the function of red blood cells?

A

Carrying oxygen in bloodstream

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3
Q

What are the two main plasma proteins?

A
  • albumin
  • globulin
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4
Q

What is meant by, FBC?

A

Full blood count

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5
Q

What is meant by, RBC?

A

Red blood cells

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6
Q

What is meant by, RCC?

A

Red cell counts

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7
Q

What is meant by, WCC?

A

White cell count

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8
Q

What is meant by, PLT?

A

Platelets

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9
Q

What is meant by, HCT?

A

Haematocrit

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10
Q

What is meant by, MCV?

A

Mean cell volume

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11
Q

What condition is characterised by low levels of Hb in the blood?

A

Anaemia

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12
Q

What condition is characterised by low WCC?

A

Leukopenia

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13
Q

What condition is characterised by low platelets?

A

Thrombocytopenia

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14
Q

What condition is characterised by all cell counts being reduced?

A

Pancytopenia

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15
Q

If there are multiple low levels of cell counts what does this suggest?

A

Bone marrow failure

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16
Q

What condition is characterised by raised Hb count in the blood?

A

Polycytheamia

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17
Q

What condition is characterised by raised WCC in blood?

A

Leukocytosis

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18
Q

What condition is characterised by raised platelets in blood?

A

Thrombocythaemia

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19
Q

What are the two cancers of the blood?

A

Leukaemia
Lymphoma

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20
Q

What blood malignancy is described:

Neoplastic proliferation of white cells, usually disseminated.

A

Leukaemia

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21
Q

What blood malignancy is described:

Neoplastic proliferation of white cells, usually a solid tumour.

A

Lymphoma

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22
Q

Name 4 chronic malignancies that stem from a lymphoid lineage?

A
  1. Chronic lymphocytic leukaemia
  2. Hodgkin’s lymphoma
  3. Non-Hodgkin’s lymphoma
  4. Multiple myeloma
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23
Q

Name an acute malignancy of lymphoid lineage?

A

Acute lymphoblastic leukaemia

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24
Q

Name an acute malignancy of myeloid lineage?

A

Acute myeloid leukaemia

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25
Q

Name two chronic malignancies of myeloid lineage?

A
  1. Chronic myeloid leukaemia
  2. Myeloproliferative disorders
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26
Q

What is porphyria?

A

An abnormality of haem metabolism

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27
Q

Why is acute intermittent porphyria important for dentists to be aware of?

A

Acute attacks can be triggered by medicines including LA.

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28
Q

What is the main symptom of an acute porphyria episode?

A

Severe abdominal pain

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29
Q

What are the clinical side effects of porphyria?

A
  • photosensitive rash
  • Neuropsychiatric disturbances (motor and sensory changes, seizures)
  • hypertension and tachycardia
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30
Q

What are the two causes of haemoglobin reduction in the blood?

A
  1. Inability to make Haem (usually an iron deficiency)
  2. Inability to make the correct globin chains (e.g. thalasseamia, or sickle cell)
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31
Q

What factor is the greatest indicator as to the cause of anaemia?

A

The size of the red blood cells (MCV)

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32
Q

What is meant by haematinics? Give three examples.

A

Things used to make red blood cells.
Examples: iron, vitamin B12, folic acid (folate).

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33
Q

Give three examples of sources of iron?

A
  • meat
  • green leafy vegetable
  • iron tablets
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34
Q

What does achlorhydria mean?

A

Absence of hydrochloric acid in the gastric secretions (lack of stomach acid)

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35
Q

What drugs can induce achlorhydria?

A

Proton Pump Inhibitors

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36
Q

What food group is high in vitamin B12?

A

Meat and dairy products

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37
Q

What are 3 reasons as to why vitamin B12 absorption may be reduced?

A
  1. Problems with production of intrinsic factor in the stomach
  2. Problem with dietary B12
  3. Disease of the terminal ileum (such as Crohn’s disease)
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38
Q

What individuals are most likely to have vitamin B12 deficiency due to lack of dietary intake?

A

Strict vegans

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39
Q

Gives two examples where lack of intrinsic factor causes vitamin B12 deficiency?

A
  • autoimmune stomach disease (pernicious anaemia)
  • gastric disease
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40
Q

Give an example of when absorption failure results in folic acid deficiency?

A
  • jejunal disease (coeliac disease)
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41
Q

What can be the consequnece of folic acid deficiency in a mum, for a foetus?

A

Neural tube defects (such as spinobifida)

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42
Q

What are the two main diseases considered where abnormal globin chains cause anaemia?

A
  1. Thalassimia
  2. Sickle cell disease
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43
Q

At the very early stages of pregnancy, where is haemoglobin managed and formed?

A

Liver and spleen

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44
Q

What disease is described?

Where little to no haemoglobin is produced and there is genetic mutation of globin chains.

A

Thalassaemia

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45
Q

What are the two different types of Thalassaemia?

A
  1. Alpha chains
  2. Beta chains
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46
Q

What are the 5 clinical effects of Thalassaemia?

A
  1. Chronic anaemia
  2. Marrow hyperplasia
  3. Splenomegaly
  4. Cirrhosis
  5. gallstones
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47
Q

What is the management of Thalassaemia?

A

Blood transfusions and prevention of iron overload

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48
Q

What disease is characterised by abnormal globin chains that change the shape of RBC in low oxygen environements?

A

Sickle cell anaemia

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49
Q

What can be the consequence of change in shape of red blood cells in low oxygen environments (sickle cell anaemia)?

A

Red blood cells cannot pass through capillaries so blocking circulation and causing tissue ischaemia. This can lead to pain and necrosis of the tissue.

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50
Q

Guide two examples of haemoglobinopathies?

A
  1. Thalassaemia
  2. Sickle cell anaemia
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51
Q

What does a raised blood cell volume indicate?

A

Deficiencies in B12 or folic acid

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52
Q

What is a small shaped red blood cells usually indicative of?

A
  1. Iron deficiency
    OR
  2. Thalasseamia
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53
Q

What will tell us if anaemia is associated with normal or reduced number of RBC’s?

A

Red cell count

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54
Q

What is usually the cause of anaemia, when there are normal red cells?

A

Chronic GI bleeding

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55
Q

What is the usual cause of anaemia, presenting with abnormal red cells?

A
  • autoimmune
  • hereditary (e.g. sickle cell)
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56
Q

In what anaemic conditions would MCV of RBC be microcytic?

A
  • iron deficiency
  • thalasseamia
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57
Q

In what anaemic conditions would MCV of RBC be macrocytic?

A
  • B12 deficiency
  • folate deficiency
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58
Q

What term is used to describe red blood cells that appear pale under the microscope, due to there being less Hb in the cells?

A

Hypochromic

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59
Q

What term is used to describe red blood cells that vary in size, some very big cells and some very small cells in the same sample?

A

Ansiocytic

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60
Q

What cell type if released early into the circulation to replace losses of red blood cells in anaemia?

A

Reticulocytes

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61
Q

What are the signs of anaemia?

A
  • pale
  • tachycardia
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62
Q

What are the symptoms of anaemia?

A
  • tired and weak
  • dizzy
  • shortness of breath
  • palpitations
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63
Q

What can be an oral sign of iron deficiency?

A

Smooth tongue (glossitis) and angular chelitis

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64
Q

What can be an oral sign of vitamin B12 deficiency?

A

‘Beefy’ tongue

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65
Q

What is another term for hidden bleeding?

A

Occult bleeding

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66
Q

What investigations are required for anaemia due to GI blood loss?

A
  • faecal occult blood
  • endoscopy
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67
Q

What is the replacement treatmnet for iron deficiency?

A

200mg FeSO4 3x daily for 3 months

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68
Q

What is the replacement treatmnet for B12 deficiency?

A

1mg IM vit B12 x6

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69
Q

What is the replacement treatmnet for folate deficiency?

A

5mg folic acid daily

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70
Q

What are the three main treatment modalities for anaemia?

A
  • replace haematinics
  • transfusions
  • erythropoietin
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71
Q

What are common dental symptoms of deficiency states, such as iron deficiency?

A
  • mucosal atrophy
  • candidiasis
  • recurrent oral ulceration
  • sensory changes
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72
Q

What is the normal level of Hb in the blood for males and females?

A

Males: 14 to 18 g/dl
Females: 12 to 16 g/dl

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73
Q

What is the normal value of RCC in the blood for males and females?

A

Males 4.0 to 5.9 x1012/L
Females 3.8 to 5.2 x1012/L

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74
Q

What is the normal value of WCC in the blood?

A

4,500 to 11,000 WBC’s per micro litre (4.5 to 11.0 x10*9/L)

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75
Q

What is the normal value of red cell MCV in the blood?

A

80-100fl

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76
Q

What is the normal value of platelet count (PLT) in the blood?

A

150,000-450,000 platelets per micro litre of blood

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77
Q

What ferritin level indicates iron deficiency?

A

<30 micrograms/L

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78
Q

What is an important cause of anaemia in females?

A

Menstrual blood loss

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79
Q

name three types of antithrombotic medication and give an example for each.

A
  1. Injectable anticoagulation (e.g. heparins)
  2. Oral anticoagulation (e.g. coumarin, non-coumarin)
  3. Antiplatelet medication (e.g. aspirin/clopidegril)
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80
Q

What injectable drug allows rapid control of anticoagulation (for example during operations) in hospital base settings?

A

Unfractionated heparin

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81
Q

What injectable drug is very useful for patients who have a short term issue with hyper-caoguability? (E.g. individuals who have recently recovered from C-section which makes them more prone to coagulation and DVT)

A

Low molecular weight heparin

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82
Q

Name 5 anticoagulants.

A
  • warfarin
  • apixaban
  • edoxaban
  • rivaroxaban
  • dabigatran
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83
Q

Name 4 anti-platelets.

A
  • low dose aspirin
  • clopidegrol
  • dipyridamole
  • ticagrelor
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84
Q

What dental procedures should be undertaken with caution if a patient has a medical condition which may cause them to bleed?

A
  • extractions
  • minor oral surgery
  • implants
  • periodontal surgery
  • biopsies
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85
Q

What 5 conditions involve blood clots forming too readily on or in the circulation, and are indications for a patient to be taking anticoagulants?

A
  1. Atrial fibrillation
  2. deep vein thrombosis
  3. Heart valve disease
  4. Mechanical heart valves
  5. Thrombophilia
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86
Q

What anticoagulant is a coumarin?

A

Warfarin

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87
Q

What anticoagulant is a direct thrombin inhibitor?

A

Dabigatran

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88
Q

What anticoagulants are factor Xa inhibitors?

A
  • apixaban
  • rivaroxaban
  • edoxaban
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89
Q

What commonly used anticoagulant is described as a vitamin K antagonist?

A

Warfarin

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90
Q

What is the action of warfarin?

A

Inhibits production of vitamin K dependent clotting factors 2,7,9 and 10.

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91
Q

What does INR stand for?

A

International normalised ratio

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92
Q

What does INR measure?

A

How long it takes for your blood to clot.

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93
Q

What is a normal INR reading?

A

2-3

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94
Q

What is a normal INR reading in individuals with a prosthetic valve and who are at higher risk of DVT?

A

3-4

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95
Q

How often should a patients INR be checked?

A

Every 4-8 weeks

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96
Q

What precautionary steps must be taken for patients on warfarin who require dental procedures likely to cause haemorrhage?

A
  • INR and FBC blood test within 72 hours of treatment
  • treat early in the day and week
  • INR must be less than 4 to proceed with caution
97
Q

What drug should you assume everything interacts with and always check the BNF?

98
Q

Name three drug types that should be avoided if dental patients are taking warfarin?

A
  1. Aspirin
  2. NSAIDs
  3. Azole antifungal drugs (e.g. fluconazole)
99
Q

What is the most likley cause of haemorrhage due to warfarin intake?

A

Trauma, such as a hip/bone fracture following a fall.

100
Q

What does NOAC’s stand for?

A

New oral anticoagulants

101
Q

What are the main advantages of NOAC’s over warfarin?

A
  • no need to monitor action as they have predictable bioavailability
  • rapid onset of action, working within a few hours of dose
102
Q

What is the disadvantage of NOAC’s compared to warfarin?

A

Short duration of action, so their effect is lost within a day

103
Q

What is the specific function of NOAC’s?

A

Act by preventing the effect of factor X

104
Q

Name 4 NOAC’s and how often they must be taken daily.

A
  1. Rivaroxaban - once daily
  2. Apixaban - twice daily
  3. Edoxaban - once daily
  4. Dabigatran - once daily
105
Q

Why does apixaban have a higher dosage daily compared to other NOAC’s?

A

Because it has a very short half-life

106
Q

If a low risk dental procedure is being carried out, is NOAC dosage required to be changed?

107
Q

If a higher risk dental procedure is to be carried out, is NOAC dosage to be changed?

A

Yes, miss/delay morning dose

108
Q

How soon after a high risk treatment should the patient start taking their NOAC again?

A

Restart dose immediately after treatment for once daily

109
Q

It’s an IANB safe to give to a patient who is taking NOAC’s or warfarin?

110
Q

For what disorders, is it unsafe to give an IANB?

A

Inherited coagulation defects/blood disorders

111
Q

How long post extraction should an individual with high bleeding risk be kept to assess their bleeding?

112
Q

What class of antibiotics should not be prescribed when a patient is taking a NOAC, due to drug interactions? name two examples of antibiotics from this class.

A

Macrolides.
1. Erythromycin
2. Clarithromycin

113
Q

Other than Macrolides, what two other drugs have interactions with NOACs and should therfore be avoided?

A
  • NSAIDs
  • carbamazepine
114
Q

Name the three drugs grouped as the standard antiplatelet therapy?

A
  1. Low dose aspirin (75mg)
  2. Clopidegrol
  3. Dipyridamole
115
Q

What are the two main functions of antiplatelet drugs?

A
  1. Inhibit platelet aggregation
  2. Inhibit thrombus formation in the arterial circulation
116
Q

Should aspirin ever be stopped for a dental procedure?

117
Q

What prescribed drug interactions are relevant for clopidegrol?

A

Avoid erythromycin/ Fluconazole as this may reduce efficacy

118
Q

What prescribed drug interactions are relevant for ticagrelor?

A

Clarithromycin may increase the antiplatelet effect

119
Q

What is an inherited bleeding disorder?

A

An acquired defect which affects the coagulation of the blood

120
Q

What factors within the blood does an inherited bleeding disorder affect?

A
  1. Coagulation cascade
  2. Platelets
  3. A combined deficiency
121
Q

What is the name of the inherited bleeding disorder characterised by too little clot formed in the coagulation cascade?

A

Haemophilia

122
Q

What is the name of the inherited bleeding disorder characterised by too much clot formed in the coagulation cascade?

A

Thrombophilia

123
Q

What inherited bleeding disorders cause a deficiency in the coagulation factor, VIII?

A

Haemophilia/haemophilia A
Von willebrands disease

124
Q

What inherited bleeding disorders cause a deficiency in the coagulation factor, IX?

A

Christmas disease/haemophilia B

125
Q

What type of inheritance does haemophilia A&B have?

A

Sex-linked recessive

126
Q

What sex chromosome has a defective gene in haemophilia A&B?

A

X chromosome

127
Q

What sex is more likely to be affected by haemophilia A & B?

128
Q

What does the severity of Haemophilia depend on?

A

The amount of factor produced (1u is normal)

129
Q

What does DDAVP stand for?

A

Desmopressin

130
Q

How does DDAVP temporarily boost the amount of factor VIII present within the circulation, to treat mild/carriers of haemophilia A?

A

It doesn’t have affects on coagulation cascade itself, instead displaces protein (factor VIII) from binding to walls of blood vessels, allowing VIII to move into circulation.

131
Q

What is the function of tranexamic acid?

A

Inhibitor of fibrinolysis (keeps any clot that is formed)

132
Q

What would be the appropriate management of very mild cases of haemophilia A?

A

Oral tranexamic acid

133
Q

How can severe and moderate haemophilia A be managed?

A

Use of recombinant factor VIII (medication)

134
Q

How would severe and moderate haemophilia B be managed?

A

Use of recombinant factor IX (medication)

135
Q

How would mild and carriers of haemophilia B be managed?

A

Use of recombinant factor IX (medication)

136
Q

What is another name for haemophilia B?

A

Christmas disease

137
Q

What are coagulation factor inhibitors?

A

Antibodies which develop to factor VIII and IX

138
Q

What inheritance does von willebrands disease have?

A

Autosomal dominant (not transmitted by the X chromosome)

139
Q

What is von willebrands disease?

A

An inherited bleeding disorder caused by deficiency of a plasma coagulation factor (von willebrands factor)

140
Q

What other coagulation factor is reduced upon deficieny in von willebrands factor?

A

Factor VIII

141
Q

How many types of von willebrands disease are there?

142
Q

What types of von willebrands disease have a dominant mild inheritance?

A

Type 1 and 2

143
Q

What type of von willebrands disease has an inheritance of recessive severe?

144
Q

What is the management of severe and moderate von willebrands disease?

145
Q

What is the management of mild/carriers of von willebrands disease?

A

Mild cases may only require tranexamic acid

146
Q

What is the incidence in the UK of haemophilia A?

147
Q

What is the incidence in the UK of haemophilia B?

148
Q

What is the incidence in the UK of von willebrands disease?

149
Q

What is the incidence in the UK of factor XI deficiency?

150
Q

What does degree of bleeding risk depend on?

A

Baseline coagulation factor activity (higher factor activity gives less risk)

151
Q

How often should a haemophilia patient, be reviewed at a haemophilia centre dental unit?

A

Every 2 years

152
Q

What are the 5 main high risk bleeding risk procedures for someone with an inherited bleeding disorder?

A
  • administration of LA
  • extractions
  • minor oral surgery
  • periodontal surgery
  • biopsies
153
Q

What local anaesthesia is safe in patients haemophilia?

A
  • buccal infiltration
  • intraligamentary injections
  • intra-papillary injections
154
Q

What local anaesthesia is dangerous in patients with haemophilia?

A
  • inferior alveolar nerve block
  • lingual infiltration
  • posterior superior nerve block
155
Q

What is the post-op management of someone with severe/moderate haemophilia?

A

Patients should be observed overnight following surgery

156
Q

What is the post-op management of someone with mild/carriers of haemophilia?

A

Patients must be observed for 2-3 hours after surgery

157
Q

What is Thrombophilia?

A

Increased risk of clots developing

158
Q

What can be the life-threatening consequences of thrombophilia?

A
  • pulmonary thromboembolism
159
Q

What bleeding condition is caused by reduced platelet numbers?

A

Thrombocytopenia

160
Q

What bleeding condition is caused by normal number of platelets but with abnormal functions?

A

Qualitative disorders

161
Q

What bleeding condition is caused by increased platelet numbers?

A

Thrombocythemia

162
Q

What must the platelet count be greater than for dental treatment to proceed safely in primary care for someone with thrombocytopenia?

A

100x10^9/L

163
Q

What is the most likley cause of thrombocythemia ?

A

Usually patients who are on aspirin to prevent clot formation

164
Q

Name three inherited (rare) qualitative platelet disorders?

A
  1. Bernard soulier syndrome
  2. Hermansky pudlak
  3. Glanzmann’s thromboasthenia
165
Q

Name 4 acquired platelet disorders?

A
  • cirrhosis
  • drugs
  • alcohol
  • cardiopulmonary bypass
166
Q

Why might an individual require a blood transfusion?

A
  1. Where one or more components of the blood has to be replaced quickly
  2. Where the bone marrow cannot produce blood cells
167
Q

What system has core surface markers for red blood cells?

A

ABO system

168
Q

What blood system is important for maternal and foetal compatibility?

A

D system (rhesus)

169
Q

What are the two main indications for blood transfusion?

A
  1. Blood loss
  2. Specific production problems (e.g. RBC, platelets, plasma proteins)
170
Q

What are the 4 main stages in the blood transfusion process?

A
  1. Sample taken from patient
  2. Tested against known blood types
  3. Patient sample tested against selected donated sample
  4. Successfully matched blood given to patient
171
Q

What are the 4 ABO blood groups?

A
  • group A
  • group B
  • group AB
  • group O
172
Q

What ABO blood group is described:

  1. Anti-B antibodies in plasma
  2. A antigen in red blood cells
173
Q

What ABO blood group is described:

  1. No antibodies in plasma
  2. A and B antigens in red blood cells
174
Q

What ABO blood group is described:

  1. Anti-A antibodies in plasma
  2. B antigen in red blood cells
175
Q

What ABO blood group is described:

  1. Anti-A and Anti-B antibodies in plasma
  2. No antigens in red blood cells
176
Q

What are the three main blood transfusion complications?

A
  1. Incompatible blood leading to fever, jaundice and death.
  2. Fluid overload leading to heart failure
  3. Transmission of infection (e.g. BBV’s, bacterial infections)
177
Q

Define, clonal proliferation of lymphocytes arising in a lymph node or associated tissue?

178
Q

What are the two types of lymphoma?

A

1 Hodgkin’s lymphoma
2. Non-Hodgkin’s lymphoma

179
Q

Which type of lymphoma is most common?

A

Non-Hodgkin lymphoma (ratio of 6:1)

180
Q

Define, a disseminated tumour of white cells within the circulation that can spill over into tissues?

181
Q

What are the main symptoms of lymphoma?

A
  • fever
  • swelling of the face and neck
  • lump in neck, armpits or groin
  • excessive night sweats
  • breathlessness
  • weakness
  • itchiness of skin
182
Q

How many stages of disease are there for lymphoma?

183
Q

What investigations are required to stage lymphoma?

A

CT imaging or MRI

184
Q

What three factors are considered when staging lymphoma?

A
  1. Number of nodes involved and site
  2. Extra-nodal involvement
  3. Systemic symptoms
185
Q

What are characteristics of lymphadenopathy?

A
  • painless
  • typically cervical
  • fluctuates in size
  • pain with alcohol use notable
186
Q

What lymphoma stage is described?:

Single lymph node region or single extralymphatic site.

187
Q

What lymphoma stage is described?:

Two or more sites, same side of diaphragm or contiguous extralymphatic site.

188
Q

What lymphoma stage is described?:

Both sides of the diaphragm or spleen, or contiguous extralymphatic site.

189
Q

What lymphoma stage is described?:

Diffuse involvement of extralymphatic sites +/- nodal disease

190
Q

What type of lymphocyte makes up majority (85%) of non-Hodgkin lymphomas?

191
Q

What microbial factors are strongly implicated in lymphoma?

A
  • EBV, HIV, H.pylori
192
Q

Name three autoimmune diseases mainly associated with lymphoma?

A
  1. Sjögren’s syndrome
  2. RA
  3. Peptic ulcer disease
193
Q

What is the presentation of NHL?

A
  1. Lymphadenopathy (“invisible”)
  2. Extra-nodal disease (oropharyngeal involvement, waldeyers ring)
  3. Symptoms of marrow failure
194
Q

NHL is an aggressive disease with poor prognosis. True or false?

195
Q

Define, a malignant proliferation of plasma cells?

A

Multiple myeloma

196
Q

What are the three main features of multiple myeloma?

A
  1. Monoclonal paraprotein in blood and urine
  2. Lytic bone lesions
  3. Excess plasma cells in bone marrow
197
Q

What are the main symptoms of multiple myeloma?

A
  • infection
  • bone pain/ fracture
  • renal failure
  • amyloidosis
198
Q

What are the 4 treatments of haematological malignancies?

A
  1. Chemotherapy
  2. Radiotherapy
  3. Monoclonal antibodies
  4. Haemopoietic stem cell transplantation
199
Q

What is meant by induction as part of treatment for haematological malignancies?

A

Initial chemotherapy a person receives before undergoing additional cancer treatment

200
Q

What is meant by remission as part of treatment for haematological malignancies?

A

Where the patient is effectively normal bone marrow and no evidence of disease

201
Q

What is meant by maintenance & consolidation as part of treatment for haematological malignancies?

A

Where a patient requires treatment at a low-level over many years

202
Q

What is meant by relapse as part of treatment for haematological malignancies?

A

Where an individual will relapse after treatment and the process of induction will be started again.

203
Q

What cells are targeted in chemotherapy?

A

Cells with high turnover

204
Q

What are the common side effects of chemotherapy?

A
  • hair loss
  • nausea
  • vomiting
  • tiredness
205
Q

What are the two main risks of radiotherapy?

A
  1. Cytotoxic effect of ionising radiation (adjacent healthy tissue will also be irradiated)
  2. Risk of inducing late cancers
206
Q

What is an increasingly effective way of targeting cancer treatment to particular cells?

A

Monoclonal antibodies

207
Q

What does “Allogenic” mean, in regards to Haemopoietic stem cell transplant?

A

From a live donor

208
Q

What does “Autologous” mean, in regards to Haemopoietic stem cell transplant?

A

From the patient

209
Q

Haemopoietic stem cell transplant is a high risk procedure. 1. What is the mortality rate for such a procedure, and 2. what are the potential consequences for the patient?

A
  1. 10% mortality
  2. Life-threatening infection, graft-versus-host disease, graft failure and total marrow failure
210
Q

What is meant by “graft-versus-host disease”?

A

Where new bone marrow after transplantation starts to attack the individual and casue tissue damage

211
Q

The earlier a haematological cell line turns neoplastic, what is the effect on malignancy?

A

The more potentially aggressive the malignancy

212
Q

What are the three main characteristics of cancer cells?

A
  1. Uncontrolled proliferation
  2. Loss of apoptosis
  3. Loss of normal functions/products
213
Q

What type of leukaemia is the most serious and life-threatening?

A

Acute leukaemia

214
Q

What condition describes a group of cancers of the bone marrow which prevent normal manufacture of the blood and therefore result in:
1. Anaemia
2. Infection
3. Bleeding

215
Q

What is meant by “neutropenia”?

216
Q

What is meant by “thrombocytopenia”?

217
Q

What is the pathogenesis of leukaemia?

A

The bone marrow will gradually be replaced by the leukaemic cells and this prevents the patient from being able to maintain normal blood haemostasis

218
Q

What are usually the clinical features of leukaemia ?

A
  1. Anaemia
  2. Neutropenia
  3. Thrombocytopenia
  4. Lymphadenopathy
  5. Splenomegaly/hepatomegaly
  6. Bone pain
219
Q

What is meant by Splenomegaly?

A

An enlarged spleen

220
Q

What is meant by hepatomegaly?

A

Enlargement of the liver

221
Q

Why does Splenomegaly or hepatomegaly present in leukaemia?

A

Red cells are reprocessing at a higher rate

222
Q

What are the progressive symptoms of anaemia?

A
  • breathlessness
  • tiredness
  • easily fatigued
  • chest pain/angina
223
Q

What are the clinical signs of anaemia?

A
  1. Pallor
  2. Signs of cardiac failure (ankle swelling, breathlessness)
  3. Nail changes (e.g. brittle nails)
224
Q

What condition often presents after chemotherapy and increases you risk for infection?

A

Neutropenia

225
Q

What are symptoms for neutropenia?

A
  • recurrent infection
  • unusual severity of infection
226
Q

What are the clinical signs of neutropenia?

A
  • unusual patterns of infection and rapid spread
  • will respond to treatment but recur
  • signs of systemic involvement (fever, rigors, chills)
227
Q

If a child presents in the dental practice with swollen and bleeding gums, what should be suspected?

228
Q

What bleeding symptoms can be associated with leukaemia?

A
  • bruises easily or spontaneously
  • minor cuts fail to clot
  • gingival bleeding or nose bleeds
  • menorrhagia (heavy periods)
229
Q

What form of leukaemia is most common in children?

A

Acute lymphoblastic leukaemia

230
Q

What is the most common form of leukaemia?

A

Chronic lymphocytic leukaemia

231
Q

What type of leukaemia has slow progression, and is mostly asymptomatic and discovered on routine blood tests

A

Chronic lymphocytic leukaemia

232
Q

What leukaemia is characterised by presentation of the “Philadelphia” chromosome?

A

Chronic myeloid leukaemia

233
Q

When the GP does Mrs Smith’s haemoglobin (Hb) level, it is 100g/L (normal range 115-165g/L). Other full blood count readings are within normal range. What is your provisional diagnosis?

A

Normocytic anaemia

234
Q

List the signs and symptoms of symptoms of normocytic anaemia?

A
  • glossitis
  • pallor
  • conjunctiva
  • dizzy
  • fatigued
  • tachycardia
  • shortness of breath
235
Q

What are oral symptoms of anaemia induced by iron deficiency?

A
  • angular chelitis
  • ulceration
236
Q

What does INR stand for?

A

International normalised ratio

237
Q

What ratio does INR measure?

A

It measures the ratio of the patients prothrombin time to a normal control sample (measures how long it takes for blood to clot)

238
Q

When is the best time for a patient to have their INR checked prior to dental appointment?

A

24 hrs prior

239
Q

After removing roots surgically for an extraction, the patient starts bleeding profusely, what can you do to address this?

A
  1. Use local haemostatic measures
  2. Consider packing with haemostatic material and suturing

Dentistry Human Disease (29 decks)

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