Haematology

Question 0

What is leukaemia?

Answer 0

Describes a group of cancers of the bone marrow which prevent normal manufacture of blood.

Question 1

What does ‘blast’ describe?

Answer 1

An immature cell

Question 3

What is the clinical presentation of leukaemias?

Answer 3

Anaemia, neutropenia, thrombocytopenia, lymphadenopathy, splenomegaly/hepatomegaly (swollen abdomen), bone pain (especially in children)

Question 4

What are the clinical presentations of acute lymphoblastic leukaemia and acute myeloid leukaemia?

Answer 4

Acute lymphoblastic leukaemia = peak age 4yrs but can also develop in adults, develops rapidly
Acute myeloid leukaemia = occurs at any age but more common in elderly
Both can present with symptoms of fevers, sweats and malaise

Leukaemias usually present with anaemia, neutropenia, thrombocytopenia, lymphadenopathy, splenomegaly and bone pain (especially in children)

Question 5

What is the pathogenesis of leukaemia?

Answer 5

Clonal proliferation, replacement of marrow, increasing marginalisation of productive bone marrow - marrow failure and organ infiltration

Question 6

What is the commonest leukaemia?

Answer 6

Chronic lymphocytic (lymphoid) leukaemia

Question 7

What is chronic lymphocytic leukaemia? How does is present?

Answer 7

Proliferation of mature lymphocytes, B-cell clonal lymphoproliferative disease, peak age >70yrs, 70cases per million per yr, males:females 2:1
Mostly asymptomatic, slow progression (may not require treatment), occasional blast formation -> aggressive (may transform into an acute leukaemia)

Question 8

What is chronic myeloid leukaemia? How does it present?

Answer 8

Increase in neutrophils and their precursors, 95% of patients have Philadelphia chromosome (translocation of chromosomes 9 and 22), 15 cases per million per yr, peak age 50-70yrs but can occur at any age, slight male preponderance
Fatigue, weight loss, sweating, anaemia, thrombocytopenia, splenomegaly

Question 9

What is a lymphoma? What are the two types of lymphoma?

Answer 9

Clonal proliferation of lymphocytes arising in a lymph node or associated tissue, 200cases per million per yr, Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma, NHL more common that HL 6:1

Question 10

Describe the staging for lymphomas.

Answer 10

Stage I - single lymph node region or single extra lymphatic site (Ie)
Stage II - two or more sites, same side of diaphragm or contiguous extra lymphatic site (IIe)
Stage III - both sides of diaphragm or spleen (IIIs) or contiguous extra lymphatic site (IIIe)
Stage IV - diffuse involvement of extra lymphatic sites +/- nodal disease

Question 11

What is Hodgkin lymphoma? How does it present?

Answer 11

peak age 15-40yrs, M>F 2:1
painless lymphadenopathy, fever, night sweats, weight loss, itching, infection
stage I and II -> cure prognosis >90%
stage III and IV -> cure prognosis 50-70%
older people do less well

Question 12

What is Non-Hodgkin lymphoma? How does it present?

Answer 12

B-cell (85%) or T-cell (15%), any age (more indolent in elderly)

aetiology: microbial factors (EBV, HTLV-1, H. Pylori), autoimmune disease (Sjogrens syndrome, rheumatoid arthritis), immunosuppression (AIDS, post-transplant)
presentation: lympahdenopathy, extra-nodal disease more common (oropharyngeal involvement, Waldeyers ring - noisy breathing, sore throat), symptoms of marrow failure, constitutional symptoms less common (i.e. sweats, fevers, high temp.)
prognosis: >50% will relapse after treatment

Question 13

What is multiple myeloma? How does it present?

Answer 13

malignant proliferation of plasma cells, 50 cases per million per yr, mean age at diagnosis 70yrs, M>F, blacks>whites
features: monoclonal paraprotein in blood and urine, lytic bone lesions (pain and fracture), excess plasma cells in bone marrow (marrow failure)
infection, bone pain, renal failure, amyloidosis

Question 14

What are the treatment options for haematological malignancies?

Answer 14

chemotherapy, radiotherapy, monoclonal antibodies (target specific cancer cell antigens, drugs end in -mab), haemopoietic stem cell transplant (high risk procedure with 10% mortality, less risky than marrow transplant)

Question 15

What are the possible causes of vitamin B12 deficiency? How would this present intra-orally? How could you investigate?

Answer 15

lack of intrinsic factor, disease of terminal ileum (e.g. Crohn’s), pernicious anaemia, bowel problems, vegan diet (low intake of dairy produce)
beefy tongue
FBC and blood film - macrocytic MCV

Question 16

What are the possible causes of iron deficiency? How would this present intra-orally? How could you investigate?

Answer 16

heave menstrual periods, pregnancy, bleeding into GIT, poor iron absorption (e.g. in Coeliac disease), low iron intake (bad diet)
smooth tongue
ferritin estimation, blood film - microcytic MCV

Question 17

What is the Philadelphia chromosome associated with?

Answer 17

Chronic myeloid leukaemia

Question 18

What are the dental implications for a patient with chronic lymphocytic leukaemia?

Answer 18

infection risk, bleeding risk, oral ulceration, prolonged healing, oral candidosis risk

Question 19

What oral conditions are associated with haematinic deficiency?

Answer 19

fungal and viral infections, oral ulceration, painful mucosa
beefy tongue = vit B12 def
smooth tongue = iron def

Question 20

What are the signs and symptoms of neutropenia?

Answer 20

recurrent infection, unusual severity of infection

unusual patterns of infection, rapid spread, responds to treatment but recurs

Question 21

What are the signs and symptoms of thrombocytopenia?

Answer 21

menorrhagia, bruises easily/spontaneously, minor cuts fail to clot
bruising, petechiae, BOP, bleeding/bruising following procedures

Question 22

What types of anaemia give a low, high or normal MCV?

Answer 22

low MCV (microcytic) = iron deficiency anaemia, thalassaemia
normal MCV (normocytic) = bleeding, renal disease, chronic disease
high MCV (macrocytic) = folate/vit B12 deficiency, reticulocytes

Question 23

What features would be seen in a blood film in iron deficiency anaemia?

Answer 23

microcytic cells, pale colour, reduction in Hb concentration, odd shaped

Question 24

What are the signs and symptoms of anaemia?

Answer 24

pale, tachycardia, tired, weak, dizzy, SOB, palpitations

Question 25

What is the dental relevance of anaemic patients?

Answer 25

general anaesthesia - oxygen capacity
deficiency states (iron usually) - mucosal atrophy, candidiasis, recurrent oral ulceration, dysaesthesia (ie pins and needles)

Question 26

What are the normal values for MCV, PLT, HCT, Hb, RCC, WCC?

Answer 26

PLT = 150-400 x 10^9 / L
Hb = 13-18 g/dL in adult males, 11.5-16.5 g/dL in adult, non pregnant females
MCV = 27-32pg
RCC = 4.5-6.5 x 10^12 / L in adult males, 3.8-5.8 x 10^12 / L in adult females
HCT = 42-54% adult males, 38-46% adult females
WCC = 4,500-10,000 wbc per microlitre (mcL)

Question 27

What are common causes of blood loss, that can cause anaemia?

Answer 27

heavy menstrual periods, bleeding into GIT or urinary tract, surgery, trauma, cancer

Question 28

Which cells are derived from a myeloid lineage and a lymphoid lineage?

Answer 28

myeloid -> erythrocytes, platelets (megakaryocytes), neutrophils, basophils, eosinophils, monocytes
lymphoid -> NK cells, B cells, T cells

Question 29

What is the Reed Sternberg cell associated with?

Answer 29

Hodgkins lymphoma