Lecture 9 Flashcards
What are the main components of normal blood?
Plasma and formed elements
Formed elements include erythrocytes (RBCs), leukocytes (WBCs), and thrombocytes (platelets)
What is the primary composition of plasma?
90% water and 10% plasma proteins, inorganic salts, gases, transported substances
What are the formed elements found in blood?
Erythrocytes (RBCs), leukocytes (WBCs), thrombocytes (platelets)
Each type of formed element has distinct functions in the body
Where do formed elements originate from?
- Bone marrow
- Hemocytoblasts (stem cells found in bone marrow)
What are erythrocytes?
Erythrocytes are red blood cells.
Do erythrocytes have nuclei?
No, erythrocytes do not have nuclei.
What is the shape of erythrocytes?
Erythrocytes are biconcave discs containing hemoglobin.
What is the primary function of erythrocytes?
The primary function of erythrocytes is to transport O2 to cells and CO2 away from cells via hemoglobin
What is anemia?
Reduction of hemoglobin concentration, hematocrit, or number of red blood cells.
Oxygen carrying capacity decreases.
What are the signs and symptoms of anemia? (15)
Pale or yellowish thin skin & mucosa, weakness, malaise, fatigue, dyspnea on slight exertion, headache, vertigo, tinnitus, vision dimness, seeing spots, brittle nails, cold hands and feet, dizziness or lightheadedness, irregular heartbeat, chest pain.
What are the main causes of anemia?
Blood loss, diminished RBC production, hemolysis, and genetic blood disorders.
What types of blood loss can cause anemia?
Acute and chronic blood loss, with chronic leading to iron deficiency anemia.
What are the two causes of decreased red blood cell production?
Nutritional deficiency and bone marrow failure
What nutritional deficiencies can lead to anemia?
Pernicious anemia (B12) and iron deficiency anemia (e.g., during pregnancy or growth spurts).
Give an example of bone marrow failure that leads to anemia
aplastic anemia (can be inherited): injury to bone marrow from medications, radiation, chemotherapy, infection, etc.
How does hemolysis cause anemia?
destroys of RBCs (hemolytic anemia)
What are two examples of hemolytic anemia?
Hereditary (sickle cell) and Acquired (Erythroblastosis fetalis: Rh negative mother develops antibodies against Rh positive fetus)
Give an example of a genetic blood disorder
Thalassemia
What is thalassemia?
A genetic blood disorder characterized by decreased production of normal hemoglobin.
Which populations are most affected by thalassemia?
Individuals of Middle Eastern, Mediterranean, African, or Southeast Asian descent.
What is Iron Deficiency Anemia?
Deficiency of iron in blood making RBCs smaller and deficient in hemoglobin.
Who is more commonly affected by Iron Deficiency Anemia?
Younger individuals and females.
What are some etiologies of Iron Deficiency Anemia?
Malnutrition or malabsorption, chronic infection, increased body demand for iron, and chronic blood loss.
What are the causes of chronic blood loss in Iron Deficiency Anemia?
Internal bleeding, excessive menstruation, or frequent blood donations.
What is a common medical management for Iron Deficiency Anemia?
Oral ferrous iron tablets and dietary changes.
Liquid preparations may stain teeth.
What are some oral manifestations of Iron Deficiency Anemia?
Atrophic glossitis, angular cheilitis, and secondary irritations.
What can cause secondary irritations in Iron Deficiency Anemia?
Smoking, mechanical trauma, and hot, spicy foods.
How are megaloblastic anemias characterized?
Megaloblastic anemias are characterized by abnormally large RBCs.
What causes megaloblastic anemias?
They result from a vitamin B12 deficiency (pernicious anemia), folate deficiency (folate deficiency anemia), or both.
What is pernicious anemia?
Pernicious anemia is a type of megaloblastic anemia caused by vitamin B12 deficiency.
What are the etiologies of pernicious anemia?
The etiologies include inadequate intake of B12 and impaired absorption of B12.
What is the medical management for pernicious anemia?
Medical management includes B12 injections and dietary modifications.
What dietary sources are recommended for B12?
Recommended dietary sources include meat, kidney, fish, oysters, clams, milk, cheese, and eggs.
What is Folate Deficiency Anemia?
A condition caused by insufficient folate in the body.
What are the etiologies of Folate Deficiency Anemia?
Decreased intake of folate and increased requirement of folate.
What are some sources of folate?
Liver, kidney, fruits, green leafy and cruciferous vegetables, dairy products, and whole grain cereals.
What is a consequence of folate deficiency during fetal development?
Neural tube defects.
What is an example of a neural tube defect associated with folate deficiency?
Spina bifida.
What are the signs and symptoms of Megaloblastic Anemias?
Tingling or numbness of fingers and toes, palpitations, weight loss, and syncope. Difficulty walking, lack of coordination, mental confusion.
Neurologic symptoms specific to pernicious anemia.
What are the oral manifestations of Megaloblastic Anemias?
Atrophic glossitis, sensitivity to hot or spicy foods, and painful swallowing.
What is Sickle Cell Disease?
A hereditary hemolytic disease resulting in a defective hemoglobin molecule causing sickle-shaped erythrocytes.
Who is primarily affected by Sickle Cell Disease?
Primarily affects individuals of African American and Mediterranean descent.
What is the test used for Sickle Cell Disease?
Hemoglobin electrophoresis test
Can Sickle Cell Disease be detected before birth?
Yes, detection is possible before birth.
When do signs and symptoms of Sickle Cell Disease typically appear?
Signs and symptoms appear after 6 months old.
How does Sickle Cell Disease affect growth and development?
It impairs growth and development during youth.
What happens to hemoglobin in Sickle Cell Disease?
Hemoglobin loses oxygen, causing red blood cells to distort.
What are the consequences of increased fluid viscosity in Sickle Cell Disease?
It can lead to thrombosis and infarction.
What is a Sickle Cell Crisis?
An acute form of Sickle Cell Disease that involves clinical exacerbations with periods of remission. Can occur with or without stimuli
What can trigger a Sickle Cell Crisis? (11)
Triggers include viral or bacterial infections, systemic disease, hypoxia, dehydration, sudden temperature changes, physical activity, extreme fatigue, acidosis, stress/anxiety, physical burden (such as pregnancy), and trauma.
What are common pain locations in Sickle Cell Disease?
Pain can occur in the extremities, head, back, chest, and abdomen.
What complications can arise from Sickle Cell Disease?
Infarctions can occur in various tissues and organs.
What neurological symptoms may be associated with Sickle Cell Disease?
Symptoms may include seizure, stroke, and coma.
How do infections affect Sickle Cell Disease patients?
Infections can reduce red blood cell production.
What are the systemic changes in Sickle Cell Disease?
Enlargement of heart, murmurs, coronary insufficiency, and ocular disturbances, even blindness.
Which organs are majorly affected by Sickle Cell Disease?
Kidney.
Which organs are minorly affected by Sickle Cell Disease?
Lungs, liver, spleen, and bones.
What is the mortality rate in young children with Sickle Cell Disease?
High due to infections and crisis.
Children < 3 are at risk for fatal sepsis and meningitis.
What supplements are recommended for Sickle Cell treatment?
Folate supplements
How should infections be managed in Sickle Cell patients?
Treat infections promptly
What is a potential curative treatment for Sickle Cell disease?
Stem-cell transplantation
What preventive measure is recommended for children ≤ 6 years old who have SCD?
Daily penicillin to prevent infections
What type of medications are used for pain management for sickle cell anemia patients?
Pain relief medications
What therapies are used to improve oxygen levels in Sickle Cell patients?
Oxygen therapy and blood transfusions
What is a key dental management practice for Sickle Cell Disease?
Use antibiotics prophylactically.
What type of local anesthesia should be used in dental procedures for patients with Sickle Cell Disease?
Use local anesthesia without epinephrine.
What type of dental appointments should be avoided for patients with Sickle Cell Disease?
Avoid long complicated dental appointments.
What is a common oral manifestation of Sickle Cell Disease?
Jaundice color.
What are the radiographic findings associated with Sickle Cell Disease?
Decreased radiodensity; osteoporosis.
What is the characteristic trabecular pattern seen in Sickle Cell Disease?
Coarse trabecular pattern ‘step-ladder’.
What dental condition can lead to a sickle cell crisis?
Periodontal involvement.
What is a significant concern regarding bone health in children with Sickle Cell Disease?
Significant bone loss in children → perio.
What are polycythemias?
Number of RBCs above the normal level
What are the three types of polycythemias?
1) Relative 2) Primary 3) Secondary
What is relative polycythemia?
Loss of plasma without loss of RBCs
Causes include dehydration, diarrhea, vomiting, sweating, burns.
What is primary polycythemia?
Increased RBC count and hemoglobin level
Affects oxygen transport to tissues due to blood viscosity.
What is secondary polycythemia?
Increase in RBCs from hypoxia
Causes include high altitude, pulmonary/heart disease, smoking.
What are the overall oral manifestations of red blood cell disorders? (9)
- 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 leukocytes?
Leukocytes are white blood cells.
What are the types of leukocytes?
There are two types: Granulocytes and Agranulocytes.
What are the types of granulocytes?
Granulocytes include neutrophils, eosinophils, and basophils.
What are the types of agranulocytes?
Agranulocytes include lymphocytes and monocytes.
What are the functions of leukocytes?
Leukocytes have phagocytic, immunologic, and inflammatory process functions.
How are leukocytes used in medicine?
Leukocyte cell count is used in detection and monitoring of disease states.
What are neutrophils (PMNs)?
Neutrophils are the most numerous of all WBCs and are responsible for phagocytosis.
When do neutrophils arrive at an injury?
Neutrophils arrive first at the site of injury.
What are eosinophils?
Eosinophils are few in number and are prominent in allergic conditions.
What are basophils?
Basophils increase vascular permeability during inflammation, allowing phagocytic cells to enter.
What are agranulocytes?
A type of white blood cell that includes lymphocytes and monocytes.
What are lymphocytes?
A type of agranulocyte that can revert to blast-like cells and differentiate into B, T, and NK cells.
What is a plasma cell?
A differentiated form of B lymphocyte that produces antibodies.
What are monocytes?
A type of agranulocyte that is the second cell to participate in the inflammatory response.
What is the function of monocytes?
They perform phagocytosis and can differentiate into macrophages.
What is leukopenia?
A decrease in total white blood cells.
What are some specific conditions that can cause leukopenia?
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 some causes of leukopenia related to bone marrow?
Chronic drug poisoning, radiation, autoimmune reactions, drug-induced immune reactions.
What is lymphoma?
Abnormal lymphocytes (T-,B-). Cancer:Non-Hodgkin’s and Hodgkin’s lymphoma.
What are some medical management options for lymphoma?
Chemotherapy and stem cell transplant.
What is Agraulocytosis?
Agraulocytosis (malignant neutropenia) is the destruction of the bone marrow, which is rare.
What are the etiologies of Agraulocytosis?
Etiologies include drug and chemical toxicity, antipsychotic medications, and autoimmune reactions.
What is a consequence of Agraulocytosis?
A consequence is increased infection susceptibility, such as oral ulceration.
What is Leukocytosis?
Leukocytosis is an increase in circulating white blood cells (WBCs).
What are the etiologies of Leukocytosis?
Etiologies include inflammatory or infectious states, trauma, exertion, and leukemia.
What is one function of platelets?
Blood clotting mechanism
How do platelets maintain the integrity of blood capillaries?
They close when injured
What happens to a clot after healing?
Platelets dissolve the clot
What are some acquired coagulation disorders?
Vitamin K deficiency, Liver disease, Thrombocytopenia, Anticoagulation drugs
What are some hereditary coagulation disorders?
Hemophilia A, Hemophilia B, von Willebrand’s disease
What is thrombocytopenia?
Thrombocytopenia is characterized by decreased production of thrombocytes, resulting in a low number of platelets.
What are the etiologies of thrombocytopenia?
Etiologies include invasive diseases like leukemia and deficiencies such as folate or pernicious anemia.
What are anticoagulation drugs?
Anticoagulation drugs interfere with the blood clotting mechanism, leading to bleeding.
What are some examples of anticoagulation drugs?
Examples include Heparin, Coumadin, and Aspirin.
What are hemophilias?
Congenital disorders resulting in defective blood clotting mechanism.
What is Hemophilia A?
Hereditary disorder of the platelet function with Factor VIII deficiency.
85% of hemophiliacs have this form.
What is Hemophilia B?
Deficient plasma protein (factor IX) leading to clotting issues.
Also known as Christmas Disease.
What is von Willebrand’s disease?
Characterized by prolonged bleeding time with a normal platelet count.
There are 3 types based on how it is inherited.
What are the Effects & Long-term complications of hemophilias?
- Minor trauma → bleeding and bruising
- Bleeding into joint soft tissue (hemarthroses)
- Joint deformity, crippling
- Intramuscular hemorrhage
How does fear of bleeding affect oral hygiene in hemophilias?
Oral bleeding specifically Gingival bleeding common; Fear of bleeding can lead to decreased oral hygiene, which increases biofilm and inflammation.
What should be included in the medical history for dental management of coagulation disorders?
Type, severity, treatment, medications, family history
What should be consult with a physician/hematologist concerning a patient with a coagulation disorder?
Signs of leukemia and lymphoma (WBC disorders)
Premedication requirement
Factor replacement therapy prior to dental appointment
What are the clinical procedures with a patient that has a coagulation disorder?
- 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
• Radiographs, impression, suction (hematomas)
How to manage pain in a patient with coagulation disorder?
No asprin suggest acetaminophen
