The Hemotological Exam Flashcards

Question

What is the most common oral lymphoma?

Answer 1

Most common lymphomas of oral origin- Diffuse Large B Cell Lymphoma (NHL). Most common complaint is pain in the maxilla (55%) and swelling accompanied by paraesthesia or numbness (20%); symptoms of lower frequency include poor dentition, tooth mobility, continuous pain and swelling after exocytosis, and even pathologic fracture Lymphoma Types: DLBCL is the most common type of NHL. - Centroblastic, anaplastic, and immunoblastic types. - DLBCL can also be further subdivided by gene expression profiles: B cell-like, activated B cell-like, or type 3 gene expressing profile - Each type has a different clinical outcome, genetic alterations, and underlying oncogenic mechanisms. - Most maxillary lymph gland tumours are highly malignant DLBCL. - Tx: Chemotherapy and Rituximab (Reduce BP, increase infection risk)

Answer 2

ØProliferation of abnormal cells in the bone marrow -Chronic Myeloid Leukemia: Tiredness, Anaemia, Gout -Polycythaemia Vera: * Ruddy, plethoric appearance, injected conjunctiva * Hypertension, Gout, Pruritis, Cyanosis -Primary Myelofibrosis: Pallor, Petechiae -Thrombocythemia: Spontaneous bleed, thrombosis Ø Splenomegaly, common haematopoietic sign Surgical Challenges: Risk of infection and bleeding due to platelet dysfunction

Answer 3

Leukemic, Lymphoma, Myeloproliferative Disorder Patients - Chemotherapy - Haemopoietic Stem Cell Transplant - Immunosuppressive Medications

Answer 4

Ø Management: - Treat patients prior to chemotherapy (At least 3 weeks prior to start of chemo) - AB Prophylaxis (\< 6 months post chemotherapy- Neutrophil count \< 1.5 \*10^9/L) - Consult with Haematologist •Timing of Chemotherapy (Exodontia during chemo- MRONJ, life threating bacteraemia (Koulocheris P et al, 2009) Grade of Chemotherapy \> Severity of myelosuppression Platelet Infusion? Akashi M et al, 2018, PCS: Age, type of malignancy(commonly AML), shorter time between extraction and chemotherapy, low haemoglobin and PLT levels, absorbable haemostatic agents – increased risk of complications Medical Emergency: Bacteraemia \> Septic Shock

Answer 5

Platelet-derived growth factor and endothelial growth factor have pivotal roles in the natural healing of extraction sockets Platelet-rich plasma improves soft tissue healing of extraction sockets and decreases the incidence of alveolar osteitis and postoperative pain Platelets contain α-granules that at degranulation release cytokines that stimulate cell migration and enhance cellular-level events to expedite wound healing. In addition, platelet-rich fibrin allows the slow release of cytokines, contributing to the formation and stabilization of blood clots after dental extraction Platelet quantity and quality are critical because some patients' immune systems sequester and destroy platelets shortly after platelet administration. Anaemia affects wound healing and haemoglobin decrease correlates with deterioration and progression of wounds.27 Haemoglobin is an essential oxygen transporter to wounds and probably has an important role in socket healing after dental extraction.

Answer 6

Inherited Bleeding Disorders (Factor Deficiencies) Platelet Destruction/ Dysfunction (Hypersplenism, Autoimmune, ITP, TTP, DIC) Bone Marrow Conditions (Aplastic Anaemia, Iron/ folate Deficiency, Leukemia, chemotherapy, cirrhosis)

Answer 7

Management: - Inherited Bleeding Disorder Patients (Factor Deficiencies) (Hsieh JT et al, 2017) - Poorly researched and no current standardised guidelines to follow - Variability in definition of ‘high risk procedure’, type/ severity of bleeding disorder, use of factor replacement/ antifibrinolytic therapy, local agents used. - Factor Replacement or Desmopressin Infusion or local haemostatic measures – risk of antibodies - Consultation with Haematologist - Appropriate patient post-operative care and information

Answer 8

1. Acute myeloid (or myelogenous) leukemia (AML) - usally seen in kids 2. Chronic myeloid (or myelogenous) leukemia (CML) - we may pick up 3. Acute lymphocytic (or lymphoblastic) leukemia (ALL) 4. Chronic lymphocytic leukemia (CLL)

Answer 9

Noval Oral Anticoagulants The NOACs currently approved in Australia are dabigatran, rivaroxaban and apixaban. Direct thrombin inhibitors (dap) and the factor Xa inhibitors (Riv,Api). Pradaxa (dabi), Xeralto (riveroxaban), Eliquis (apixoban) - careful in renal failure - not continously monitored.

Answer 10

do not touch under 50 (will not stop bleeding), 100 safe limit, normal count 140-300.

Answer 11

The mean corpuscular volume, or mean cell volume (MCV), is a measure of the average volume of a red blood corpuscle (or red blood cell). The measure is attained by multiplying a volume of blood by the proportion of blood that is cellular (the hematocrit), and dividing that product by the number of erythrocytes (red blood cells) in that volume. The mean corpuscular volume is a part of a standard complete blood count. The hematocrit, also known by several other names, is the volume percentage of red blood cells in blood, measured as part of a blood test. The measurement depends on the number and size of red blood cells. It is normally 40.7%–50.3% for men and 36.1%–44.3% for women - in anemia it decreases

Answer 12

1. von Willebrand’s Factor (vWF) adheres to the vascular injury. 2. vWF then binds to GpIb receptors on surrounding platelets. 3. After binding, the ADP (P2Y12) receptor on the platelet may then become activated and will lead to increased expression of GpIIb/IIIa. 4. These newly expressed receptors then finally bind to fibrinogen, which leads to further platelet aggregation.

Answer 13

Low lymphacytes = lymphacytopenia Indicates an infection B cells make antibodies and signaling proteins that help to flag or attack invading bacteria, viruses, and toxins. T cells seek and destroy the cells that have become infected or are cancerous, and they also communicate with B cells. Natural killer (NK) cells contain compounds that can kill cancer tumor cells and cells infected with a virus. Low levels of T cells or too few NK cells can lead to uncontrolled viral, fungal, and parasitic infections. B-cell lymphocytopenia can lead to an increase in harmful and different types of infections.

Answer 14

Your bone marrow constantly produces cells that will become lymphocytes. Some will enter your bloodstream, but most will move through your lymphatic system. The lymphatic system is the group of tissues and organs, like the spleen, tonsils, and lymph nodes, that protect your body from infection (1). About 25 percent of the new lymphocytes remain in the bone marrow and become B cells. The other 75 percent travel to your thymus and become T cells

Answer 15

Anemia cancers, systemic immune issues, syndromes eg HPT. Can be due to: Your body produces fewer red blood cells than usual Your body destroys red blood cells faster than they can be produced You have blood loss Risks: High levels = stroke/Clots/HA Low levels = infection risk and desaturation risk

Answer 16

Factor XII → Factor XI → Factor IX (+ Factor VIII + vWF) → Common pathway

Answer 17

Factor VII → Common pathway

Answer 18

Factor X (+ Factor V) → Factor II → Factor I (+ Factor XIII → Fibrin mesh)