Anemia and other blood Anemia and other blood diseasesdiseases

HEMATOLOGIC HEMATOLOGIC (BLOOD)(BLOOD) DISEASESDISEASES

• Bleeding DisordersBleeding Disorders– Platelet Function Platelet Function – Coagulation Factor Coagulation Factor

• Platelet DeficiencyPlatelet Deficiency– Thrombocytopenia / ThrombocytopathiaThrombocytopenia / Thrombocytopathia

• Red Blood Cell (RBC) DisordersRed Blood Cell (RBC) Disorders– AnemiaAnemia

• White Blood Cell (WBC) DisordersWhite Blood Cell (WBC) Disorders– LeukopeniaLeukopenia– LeukemiaLeukemia– (Lymphoma)(Lymphoma)

CLINICAL FEATURES OF BLOOD CLINICAL FEATURES OF BLOOD DISORDERSDISORDERS

• Oral Bleeding Oral Bleeding - - – Petechiae / Easily Bruised (Ecchymoses)Petechiae / Easily Bruised (Ecchymoses)– Bleeding After BrushingBleeding After Brushing– Spontaneous Gingival BleedingSpontaneous Gingival Bleeding– Prolonged After ExtractionsProlonged After Extractions– Excessive From Minor TraumaExcessive From Minor Trauma

• Other BleedingOther Bleeding: : Epistaxis, Hematemesis, Hemoptysis, Hematuria, MelenaEpistaxis, Hematemesis, Hemoptysis, Hematuria, Melena

• Possible Associated Increased Susceptibility to Infection Possible Associated Increased Susceptibility to Infection - - – LeukemiaLeukemia

– HIVHIV– Immunosuppression from Chemtherapy for Organ Transplant or Cancer TXImmunosuppression from Chemtherapy for Organ Transplant or Cancer TX

• Oral Swelling &/or UlcerationOral Swelling &/or Ulceration

• Long Term Immunosuppression carries increased Risk for Malignancy Long Term Immunosuppression carries increased Risk for Malignancy (Especially lymphoma and leukemia)(Especially lymphoma and leukemia)

Clinical BleedingClinical BleedingPetechiaePetechiae Petechiae and EcchymosesPetechiae and Ecchymoses

EcchymosesEcchymoses

Other Clinical Features of Other Clinical Features of Blood DisordersBlood Disorders

UlcerationUlceration Atrophy and Atrophy and PallorPallor

UlcerationUlceration

PLATELET-ASSOCIATED PLATELET-ASSOCIATED BLEEDING DISORDERSBLEEDING DISORDERS

ThrombocytopeniaThrombocytopenia

• Primary or Secondary Deficiency of PlateletsPrimary or Secondary Deficiency of Platelets– 110 / 0 / Idiopathic (Probably Autoimmune) Thrombocytopenic PurpuraIdiopathic (Probably Autoimmune) Thrombocytopenic Purpura– 2200 / i.e. Leukemia, HIV, Aplastic Anemia / i.e. Leukemia, HIV, Aplastic Anemia

• Altered Platelet Function as in Altered Platelet Function as in ASPIRINASPIRIN (and other (and other NSAID’s)NSAID’s)

• von Willebrands diseasevon Willebrands disease• Petechiae are Common FindingPetechiae are Common Finding

COAGULATION FACTOR-COAGULATION FACTOR-ASSOCIATED BLEEDING ASSOCIATED BLEEDING

DISORDERSDISORDERS• Hereditary DefectsHereditary Defects

– Hemophilia Hemophilia – OthersOthers

• Liver DiseaseLiver Disease– Cirrhosis, HepatitisCirrhosis, Hepatitis

• Anti-Coagulant MedicationAnti-Coagulant Medication– Coumarin (Warfarin) - Coumarin (Warfarin) - Vitamin K AntagonistVitamin K Antagonist– Heparin Heparin

• GI Malabsorption ProblemsGI Malabsorption Problems– Fat Soluble Vitamin K Deficiency Fat Soluble Vitamin K Deficiency (Sprue or Biliary Disease)(Sprue or Biliary Disease)

ANEMIAANEMIA• Clinical:Clinical: Weakness, Fatigue, Pallor Weakness, Fatigue, Pallor• Decreased Oxygen Carrying Capacity of Decreased Oxygen Carrying Capacity of

BloodBlood• Result of: Decreased Result of: Decreased NumberNumber, , SizeSize, or , or Hb Hb

ContentContent of RBC’s or of of RBC’s or of Defective HbDefective Hb

• Secondary to:Secondary to:– Nutritional / Iron DefeciencyNutritional / Iron Defeciency– RBC loss or destruction (Chronic Bleeding)RBC loss or destruction (Chronic Bleeding)– Failure of RBC formation (Leukemia)Failure of RBC formation (Leukemia)– Hereditary Hb malformationHereditary Hb malformation

• Oral Features:Oral Features:– PallorPallor– Bald TongueBald Tongue

• Possible Association with other Disease: Possible Association with other Disease: Leukemia, Kidney Disease, etc.Leukemia, Kidney Disease, etc.

LEUKOPENIA LEUKOPENIA (Decreased (Decreased Number of WBC’S)Number of WBC’S)

Increased Susceptibility to InfectionIncreased Susceptibility to Infection• Aplastic AnemiaAplastic Anemia

– Failure of Formation of All Blood Cells: Failure of Formation of All Blood Cells: RBC’s, WBC’s and RBC’s, WBC’s and PlateletsPlatelets

• AgranulocytosisAgranulocytosis– Failure of Formation of Failure of Formation of NeutrophilsNeutrophils

• Cyclic NeutropeniaCyclic Neutropenia– Periodic Suppression of Periodic Suppression of NeutrophilNeutrophil Formation Formation

• Associated Oral Ulceration and Infection:Associated Oral Ulceration and Infection:– CandidiasisCandidiasis– HSVHSV

Oral Ulceration and Infection Oral Ulceration and Infection Secondary to Secondary to LeukopeniaLeukopenia or or

LeukemiaLeukemia

LEUKEMIALEUKEMIA• Leukemia - DefinitionLeukemia - Definition

– Malignancies of WBC’s Originating inMalignancies of WBC’s Originating in

BONE MARROWBONE MARROW– Expression in Expression in PERIPHERAL BLOODPERIPHERAL BLOOD

LeukemiaLeukemia

Leukemia - Blood Smear

Clinical SignificanceDisease and Treatment Make Patients Anemic and More Susceptible to Infection and BleedingDecreased RBC Formation, Ineffective Leukocytes (&/or Leukopenia) and Thrombocytopenia

Diagnosis by: CBC with Differential and Bone Marrow Biopsy

There are several management considerations in the dental treatment of patients with hematologic disease. In patients with anemia that is or was associated with stomach ulceration as a source of the GI bleed, aspirin or non-steroidal medication should be avoided.

Drugs combined with phenacetin should not be prescribed for patients with anemia caused by glucose-6-phosphate dehydrogenase deficiency. This form of anemia has also been associated with an increased incidence of sensitivity to sulfonamides, aspirin, and chloramphenicol.

Patients with sickle-cell anemia should only receive dental treatment when they are not in crisis. Management of caries is extremely important as non-treated caries leading to periapical infection can precipitate a crisis.

Infection has to be managed aggressively with local and systemic measures including appropriate dental treatment, antibiotics, and surgical procedures if necessary (i.e. incision and drainage, extraction

The presence of angular cheilitis in the patient with iron-deficiency anemia suggests the possibility of a candidiasis which can be effectively managed with the anti-fungal medications previously described.

Test with Complete Blood Count (CBC) with Differential White Cell Count (WBC) + Hgb, Hct, and Red Cell Indices:RBC Count - Normal = 4.5-5.0 Million RBC’s / 100 mLWBC Count - Normal = 4 - 6 Thousand WBC’s / 100 mL

Neutrophils ~ 60 - 65 %Lymphocytes ~ 30 - 35 %Monocytes ~ 4 - 6 %Eosinophils ~ 1 - 2 %Basophils ~ 0 - 1 %

Platelets = 150 - 600 Thousand / 100 mL