Blood Disorders and Anemia Quiz

Blood Disorders Overview

• Blood disorders are a broad category encompassing various conditions affecting the blood's composition and function.
• These conditions can have significant implications for oral health.
• Different types of blood disorders exist, including anemias, leukaemias, other dyscrasias, and coagulopathies.

Learning Outcomes

• Explain general and systemic diseases in relation to oral health
• Describe and apply relevant physiology to patient management
• Recognise abnormalities of the oral cavity and raise related concerns
• Identify when patient needs differ from treatment plans, and refer appropriately
• Explain the impact of medical and psychological factors on patient care
• Recognise local referral networks, clinical guidelines, and policies
• Implement a preventive approach in all patient care, promoting long-term oral and general health
• Explain the impact of periodontal and general health on treatment plans and outcomes

Aim of the Session

• Describe blood disorders and their implications for dental hygienists/therapists

Intended Learning Outcomes

• Classify blood disorders
• Describe deficiency anaemias and thalassemia
• List main types of leukaemia
• Describe differences between leukaemia, multiple myeloma, and lymphoma
• Explain how these conditions relate to dental hygienist/therapist practice

Types of Blood Disorders

• Anaemias: conditions related to insufficient red blood cells or haemoglobin (e.g. iron deficiency, vitamin B12 deficiency, haemolytic anaemia, aplastic anaemia, anaemia of chronic disease)
• Leukaemias: cancers of the blood or bone marrow, stemming from white blood cell precursors (e.g., acute lymphoblastic leukaemia, acute myeloid leukaemia, chronic myeloid leukaemia, chronic lymphocytic leukaemia)
• Other dyscrasias: conditions besides anaemia and leukaemia including multiple myeloma and lymphoma.
• Bleeding disorders: problems with blood clotting, including thrombocytopenia and coagulopathies

Anaemias - Details

• Deficiency anaemias: caused by insufficient iron, vitamin B12, or folate.
• Iron deficiency anaemia: caused by inadequate dietary iron intake, or blood loss.
• Vitamin B12 deficiency anaemia: caused by a lack of Vitamin B12 in the diet, or malabsorption.
• Folate deficiency anaemia: result from dietary folate deficiency.
• Haemolytic anaemias (inherited): involve inherited abnormalities in haemoglobin structure (e.g. sickle cell disease, thalassemia)
• Haemolytic anaemias (acquired): involve a variety of conditions that cause premature red blood cell destruction (e.g. infections, medications, autoimmune disorders, mechanical heart valves)
• Aplastic anaemia: a condition in which the bone marrow is depressed, leading to a reduction in blood cell production
• Anaemia related to chronic disease: a commonly occurring anaemia that arises from chronic infections or conditions such as HIV, chronic disease, and autoimmune disorders that directly affect red blood cell production.

Anaemias - Clinical Features

• Fatigue, lethargy
• Breathlessness
• Palpitations
• Pallor (pale skin)
• Headache
• Brittle nails (or koilonychia)
• Oral features such as pale oral mucosa, glossitis, recurrent aphthous ulcers, angular cheilitis, burning mouth syndrome
• Symptoms may depend on underlying blood disorder

Anaemias - Management

• Check medical history and refer to General Practitioners
• Prescribe iron supplements, where applicable
• Establish preventative dental regimes, and regular care
• Advise patients about potential increased risk of infections

Vitamin B12 Deficiency

• Synthesizes DNA and RNA, and needed for red blood cell production
• Absorbed in the terminal ileum with an intrinsic factor
• Dietary deficiency affects vegans primarily
• Causes include impaired absorption (Crohn's disease, pernicious anaemia).
• Clinical Features: Similar to other deficiency anaemias (fatigue, lethargy, breathlessness, pallor) Glossitis, recurrent aphthous ulcers Develops slowly
• Management: Correct diagnosis Injection of hydroxocobalamin (vitamin B12) at regular intervals Preventative dental care and regular recall

Folate (Folic Acid) Deficiency

• Needed for DNA and RNA synthesis and cell growth, as well as red blood cell production
• Absorbed in the small intestine.
• Usually caused by dietary insufficiency
• Clinical Features: Similar to other deficiency anaemias (fatigue, lethargy, breathlessness, pallor) Glossitis, recurrent aphthous ulcers
• Management: Dietary changes to increase folic acid intake Supplement with folic acid (folate) Preventive dental care, and regular recall

Haemolytic Anaemias

• Inherited: haemoglobinopathies (e.g., sickle cell disease, thalassemia)
• Acquired: infections, medicines, blood cancers, autoimmune disorders, overactive spleen, and heart valve damage.

Sickle Cell Disease

• Autosomal recessive genetic disease of haemoglobin production
• Most common in people of African descent
• Causes red blood cells to become rigid, irregularly shaped, and prone to clumping (sickling)
• Can result in intermittent acute crises, pain, organ damage, and death
• High-risk cases require specialist dental management
• Manage in a manner to avoid general anesthesia.

Sickle Cell Trait

• Has a reduced risk of developing sickle cell crisis
• Carrier carriers, and health problems are rare.
• Patients with sickle trait may inherit sickle genes and SC disease.

Sickle Cell Crisis

• State of low oxygen, caused by dehydration, infection, exercise etc
• Misshapen red blood cells clog blood vessels, causing anoxia.
• Can result in severe pain, clotting, and death.
• Important to treat with supportive care

Thalassaemia

• Genetic disorders characterized by abnormal amounts of haemoglobin,
• Inherited from both parents
• Primarily noted in specific ethnic groups
• Red blood cells exhibit fragility and short lifespan, often leading to anaemia.

Types of Thalassaemia

• Alpha-thalassaemias: Often noted in Asians. Various subtypes with different severity. Major types are frequently lethal.
• Beta-thalassaemias: Note in Mediterranean and Caribbean groups Homozygous and heterozygous forms exist, with major (homozygous form) being more serious.

Symptoms of Beta Thalassaemia

• Homozygous (major): chronic anaemia, skeletal deformities, enlarged spleen, iron overload, and potential organ damage..
• Heterozygous (minor): frequently asymptomatic, but possible mild anaemia.

Orofacial Manifestations

• 'Hair on end' appearance on lateral skull x-rays.
• Prominent maxillae, frontbossing.
• Spacing and forward drift of maxillary incisors.
• Parotid gland enlargement and xerostomia, and associated pain or discomfort

Thalassaemia - Management

• Severe cases frequently need hospital clinics.
• Important to manage with infection prevention practices.
• Preventive dental care is crucial.

Acquired Haemolytic Anaemias

• Not inherited
• Some viral infections, medicines, blood cancers, autoimmune disorders (e.g., lupus, rheumatoid arthritis), or an overactive spleen can cause acquired haemolytic anaemias.
• Mechanical heart valves may damage red blood cells (as they leave the heart).
• Severe reaction to a blood transfusion may cause acquired haemolithic anaemia.

Aplastic Anaemia

• Bone marrow depression resulting in fewer blood cells.
• Causes: idiopathic (including autoimmune), genetic, certain chemicals, malignancy, viral infections, antibiotics, anticonvulsants, and sulphonamides.
• Symptoms: severe bruising, fatigue and dyspnea.
• Management: removal of cause, immunosuppressant therapy, and bone marrow transplant in severe instances

Anaemia of Chronic Disease

• Characterized by anaemia and signs of immune system activity
• Commonly found in chronic infections, autoimmune disorders, chronic diseases (e.g., kidney/liver disease), or malignancy, after major trauma, after major surgery.
• Reduced red blood cell production and/ or increased haemolysis.

Leukaemias

• Malignant proliferation of white blood cell precursors in bone marrow.
• Immature blast cells crowd other blood cells, resulting in anaemia, thrombocytopenia, leukopenia.
• Risk of infection increases.
• Risk factors include radiation, chemicals, or genetic disposition.
• Many cases have unknown causes.

Types of Leukaemia

• Acute lymphoblastic leukaemia (ALL): most common in children and young adults
• Acute myeloid leukaemia (AML): most common in adults, frequently fatal without treatment
• Chronic myeloid leukaemia (CML): slowly developing, usually in adults
• Chronic lymphocytic leukaemia (CLL): slowly developing, mostly in adults

Acute Lymphoblastic Leukaemia (ALL)

• Occurs frequently in children and young adults
• Large numbers of immature white blood cells are frequently released.
• Red blood cells and platelets are reduced.
• Treated with chemotherapy, antibiotics, blood transfusions, and stem cell transplants.

Acute Myeloid Leukaemia (AML)

• Aggressive cancer of myeloid cells
• Abnormal myeloblasts, red blood cells or platelets are created in bone marrow.
• Affects all ages, risk increases with age
• Often quickly fatal if untreated
• Treated with chemotherapy, radiotherapy, bone marrow transplant, or stem cell transplants

Chronic Myeloid Leukaemia

• Rare, mostly affecting adults aged 60+.
• Slow development
• Increased growth of myeloid cells
• Treated with tyrosine kinase inhibitors, and sometimes stem cell transplant.

Chronic Lymphocytic Leukaemia (CLL)

• Most common leukaemia
• Results from too many immature lymphocytes in the blood
• Usually in over-60s
• May not need immediate treatment
• Treated with tyrosine kinase therapy, BCL2 inhibitor therapy, monoclonal antibody therapy, chemotherapy, radiotherapy, or immunotherapy.

Common Symptoms of Leukaemia

• Systemic: fatigue, weight loss, fever, frequent infections.
• Psychological: fatigue, loss of appetite.
• Lungs: shortness of breath.
• Muscular weakness, and musculoskeletal pain
• Bones and joints: pain.
• Oral cavity: pale mucous membranes, ulcers, gingival hypertrophy, spontaneous gingival bleeding, petechial haemorrhages, and infections

Leukaemia - Clinical Features

• Anaemia, fatigue, pallor.
• Thrombocytopenia (purpura, bleeding), susceptibility to infections.
• Lymphadenopathy (enlarged lymph nodes)

Multiple Myeloma

• Cancer of antibody-producing plasma cells that grow uncontrollably in the bone marrow.
• Faulty antibodies (paraprotein) are produced, impeding immune function.
• Osteolytic lesions (holes) form in bones, causing pain, recurring infections.
• Kidney damage commonly occurs, frequently accompanied by fatigue.

Lymphoma

• Lymph nodes or lymph tissue cancer
• Lymphocytes grow uncontrollably, collecting in lymph nodes, spleen or other lymphatic tissue in lymph tissue.
• Often accompanied by lymph node swelling.

Dental Implications

• Radiotherapy or chemotherapy may be involved in treatment, exposing individuals to increased risk of infection, osteoradionecrosis, or other dental/oral complications.
• Infectious risk increases: viral, candidal, bacterial.
• Patients should delay dental treatment to a stable remission period.
• Seek advice from physicians specialising in haematological disorders.

Further Reading

• References to various resources containing information about Blood disorders.