Podcast
Questions and Answers
What is a primary characteristic of Aplastic Anaemia?
What is a primary characteristic of Aplastic Anaemia?
Which condition is associated with Chronic Anemia?
Which condition is associated with Chronic Anemia?
What type of leukaemia is most common in children?
What type of leukaemia is most common in children?
What is the main treatment option for Chronic Myeloid Leukaemia?
What is the main treatment option for Chronic Myeloid Leukaemia?
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What are the common clinical features of leukaemia?
What are the common clinical features of leukaemia?
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What is one of the key roles of a dental hygienist/therapist in relation to blood disorders?
What is one of the key roles of a dental hygienist/therapist in relation to blood disorders?
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Which of the following describes a key difference between leukaemia and lymphoma?
Which of the following describes a key difference between leukaemia and lymphoma?
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What is a common characteristic of deficiency anaemias?
What is a common characteristic of deficiency anaemias?
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Sickle cell disease primarily affects which type of blood cell?
Sickle cell disease primarily affects which type of blood cell?
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What is the primary difference between multiple myeloma and leukaemia?
What is the primary difference between multiple myeloma and leukaemia?
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What is a common clinical feature associated with all types of deficiency anaemias?
What is a common clinical feature associated with all types of deficiency anaemias?
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Which nutritional deficiency is most likely to cause glossitis and recurrent aphthous ulcers?
Which nutritional deficiency is most likely to cause glossitis and recurrent aphthous ulcers?
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What is the primary treatment for iron deficiency anaemia?
What is the primary treatment for iron deficiency anaemia?
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In vitamin B12 deficiency, which factor is crucial for the absorption of vitamin B12?
In vitamin B12 deficiency, which factor is crucial for the absorption of vitamin B12?
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Which deficiency is most likely to cause neural tube defects in a developing fetus?
Which deficiency is most likely to cause neural tube defects in a developing fetus?
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What is a key dietary source for vitamin B12, making vegans most at risk for deficiency?
What is a key dietary source for vitamin B12, making vegans most at risk for deficiency?
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What is the recommended management for folate deficiency during pregnancy?
What is the recommended management for folate deficiency during pregnancy?
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What is the primary characteristic of Sickle Cell Disease?
What is the primary characteristic of Sickle Cell Disease?
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Which of the following statements about Thalassaemia is correct?
Which of the following statements about Thalassaemia is correct?
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What is a key management strategy for patients with Sickle Cell Trait during dental procedures?
What is a key management strategy for patients with Sickle Cell Trait during dental procedures?
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Which symptom is commonly associated with homozygous β-thalassaemia?
Which symptom is commonly associated with homozygous β-thalassaemia?
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What is a potential consequence of sickle cell crises?
What is a potential consequence of sickle cell crises?
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Which condition requires antibiotic prophylaxis for invasive dental treatment?
Which condition requires antibiotic prophylaxis for invasive dental treatment?
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What common side effect is associated with thalassaemia due to iron overload?
What common side effect is associated with thalassaemia due to iron overload?
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What factor is NOT a trigger for a Sickle Cell Crisis?
What factor is NOT a trigger for a Sickle Cell Crisis?
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Which of the following is NOT associated with acquired haemolytic anaemias?
Which of the following is NOT associated with acquired haemolytic anaemias?
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Which dental manifestation is associated with thalassaemia?
Which dental manifestation is associated with thalassaemia?
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Study Notes
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.
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Description
Test your knowledge on various blood disorders including aplastic anemia, leukemia, and anemia causes and treatments. This quiz covers important characteristics, clinical features, and treatment options related to these conditions. Perfect for students in healthcare and medical fields.
