Blood Disorders and Cancers Quiz

Blood Disorders Overview

• Blood disorders are conditions affecting the composition or function of blood cells.
• Types of blood disorders include anemias, leukaemias, other dyscrasias (e.g., multiple myeloma, lymphoma), bleeding disorders (e.g., thrombocytopenia), and coagulopathies.

Anemia

• Anemia is a condition where the blood's oxygen-carrying capacity is reduced.
  • Levels are below 11.5 g/dL for females and 13.5 g/dL for males.
• Causes include deficiency anemias (iron, B12, folate), haemolytic anemias (inherited or acquired), aplastic anemia, and anemia of chronic disease.
• Clinical features include fatigue, lethargy, breathlessness, palpitations, pallor, headache, brittle nails, koilonychia (spoon-shaped nails), pale oral mucosa, and atrophic glossitis.
• Dietary deficiencies like iron or folate may cause anemias.
• Chronic blood loss, malabsorption, or pregnancy can also cause anemia.
• Management often includes medical history check, identifying the cause, iron supplements, and a preventive dental regime.

Anemia Types: Deficiency Anemia

• Iron deficiency anemia: A lack of iron leading to smaller, paler red blood cells.
  • Causes: Dietary deficiency, chronic blood loss, malabsorption, pregnancy.
  • Symptoms: fatigue, lethargy, breathlessness, pallor, brittle nails, koilonychia. Clinical features include pale oral mucosa and atrophic glossitis.
• Vitamin B12 deficiency anemia: Insufficient B12 for DNA & RNA synthesis; causing larger red blood cells.
  • Causes: Dietary deficiency (low intake in vegans or vegetarians), impaired absorption (e.g., Crohn's disease, pernicious anemia).
  • Clinical Features: similar dental symptoms to iron deficiency anemia, glossitis, recurrent aphthous ulcers, angular cheilitis, burning mouth syndrome, and red beefy tongue.
• Folate deficiency anemia: Folate required for DNA & RNA production, resulting in larger RBCs.
  • Causes: Dietary deficiency.
  • Clinical Features: similar dental features to other deficiency anemias.
• Haemolytic anemias (inherited/acquired): Premature destruction of red blood cells.
  • Inherited: Haemoglobinopathies (e.g., sickle cell disease, beta-thalassemia).
  • Causes of acquired: Infections, medications (e.g., penicillin), blood cancers, autoimmune disorders, overactive spleen, mechanical heart valves, severe blood transfusions.

Anemia Types: Haemolytic Anemia

• Inherited: Haemoglobinopathies.
  • Sickle Cell Disease: Chronic hemolytic anemia with a genetic mutation that can cause rigid and misshapen red blood cells causing episodes of severe pain, damage to vital organs, and potentially death.
  • Sickle Cell Trait: Carriers of the sickle cell gene, rarely have health problems.
  • Thalassaemia: Characterized by an abnormal amount of haemoglobin from inherited genes, resulting in fewer and more fragile red blood cells, causing early haemolysis and anaemia.
    • Alpha-thalassaemias: mostly found in Asians, with 4 subtypes of varying severity.
    • Beta-thalassaemias: mainly in Mediterranean and Caribbean populations. Homozygous beta-thalassemia major is typically lethal in utero or infancy.

Anemia Types: Others

• Aplastic Anemia: Bone marrow depression leading to fewer blood cells.
  • Causes: Idiopathic, genetic, cytotoxic drugs, radiation, certain chemicals, malignancies (e.g., leukemia), viral infection.
  • Symptoms: severe bruising, fatigue, dyspnoea.
• Anemia of Chronic Disease: Anaemia and immune system activation due to reduced red blood cell production and increased haemolysis.
  • Common conditions causing this include chronic infections (e.g., HIV), autoimmune disorders (e.g., rheumatoid arthritis), chronic diseases (e.g., liver or kidney disease), malignancy, major trauma, major surgery or critical illness, or older age.

Leukaemias

• Leukaemias are cancers of the white blood cells, usually arising in the bone marrow.
  • Characterised by an uncontrolled proliferation of immature white blood cells, crowding out other blood cells, causing anaemia, thrombocytopenia, and leukopenia.
• Treatment often includes chemotherapy, radiotherapy, bone marrow transplant, and stem cell transplant.
  • Acute Leukemia (lymphocytic, myeloid): rapidly developing cancers of the bone marrow characterized by high numbers and immature blast type white cells released in the blood. Usually occurs in children, but risk increases with age.
  • Chronic leukemia: slowly developing cancers of the bone marrow, characterized by an increase in immature white blood. Typically in adults aged 60+.
• Clinical Features related to blood cell depletion and/or infection risk.
• Additional clinical features potentially include oral manifestations like lymphadenopathy, mucosal pallor, gingival hypertrophy, spontaneous gingival bleeding, and petechial haemorrhages.

Other Dyscrasias

• Multiple Myeloma: Cancer of antibody-producing plasma cells that grow uncontrollably in the bone marrow, leading to osteolytic bone lesions.
  • Symptoms can include bone pain, recurring infections, kidney damage, and fatigue.
• Lymphoma: Cancer involving the lymphatic system, where lymphocytes grow uncontrollably in lymph nodes, spleen or other lymph tissues, often causing node enlargements in the neck, groin, or armpit.
  • Types: Hodgkin lymphoma, and non-Hodgkin lymphoma.

Dental Implications

• Dental Implications for patients with hematological disorders include consideration for radiotherapy, chemotherapy, potential infections, osteoradionecrosis risk, and the need to defer dental treatment with appropriate advice from a physician.
• Specific considerations include preventive regimes, avoiding general anaesthetics or stressors. Vasoconstrictors need caution. NSAIDs may also be a contra-indication or require specific guidelines.

General Management

• Patients with blood disorders often require specialized care, potentially hospitalization. Preventing infection and ensuring good dental hygiene are paramount.