Blood Disorders Quiz (BMS Learning Outcomes)

Blood Disorders Classification

• Blood disorders are grouped into:
  • Anemias
  • Leukemias
  • Other dyscrasias (e.g., multiple myeloma, lymphoma)
  • Bleeding disorders (separate lecture—thrombocytopenia/coagulopathies)

Deficiency Anemias

• Symptoms of deficiency anemias include fatigue, lethargy, breathlessness, palpitations, pallor, headache, brittle nails, and koilonychia (spoon-shaped nails)
• Dental features of deficiency anemias include pale oral mucosa, atrophic glossitis, recurrent aphthous ulcers, angular cheilitis, and burning mouth syndrome.
• Iron deficiency anemia:
  • Characterized by low iron in the body, reducing red blood cell numbers
  • Red blood cells become smaller, paler, and carry less haemoglobin.
  • Causes include dietary deficiency, chronic blood loss, malabsorption, and pregnancy.
  • Management includes checking medical history, identifying the underlying cause, iron supplements, preventative dental care, and regular checkups.
• Vitamin B12 deficiency:
  • B12 is required for DNA/RNA synthesis.
  • Absorption depends on intrinsic factor secretion from parietal cells and absorption in the terminal ileum.
  • Causes include dietary deficiency (e.g., vegans) and impaired absorption (e.g., Crohn's disease, pernicious anemia).
  • Red blood cells become larger, and the condition develops slowly.
  • Management involves diagnosis, replacing B12 (cobalamin) via regular intramuscular injections of hydroxocobalamin, and preventive dental care.
• Folate deficiency:
  • Necessary for DNA/RNA synthesis and red blood cell production.
  • Found in fresh leafy vegetables.
  • Absorption occurs in the small intestine, and the body has virtually no stores.
  • Primarily caused by dietary deficiency.
  • Management includes folic acid supplements and improved diet. Fetal neural tube defects, like spina bifida, can result from folate deficiency in pregnancy.

Haemolytic Anaemias

• Inherited:
  • Haemoglobinopathies:
    • Sickle cell disease
    • Thalassemia
• Acquired:
  • Infections
  • Medications (e.g., penicillin, antimalarials)
  • Blood cancers
  • Autoimmune disorders
  • Overactive spleen
  • Mechanical heart valves
  • Severe blood transfusions reactions.

Inherited Haemolytic Anaemias

• Sickle Cell Disease:
  • Autosomal recessive, causing intermittent acute crises.
  • Primarily affects people of African descent.
  • Healthy red blood cells are deformable disks.
  • Sickled red blood cells are rigid and irregularly shaped.
• Sickle Cell Trait:
  • Carriers of the sickle cell gene have minimal health issues.
  • Having two trait carriers can result in a child with Sickle Cell Disease.
• Sickle Cell Crisis: Reduced oxygen can trigger crises due to exercise, stress, dehydration, infections, trauma, or general anesthesia. Clogged blood vessels, reduced blood flow (anoxia), pain, clotting, and potentially death.
• Thalassaemia:
  • Abnormal hemoglobin production.
  • Inherited from both parents (Mediterranean, Middle/Far Eastern, or Asian backgrounds).
  • Red blood cells are fewer and fragile, causing early hemolysis and anemia.
  • Alpha-thalassemia: Primarily in Asians, varying degrees of severity. The major type is lethal in utero or infancy.
  • Beta-thalassemia: Mainly in Mediterranean and Caribbean populations. Two types are homozygous beta-thalassemia major and heterozygous beta-thalassemia minor.

Aplastic Anemia

• Bone marrow depression, resulting in reduced blood cell production (all types).
• Causes: idiopathic, genetic, cytotoxic drugs, radiation, chemicals, malignancy, viral infections (rarely antibiotics, anticonvulsants, and sulfonamides).
• Symptoms: severe bruising, fatigue, pallor, palpitations, dyspnoea.
• Management: removing the cause, immunosupressant therapy, and bone marrow transplant.

Anemia of Chronic Disease

• Characterized by anemia and immune system activation.
• Decreased red blood cell production, possibly with increased haemolysis.
• Common in: chronic infections, autoimmune disorders, chronic diseases, malignancy, major trauma, major surgery, critical illness, and older adults.

Leukemias

• Acute lymphoblastic leukaemia (ALL): Most common in children/young adults, characterised by immature white blood cells; treated with chemotherapy, antibiotics, transfusions, and stem cell transplants.
• Acute myeloid leukaemia (AML): Aggressive myeloid cell cancer; abnormal myeloblasts; affects all ages, but risk increases with age; treated with chemotherapy, radiotherapy, bone marrow, or stem-cell transplants.
• Chronic myeloid leukaemia (CML): Rare; mostly affects adults; slow development; increased myeloid cell growth. Treated with tyrosine kinase inhibitors and sometimes stem cell transplants, with good prognosis.
• Chronic lymphocytic leukaemia (CLL): Most common adult leukemia; too many immature lymphocytes; typically affects over-60s; may not require immediate treatment but managed with tyrosine kinase therapy, BCL2 inhibitors, monoclonal antibodies, chemo, radiotherapy or immunotherapy.

Multiple Myeloma

• Cancerous plasma cells in bone marrow produce faulty antibodies (paraprotein).
• Multiple osteolytic lesions (holes) form in bones, resulting in bone pain, recurring infections, kidney damage, and fatigue.

Lymphoma

• Lymphatic system cells grow out of control.
• Tumours in lymph nodes, spleen, other lymph tissues, or neighbouring organs.
• Usually characterized by enlarged lymph nodes (neck, groin, armpit).
• Sometimes intraoral lesions.
• Two main types: Hodgkin's and non-Hodgkin's lymphoma.

Difference between Leukaemias, Lymphomas and Multiple Myeloma

• Common symptoms: weakness, fatigue, bone pain, infections, fever, weight loss
• Leukaemia: starts in bone marrow, cancerous cells found in blood
• Lymphoma: cancerous cells form tumours in lymphatic tissues
• Multiple myeloma: bone marrow tumour, too many plasma cells, bone marrow and bone damage.

Test your knowledge on blood disorders including anemias and leukemias. This quiz covers the symptoms, causes, and management of deficiency anemias along with their dental features. Dive into the details of iron deficiency anemia and other related conditions.