Hematology Part 2: WBC Disorders

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Questions and Answers

What is the most common presenting symptom of recurrent neutropenia?

  • Fever
  • Recurrent aphthous stomatitis (correct)
  • Lymphadenopathy
  • Mucosal bleeding

Which of the following accurately describes leukemia?

  • A gradual disease course progressing over years
  • Infection that primarily affects children
  • A condition limited only to adults
  • Proliferation of abnormal hematopoietic cells with impaired differentiation (correct)

What clinical manifestation is typically associated with acute leukemia?

  • Chronic fatigue syndrome
  • Bone marrow suppression (correct)
  • Migrating joint pain
  • Weight gain

Which type of leukemia is more frequently found in adults?

<p>Acute Myeloid Leukemia (AML) (B)</p> Signup and view all the answers

What is a common consequence of untreated leukemia?

<p>Infection, bleeding, or both (C)</p> Signup and view all the answers

Which imaging tests are considered key diagnostic aids for conditions involving Waldeyer’s ring structures?

<p>CT and PET scan (A)</p> Signup and view all the answers

What oral health issue is commonly associated with radiation therapy affecting cervical nodes?

<p>Xerostomia (A)</p> Signup and view all the answers

Which of the following symptoms is NOT typically associated with multiple myeloma?

<p>Increased appetite (A)</p> Signup and view all the answers

What is the primary cause of osteoradionecrosis in patients who have undergone radiation therapy?

<p>Radiation exposure (A)</p> Signup and view all the answers

Which symptom is commonly associated with the clonal proliferation of malignant plasma cells in multiple myeloma?

<p>Recurrent infections (D)</p> Signup and view all the answers

What complication is often a concern for multiple myeloma patients requiring dental surgery?

<p>Risk of hemorrhage (D)</p> Signup and view all the answers

Which type of lesions are typically observed in patients with multiple myeloma under radiographic examination?

<p>Osteolytic lesions (D)</p> Signup and view all the answers

What preventive measure is recommended for patients undergoing radiation therapy to combat dental caries?

<p>Topical fluoride varnish (D)</p> Signup and view all the answers

What is the absolute neutrophil count (ANC) threshold indicating neutrophilia?

<p>Above 7,700/μL (D)</p> Signup and view all the answers

Which of the following is NOT a possible etiology of granulocytosis?

<p>Genetic mutations in ELA-2 (D)</p> Signup and view all the answers

What is a common consequence of neutropenia?

<p>Increased susceptibility to infections (C)</p> Signup and view all the answers

Which of the following is a known cause of cyclic neutropenia?

<p>Inherited mutations in neutrophil elastase (A)</p> Signup and view all the answers

What treatment consideration is important for dental procedures in patients with neutropenia?

<p>Consult physician for prophylactic antibiotics (D)</p> Signup and view all the answers

What is the primary threshold for ANC to diagnose neutropenia?

<p>Below 1,000/μL (D)</p> Signup and view all the answers

Which of the following is a possible noninfectious cause of granulocytosis?

<p>Acute glomerulonephritis (B)</p> Signup and view all the answers

Neutropenia as a consequence of viral infections is commonly associated with which virus?

<p>Epstein Barr virus (EBV) (B)</p> Signup and view all the answers

What is a common oral manifestation of mucositis caused by chemotherapy?

<p>Pallor of oral mucosa (B)</p> Signup and view all the answers

What is the most significant step to take before chemotherapy to avoid oral complications?

<p>Conduct a prechemotherapy dental assessment (A)</p> Signup and view all the answers

Which characteristic defines chronic leukemia as opposed to acute leukemia?

<p>Presence of well differentiated cells in the bone marrow (A)</p> Signup and view all the answers

Which treatment is recommended for managing oral ulcers during chemotherapy?

<p>Use of analgesics for pain management (D)</p> Signup and view all the answers

What is typically the first sign of chronic leukemia?

<p>Asymptomatic enlargement of a supradiaphragmatic lymph node (A)</p> Signup and view all the answers

How should spontaneous gingival bleeding be managed?

<p>Pressure application with absorbable gelatin and thrombin (D)</p> Signup and view all the answers

Which of the following infections is associated with chemotherapy-induced mucositis?

<p>Herpes simplex ulcers (C)</p> Signup and view all the answers

What is a potential complication of untreated chronic leukemia?

<p>Untreated clinical course leading to death in months (D)</p> Signup and view all the answers

Flashcards

Cyclical Neutropenia

A condition characterized by recurrent, cyclical drops in neutrophil count, typically occurring every 21 days and lasting 3 to 5 days. This leads to a weakened immune system, making the individual more susceptible to infections.

Leukemia

A type of cancer affecting blood-forming cells in the bone marrow, leading to an overproduction of abnormal white blood cells (leukemic cells).

Acute Leukemia

A subtype of leukemia characterized by a rapid, aggressive course where leukemic cells grow and proliferate rapidly, displacing normal blood cells and leading to bone marrow failure. It often progresses over weeks to months.

Acute Lymphocytic Leukemia (ALL)

A subtype of acute leukemia distinguished by the presence of abnormal lymphocytes. It is most commonly found in children and is characterized by a rapid progression.

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Gingival Hyperplasia in Leukemia

A potential early sign of leukemia. It's caused by an abnormal buildup of leukemic cells in the gums, leading to a swelling or overgrowth of gum tissue.

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Chemotherapy-induced mucositis

Inflammation and sores in the mouth caused by chemotherapy. It can include sores from herpes (HSV) or fungus (candidiasis).

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Chronic Leukemia

A condition where there is an increased number of mature white blood cells in the bone marrow.

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Gingival enlargement

Swelling of the gums caused by inflammation, often related to poor oral hygiene and infection.

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Gingival bleeding

Bleeding from the gums, often a sign of inflammation or underlying health conditions.

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Mucositis

Inflammation of the tissues lining the mouth.

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Oral ulceration

Deep, irregularly shaped sores in the mouth, often without a red ring around them.

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Laryngeal pain

Pain in the voice box, potentially due to infection or irritation.

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Pallor

A decrease in the number of red blood cells, resulting in paleness.

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Granulocytosis

An abnormally high number of granulocytes in the blood, primarily neutrophils, leading to an increased white blood cell count.

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Neutrophilia

A total white blood cell count greater than 11,000/μL with an absolute neutrophil count (ANC) greater than 7,700/μL.

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Etiology of Granulocytosis

Infection, stress, smoking, pregnancy, myeloproliferative disorders, and various non-infectious causes.

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Neutropenia or Granulocytopenia

A condition characterized by a reduced quantity of leukocytes (ANC < 1,000/μL), making the body more susceptible to infections.

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Etiology of Neutropenia or Granulocytopenia

Viral infections like Epstein Barr virus (EBV), drug-induced myelosuppression, autoimmune disorders such as rheumatoid arthritis, and lupus.

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Oral Health Considerations for Neutropenia

Prophylactic antibiotics before dental procedures are needed, and physician consultation is crucial.

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Genetic Cause of Cyclic Neutropenia

Neutrophil elastase (ELA-2) gene mutations trigger this condition, causing cyclical episodes.

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Multiple Myeloma (MM)

A type of cancer that affects the bone marrow, causing the overproduction of abnormal plasma cells.

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Bone Marrow Suppression in MM

A symptom of MM where the body is unable to make enough healthy blood cells, leading to weakness, fatigue, and increased risk of infections.

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Bone Pain in MM

A common symptom of MM where the patient experiences pain due to cancer cells destroying bone tissue.

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Osteonecrosis of the Jaw (ONJ)

A common oral health concern in MM, involving the jawbone and potentially leading to exposed, non-healing areas.

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Xerostomia

A condition caused by radiation therapy affecting the salivary glands, leading to dry mouth.

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Radiation-Induced Caries

Tooth decay caused by radiation-induced dry mouth, which increases the risk of cavities.

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Osteoradionecrosis

Damage to the jawbone caused by radiation therapy, making the bone fragile and prone to infection.

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Imaging Tests for MM

These tests are used to detect and monitor the spread of MM including CT and PET scans.

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Study Notes

Hematology Part 2: White Blood Cell Disorders

  • Leukocytes (WBCs) are white blood cells. Different types include granular cells (neutrophils, eosinophils, basophils) and agranular cells (lymphocytes, monocytes). Specific percentages for each are provided.

Quantitative Leukocyte Disorders

  • Granulocytosis: An abnormally high number of granulocytes, typically neutrophils, often associated with an increased WBC count (greater than 11,000/µL) and an elevated absolute neutrophil count (ANC greater than 7,700/µL). Causes include infections, stress, pregnancy, and myeloproliferative disorders, as well as metabolic conditions and poisoning.

  • Neutropenia (Granulocytopenia): A decreased number of granulocytes, particularly neutrophils (ANC less than 1000/μL), increasing susceptibility to infections. Causes include transient marrow suppression, drug-induced effects, and autoimmune disorders like rheumatoid arthritis and lupus.

  • Leukemia: A cancer of the blood characterized by abnormal proliferation of hematopoietic cells. Results in marrow failure. Classified as acute (e.g., Acute Lymphocytic Leukemia (ALL), Acute Myeloid Leukemia (AML) ) or chronic (e.g., Chronic Myelocytic Leukemia, Chronic Lymphocytic Leukemia).

  • Lymphoma: Malignant neoplasm of lymphoid tissue, often categorized as Hodgkin's lymphoma, Non-Hodgkin's lymphoma, or Burkitt's lymphoma.

Oral Health Considerations

  • Prophylactic antibiotics are sometimes recommended before dental procedures.

  • Patients with WBC disorders may need physician consultation.

  • Patients receiving radiation therapy may experience salivary gland issues (xerostomia) and an increased risk of osteoradionecrosis (bone damage).

  • Multiple Myeloma (MM): A cancer of plasma cells, often causing focal osteolytic lesions in the bone marrow and jawbone (mandible is more frequently affected than maxilla).

  • Cyclic Neutropenia: An inherited disorder characterized by recurring cycles of low neutrophil counts, with symptoms like fever, mouth ulcers, and infections. The cycle typically repeats every 21 days, lasting 3-5 days.

  • Oral Manifestations: Various oral manifestations may accompany these conditions, including gingival hyperplasia, oral ulcerations, and infections. Attention to oral health is a crucial aspect of treatment and management of these disorders

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