Blood Disorder

Blood Disorders Overview

• Blood disorders include anemias, leukemias, and other dyscrasias like multiple myeloma and lymphoma.
• Bleeding disorders, such as thrombocytopenia and coagulopathies, are classified as blood disorders.

Anemias Classification

• Anemias are classified into deficiency anemias, hemolytic anemias, aplastic anemia, and anemia of chronic disease.
• Deficiency anemias include iron deficiency, vitamin B12 deficiency, and folate deficiency.
• Inherited hemoglobinopathies like Sickle Cell Disease and Thalassaemia are examples of hemolytic anemias.

Anemia

• Anemia describes the condition with reduced oxygen-carrying capacity of the blood.
• Females are considered anaemic if their blood count is below 11.5 g/dl, and for males, below 13.5 g/dl.
• It results from having too few or abnormal red blood cells.
• Common condition with a variety of causes.

Iron Deficiency Anemia

• Iron deficiency anemia is a condition where a lack of iron leads to a reduction in red blood cells.
• The red blood cells become smaller, paler, and carry less hemoglobin.
• It is caused by dietary deficiency, chronic blood loss, malabsorption, and pregnancy.

Clinical Features of Anemia

• Common symptoms of anemia include fatigue, lethargy, and breathlessness.
• Palpitations, pallor, and headache are also clinical signs of anemia.
• Anemia also causes brittle nails and koilonychia (spoon-shaped nails).
• Dental issues related to anemia include a pale oral mucosa and atrophic glossitis.
• Anemia may cause recurrent aphthous ulcers and angular cheilitis.
• Patients may experience a burning mouth.

Management of Iron Deficiency Anemia

• Management includes checking medical history, detecting underlying causes, and prescribing iron supplements.
• Preventative dental regime and regular maintenance are important aspects of anemia management.
• Anemic patients are more prone to infection.

Vitamin B12 Deficiency

• Vitamin B12 is needed to synthesize DNA and RNA.
• B12 absorption relies on intrinsic factor secretion by parietal cells and absorption of the B12-intrinsic factor complex in the terminal ileum.
• Causes of vitamin B12 deficiency include a diet lacking meat and dairy (vegans at risk) and impaired absorption due to conditions like Crohn's or Pernicious Anemia.
• Reduced number of RBC's that become larger.
• Develops sowly leading to: fatigue, lethargy, breathlessness & pallor.
• Oral manifestation is similar to other deficiencies.

Management of Vitamin B12 Deficiency

• Diagnosis should be correct
• Replacement of B12 (cobalamin) with regular intra-muscular injections of hydroxocobalamin at regular intervals
• Good preventive dental care and follow up.

Folate (Folic Acid) Deficiency

• Folate is needed to synthesize DNA and RNA and to build new cells, including RBCs.
• It is found in fresh leafy and other vegetables and is absorbed from the small intestine.
• The body has virtually no stores of folate.
• Folate deficiency is mostly due to dietary deficiency.
• Dental issues are similar to other deficiency.

Clinical features and management of Folate (Folic Acid) Deficiency

• Glossitis
• Recurrent aphthous ulcers
• Angular cheilitis
• Red beefy tongue
• Pregnancy may cause neural tube defects.

Haemolytic Anemias

• Inherited haemolytic anemias involve haemoglobinopathies like sickle cell anemia and thalassaemia.
• Acquired hemolytic anemias arises from viral or bacterial infections.
• Exposure to medicines e.g. penicillin, antimalarial medicines
• Can result in blood cancers and some tumours.
• An overactive spleen
• Mechanical heart valves that may damage the red blood cells as they leave the heart, or reactions.

Inherited Hemolytic Anemias

• Result from genetically determined disorders in haemoglobin synthesis.
• Include Sickle Cell Disease and Sickle Cell Trait.
• Include Thalassaemia and Thalassaemia Trait.

Sickle Cell Disease

• Autosomal recessive genetic disease affecting haemoglobin production causes intermittent crises.
• Common in people of African descent.
• Diseased red blood cells become rigid and irregularly shaped.
• Causes episodes of severe pain can damage vital organs.

Sickle Cell Trait

• Results from inheriting the sickle cell gene from one parent and the normal gene from the other.
• Those with the trait are generally healthy carriers.
• Issues rarely arise with the trait.
• If two people with SC trait have a child, their child may inherit sickle genes leading to sickle cell disease.

Sickle Cell Crisis

• Low oxygen triggers crises can be due to exercise, stress, dehydration, infection, trauma, and general anaesthesia.
• Misshapen red blood cells clog vessels causing anoxia.
• Leads to sudden severe pain and can cause death.

Clinical dental features of Sickle Cell

• Dental features: papillary atrophy of tongue, neuropathic pain, aseptic pulp necrosis
• Osteomyelitis or delayed dental eruption
• Mucosal pallor, bone pain & fungal infections

Sickle Cell Management by Dental Clinician

• Normal treatment for Sickle Cell Trait except avoid GA
• Preventative care dental regime
• Preventing dental infections is essential
• Antibiotic prophylaxis for invasive dental treatment must be presribed
• GA is contra-indicated
• Conscious sedation is fine with caution
• Decrease any Stress
• Good local anaesthetic is needed for pain control
• Avoid vasoconstrictors

Thalassaemia

• Occurs mainly in Mediterranean, Middle/Far Eastern, and Asian groups.
• Characterised by abnormal amounts of haemoglobin.
• It is an inherited gene that comes from both parents
• Red blood cells are fewer and more fragile.

Types of Thalassaemias

• Alpha-thalassaemias are mostly found in Asians and have subtypes with varying severity.
• The major type is lethal in utero or infancy.
• Beta-thalassaemias are common in Mediterranean and Caribbean
• Two types of ẞ-thalassaemia include homozygous (major) heterozygous (minor).

Beta-thalassaemia Symptoms

• Chronic anaemia, marrow hyperplasia or skeletal deformities.
• Splenomegaly, cirrhosis & iron overload.
• Iron overload can cause cardiac problems, liver & pancreatic dysfunctions.
• Pallor and tiredness.
• Heterozygous is much more common and usually asymptomatic due to mild anaemia

Orofacial Manifestations

• X-rays show hair like appearance which indicates skeletal abnormalities.
• There may be prominent maxillae and frontal bossing or expansion.
• It causes Spacing and forward drifting of maxillary incisors.
• Painful swelling of parotid salivary glands & xerostomia.

Thalassaemia - Management

• Severe cases need hospital treatment
• Be sure blood controls are in place.

Anaemia of Chronic Disease

• Characterised in anaemia as evidence of immune stimulation occurs.
• Due to decrease in red blood cells occurs with and increase in haemolysis.
• Commonly develops from HIV.
• Autoimmune disorders and rheumatoid arthritis are frequent.
• Patients from major illnesses can be susceptible.

Acquired Hemolytic Anemias

• Some viral or bacterial infections
• Medicines e.g. penicillin, antimalarial medicines
• Blood cancers and some tumors
• Autoimmune disorders e.g. lupus, rheumatoid arthritis, ulcerative colitis

Aplastic Anemia

• Bone marrow becomes depressed, leading to fewer blood cells (all types)
• Causes include viral infection
• Antibiotics, anticonvulsants lead to sever bruising and pallor.
• Palpitations may develop.

Management for Aplastic Anemia

• Removal of the cause
• Immunosuppressant therapy
• Bone marrow transplant

Leukaemias

• Malignant proliferation of white blood cell precursors occurs in bone marrow.
• Risk factors ionizing radiation, chemicals, genetic predisposition.

Classification of Leukaemias

• Includes: Acute lymphoblastic leukaemia
• Acute myeloid leukaemia
• Chronic myeloid leukaemia
• Chronic lymphocytic leukaemia

Acute Lymphoblastic Leukaemia

• Most common in children, young people, young adults
• Leeads to Large numbers of immature white blood cells released
• Drop in red blood cells and platelets
• Can be treated through chemotherapy, antibiotics, blood transfusions and stem cell transplant
• Survival rates after as treatment is high as 85%

Acute Myeloid Leukaemia

• Cancer to myeloblasts
• Aggressive form of Leukemia
• Can be fatal if left untreated.

Chronic Myeloid Leukaemia

• Increased and unregulated growth of myeloid cells
• Can be treated through inhibitors, and sometimes stem cell transplant
• Good outlook but watch out for blast crisis

Chronic Lymphocytic Leukaemia

• Too many immature lymphocytes produced
• Tx with tyrosine kinase therapy
• monoclonal antibody therapy

Leukaemia - Clinical Features

• Anaemia includes fatigue and pallor.
• Leads to Thrombocytopenia, purpura as well as bleeding tendencies.
• increases Liability to infections
• Causes Lymphadenopathy

###Leukaemia Dental Manifestations

• Cervical lymphadenopathy
• Mucosal pallor and Ulcers
• Spontaneous gingival bleeding
• Petechial haemorrhages of palate, lips
• Check viral and bacterial infections before proceeding with consultation
• If patients have chronic illness get advice from physician.

Other Dyscrasias

Symptoms of Multiple Myeloma

• Antibody producing plamsa cells increase.
• Plasma production with faulty structures
• Creates bone pain recurrently

Lymphoma

• Affects cells in the lymphatic system.
• Lymphocytes grow which collects as tumors.
• Common findings are lymph expansion as well as tumors.

Dental Implications

• Radiotherapy or chemotherapy
• Myeloma patients need special cares after operations.
• Consult physician before procedure.

Differences in leukaemia, lymphoma and multiple myeloma

• Weakness & fatigue are common among the 3 symptoms
• Leukaemia is a start in the bone marrow while lymphoma is cancerous cells
• Myeloma causes extra bone production than what their cell count calls for to build strong bone.