Blood Disorders Revision PDF

Blood disorders  Blood disorder classifications Anaemias Blood disorders = Leukaemia abnormal or disease of Other dyscrasias (multiple myeloma,...

Blood disorders  Blood disorder classifications Anaemias Blood disorders = Leukaemia abnormal or disease of Other dyscrasias (multiple myeloma, lymphoma) the blood, cells of the Bleeding disorders (thrombocytopenia, coagulopathies) blood or the plasma. Anaemias = A condition when there is a reduced oxygen carrying capacity of the blood, due to a decreased amount of red blood cells or abnormal red blood cells. Haemolysis = Break down of red Deficiency anaemias blood cells. Iron deficiency Quite common A condition where a lack of iron in the body leads to a reduced number of red blood cells. Red blood cells become smaller, paler and carry less haemoglobin. Nutrients not Heavy periods Poor high being absorbed fat diet within gut More prone Vegan Chronic Check medical to infection blood loss history Dietary Malabsorption deficiency Management Ref to GP - Causes Pregnancy underlying cause Preventative Iron requirements increase Iron supplements dental regime Iron deficiency Recurrent Palpitations aphthous ulcers Pale Atopic glossitis Fatigue Dental clinical features (papillae disappeared) Clinical features Headache Angular Burning mouth Brittle nails Pale oral mucosa syndrome cheilitis Breathlessness Vitamin B12 deficiency Needed to synthesise DNA and RNA — build new cells including red blood cells. Results in depressed production of red blood cells. Causes; Diet - found in meat and dairy - vegans most at risk. Impaired absorption - Crohn’s disease, pernicious anaemia. Clinical features; Management; Fatigue, breathlessness and pale skin. Ref to GP for correct diagnosis. Glossitis Replacement of B12 - Intra- Recurrent aphthous ulcers muscular injections at regular Angular Cheilitis intervals. (Hydroxocobalamin) Burning mouth syndrome Preventative dental care regime Red beefy tongue Regular monitoring. Folate deficiency (folic acid) Needed to synthesise DNA and RNA — build new cells including red blood cells. (Same as Vit B12) Absorbed from small intestine No stores within body, can quickly develop deficiency if no intake. Causes; Diet - found in fresh leafy and other vegetables, Management; Ref to GP for correct diagnosis. Clinical features; Folic acid orally for several months and Fatigue, breathlessness, pale skin. improve diet. Glossitis Preventative dental care. Recurrent aphthous ulcers Regular monitoring. Angular cheilitis Folate deficiency in pregnancy can result in Red beefy tongue fetal neural tube defects (spina bifida, cleft lip and palate) Haemolytic anaemias Red blood cells are destroyed faster than they can be made. Produce abnormal red blood cells that do not live as long. Sickle Cell Thalassaemia Sickle Cell disease One of the most common genetic diseases. Leads to production of altered haemoglobin. Irregular, inflexible, sickle shaped cells. Can cause blockages in circulatory system preventing normal flow of oxygen to tissues. If they do pass through blood vessels, they’re destroyed in liver or spleen. Can cause severe pain, damage to vital organs or death. Sickle Cell trait A person who inherits the sickle cell gene from one parent, but the normal type of gene from another. Healthy as carries, with rarely having health issues related to trait. When two people with sickle cell trait have a child, the child may inherit both sickle genes and inherit the disease. Normal dental treatment expect avoid general anaesthetic. Sickle Cell crisis In low O2 state (exercise, stress, dehydration, infection, trauma, GA), misshapen sickle cells can block and reduce flow of blood. This can cause sudden severe pain, clotting and death. Can last 7 days. Sickle cell disease management; Clinical features; Prevention+++++, preventing dental Papillary atrophy of tongue — smooth and painful. infections is essential. Neuropathic path and altered sensation. Often treated in specialist centres. Aseptic pulp necrosis. Antibiotic cover for invasive dental treatment. Osteomyelitis. Conscious sedation fine with caution. Pale oral mucosa. Avoid stress — good LA for pain control but Bone pain. avoid vasoconstrictor (adrenaline). Fungal infections. Avoid NSAIDS - paracetamol OK. Thalassaemia Inherited disease. Mutation of genes responsible for the production of haemoglobin within the blood. Affects red blood cells; fewer in numbers and more fragile. Can lead to haemolysis, causing anaemia. Alpha-Thalassaemia Mostly found in Asians 4 subtypes depending on severity. Beta-Thalassaemia Mainly found in Mediterranean and Caribbean 2 types; Homozygous (major) - iron overload causes cardiac problems, liver and pancreatic dysfunction and dry mouth due to deposits in salivary glands. Heterozygous (minor) - more common, usually asymptomatic apart from mild anaemia. Clinical features; Prominent maxillae due to bone marrow expansion. Hair on end appearance on lateral skull x-rays. Spacing and forward drifting of maxillary incisors. Painful swelling of parotid salivary glands. Xerostomia - increased risk of dental caries. Thalassaemia management; Severe cases treated in hospital. Care with infection control - patients may have had multiple blood transfusions and have contracted blood borne diseases. Dental prevention+++++ is essential. Caused by; Viral or bacterial infections Acquired haemolytic anaemia Medicines (penicillin, antimalerial) Acquired over life, NOT inherited. Blood cancers and some tumours. Some can be short term (temporary), or life long (chronic). Autoimmune disorders Same clinical features as other anaemias. Overactive spleen Requires dental prevention+++++. Mechanical heart valves Severe reaction to blood transfusions. Aplastic anaemia Depressed bone marrow leading to fewer blood cells (all types) being produced. Rare, and causes can be unknown. Causes; Idiopathic (autoimmune) Genetic Management; Cytotoxic drugs Removal of cause. Radiation Immunosuppressant therapy. Certain chemicals Bone marrow transplant. Malignancy Clinical features; Dental prevention+++++ Viral infection Fatige Severe bruising Anaemia of chronic disease; Pale skin Decreased red blood cell production and/or increased haemolysis Palpitations More common in patients with; Shortness of breath Chronic infections (HIV) (dyspnoea) Autoimmune disorders (rheumatoid arthritis) Chronic diseases Management; Malignancy (cancer) Dealing with anaemia and Major trauma underlying disorder. Major surgery or illness Dental prevention+++++ Older adults Leukaemias Leukaemias = Malignant proliferation of white blood cell precursors in the bone marrow. Acute = rapid onset, very Leukaemia risk factors: quick Ionising radiation Chemicals Chronic = Genetic predisposition slower, less Many causes unknown aggressive Classification of Leukaemias o Acute lymphoblastic leukaemia Most common in children and young people. o Acute myeloid leukaemia Most common leukaemia in adults. Gingival overgrowth. o Chronic myeloid leukaemia Rare, mainly affects over 60’s. o Chronic lymphocytic leukaemia (CLL) Most common leukaemia, manly affects over 60’s. Often picked up by chance in blood test. Common symptoms of Leukaemia Important to: Check with medical team it’s appropriate to treat Delay invasive treatments Ref on appropriate pathway PREVENTION+++++ Too few/decreased healthy white blood cells will cause patients to have; Recurrent infections Sore mouth/throat Unwell Clinical features Fever Anaemia symptoms (Fatigue, pallor, breathlessness, palpitations). Bleeding tendency. Liability to infection. Clinical features - Dental Lymphadenopathy. Symptoms depend Lymphadenopathy - EO examination. Fever/night sweats on how quickly it Recurrent ulcers. develops. Oral mucosa pallor. Acing joints/bones Tender lump UL abdomen Gingival overgrowth (AML). enlarged spleen). Heavy spontaneous gingival bleeding. Infections - viral, candidal, bacterial. Petechial haemorrhages (palate, lips). Other blood dyscrasias Important to: Multiple Myeloma Check with medical team it’s appropriate to treat Type of bone marrow cancer. Delay invasive treatments Doesn’t usually cause lump or tumour. Ref on appropriate pathway Body produces too many plasma cells in the bone marrow. PREVENTION+++++ These extra cells cause damage to the bones marrow & destroy bone. Osteolytic lesions form in the bones (holes). Harder for body to fight infections. Bone pain, fatigue, shortness of breath, stomach pain. Lymphoma Blood cancers often have Type of blood cancer affecting the lymphatic system. common symptoms; Lymphocytes multiply in abnormal way and collect in lymph weakness, fatigue, bone nodes, spleen and other lymph tissues. pain, infections, fevers Lymph node enlargement (neck or armpit). and weight loss. 2 main types; Hodgkin’s lymphoma - Rare Non-Hodgkins’s lymphoma - More common Leukaemia = starts in Lymphoma = cancerous Myeloma = tumour of bone bone marrow, cancerous commonly aggregate and marrow. Body produces too cells are discovers form tumour in lymphatic many plasma cells and they circulating in blood tissues cause damage bone marrow and destroy bone. Dental implications of blood cancers Radiotherapy/chemotherapy — Delay treatment, discuss with oncologist, increased risk of bleeding. Xerostomia — dry mouth causing increase risk of dental caries. Repair of periodontium reduced — due to radiotherapy, causing uncontrolled periodontal breakdown. Increased risk of infections Delay treatment and gain advice from oncologist. Multiple-myeloma patients may be on long-term bisphosphonates — osteoradionecrosis. Prevention and regular monitoring is essential — additional fluoride.