Oral Diagnosis and Dental Radiology-II Hematologic Diseases PDF

ORAL DIAGNOSIS AND DENTAL RADIOLOGY-II Hematologic Diseases Assoc. Prof. Büşra YILMAZ School of Dental Medicine Department of Oral and Maxillofacial Radiology [email protected] OUTLINE RED BLOOD CELL DISORDERS WHITE BLOOD CELL DISORDERS PLATELET DISORDERS RED BLOOD CELL DISORDERS Ery...

ORAL DIAGNOSIS AND DENTAL RADIOLOGY-II Hematologic Diseases Assoc. Prof. Büşra YILMAZ School of Dental Medicine Department of Oral and Maxillofacial Radiology [email protected] OUTLINE RED BLOOD CELL DISORDERS WHITE BLOOD CELL DISORDERS PLATELET DISORDERS RED BLOOD CELL DISORDERS Erythrocytes or red blood cells are the non nucleated formed elements in the blood. Red color- due to hemoglobin. RED BLOOD CELL DISORDERS  Erythrocytoses  Polycythemia vera  Anemia  Iron deficiency anemia  Anemia owing to hemolysis  Sickle cell anemia  Erythroblastosis fetalis  Thalassemia  Pernicious anemia  Aplastic anemia Erythrocytoses A conditions with an increase in circulating red blood cells (RBCs), characterized by a increased hemoglobin level. Relative polycythemia: Increase in number of RBC is only relative to the total blood volume -Seen in: vomiting, diarrhea or loss of electrolytes with accompanying loss of water. Absolute erythrocytoses: - Bone marrow with an inherited increased proliferative activity. - Resultant to enhanced stimulation of RBC production. • Bone marrow anoxia: pulmonary dysfunction, high altitude, CO poisoning. • Production of an erythropoietic stimulating factor- drugs and chemicals such as coal-tar, mercury, iron, bismuth. POLYCYTHEMIA VERA Chronic stem cell disorder with an insidious onset characterized as a panhyperplastic, malignant and neoplastic marrow disorder. • Uncontrolled RBC production. • Accompanied by increase in WBC and platelet production POLYCYTHEMIA VERA Oral Manifestations • Erythema (red-purple color) of mucosa • Glossitis • Erythematous & edematous gingiva • Spontaneous gingival bleeding Oral health consideration: • Risk of clinically significant bleeding and thrombosis • Tranexamic acid can be used • Adjustment of any concomitant antiplatelet and/or anticoagulant therapy ANEMIA Anemia refers to reduction in 1. Red blood cell count 2. Hemoglobin content 3. Packed cell volume It can also be defined as a lowered ability of the blood to carry oxygen Normocytic - occurs when the overall hemoglobin levels are decreased, but the red blood cell size (mean corpuscular volume) remains normal. Causes include: Acute blood loss, Anemia of chronic disease Macrocytic- Megaloblastic anemia, due to a deficiency of either vitamin B12, folic acid, or both. Also seen in hypothyroidism, alcoholism. Microcytic- result of hemoglobin synthesis failure/insufficiency. Iron deficiency anemia, thalassemia. Hypochromic microcytic- iron deficiency anemia. Iron deficiency anemia Iron deficiency is defined as a reduction in total body iron to an extent that iron stores are fully exhausted and some degree of tissue iron deficiency is present. Females are mostly affected Etiology • Chronic blood loss • Inadequate dietary intake • Faulty iron absorption • Increased requirements for ironinfancy, childhood, pregnancy Anemia Owing to Hemolysis Normal RBC life span - 90 to 120 days. Hemolytic diseases result in anemia if the bone marrow is not able to replenish adequately the prematurely destroyed RBCs. 3 mechanism for accelerated destruction of RBCs: 1. Molecular defect inside the red cell 2. Abnormality in membrane structure and function 3. Environmental factor- mechanical trauma Sickle Cell Anemia (TR: Orak Hücreli Anemi) Hereditary type of chronic hemolytic anemia transmitted as a mendalian dominant, nongender linked characteristic. Exclusively in blacks and in whites of Mediterranean origin. Erythrocytes have their normal biconcave discoid shape distorted, generally presenting a sickle-like shape. Reduces both their plasticity and lifetime from the normal 120 days average down to 14 days. This results in the underlying anemia and hypertrophic bone marrow. Sickle Cell Anemia (TR: Orak Hücreli Anemi) Oral Manifestations  Pallor of the oral mucosa  Increased overjet and overbite  Loss of trabeculation of the jaw bone  Delayed eruption of the teeth  Enamel hypomineralization  Pulpal necrosis Sickle Cell Anemia (TR: Orak Hücreli Anemi) Radiographic features HAIR – ON – END: Perpendicular trabeculations radiating outward from the inner table. Enlarged medullary cavities with thin cortices Mild to severe generalized osteoporosis Erythroblastosis fetalis Congenital hemolytic anemia due to Rh incompatibility results from the destruction of fetal blood brought about by a reaction between maternal and fetal blood factors. Clinical Manifestations  Some infants are stillborn  Anemia with pallor  Jaundice  Compensatory erythropoiesis  Fetal hydrops Hydrops fetalis — or hydrops — is a condition in which large amounts of fluid build up in a baby's tissues and organs, causing extensive swelling (edema). Oral Manifestations Deposition of blood pigments in the enamel and dentin Intrinsic stains Enamel hypoplasia Rh hump: ring like defect on teeth Thalassemia Thalassemia is a group of genetic disorders of hemoglobin synthesis characterized by a disturbance of either alpha (α) or beta (β) hemoglobin chain production. In heterozygotes, the disease is mild and is called as Thalassemia minor or thalassemia trait In homozygote, severe form, called Thalassemia major or β - thalassemia/ Cooley's anemia decrease in synthesis of total hemoglobin occurs → severe hypochromic anemia Clinical Manifestations  Occurs within the first 2 years of life  Siblings are commonly affected  Yellowish pallor of the skin  Fever, chills, malaise  Generalized weakness  Splenomegaly and hepatomegaly RODENT FACIES- develops mongoloid features due to prominence of the cheeks, protrusion of the maxillary anterior teeth, depression of the bridge of the nose. Oral Manifestations Anemic pallor observed Xserostomia Unusual prominance of the premaxilla Osteoporosis HAIR- ON- END appearance. SALT AND PEPPER EFFECT: Peculiar trabeculae pattern of maxilla and mandible, apparent coarsening of some trabeculae and the blurring and disappearance of others. Anemia Owing to Decreased Production of RBCs Megaloblastic (Pernicious) Anemia and Vitamin B12 (Cobalamin) Deficiency  It is adult form of anemia that is associated with gastric atrophy and a loss of intrinsic factor production in gastric secretions.  Rare congenital autosomal recessive form.  Autoimmune disease resulting from autoantibodies directed against intrinsic factor (a substance needed to absorb vitamin B12 from the gastrointestinal tract) and gastric parietal cells.  Vitamin B12 → erythrocyte – maturing factor. Oral Manifestations Burning sensation in the tongue, lips, buccal mucosa, and other mucosal sites. The tongue is generally inflammed often described as ‘beefy color. red’in Characteristically with the glossitis, glossodynia and glossopyrosis there is gradual atrophy of the papillae tongue that eventuates in a smooth or bald tongue → Hunter’s glossitis or Moeller’s glossitis. Fiery red appearance of the tongue may undergo periods of remission, recurrent attacks are common. Dysphagia and taste alterations have been reported. Oral Manifestations Aplastic Anemia Aplastic anemia (AA) is a rare blood dyscrasia in which peripheral blood pancytopenia results from reduced or absent blood cell production in the bone marrow and normal hematopoietic tissue in the bone marrow has been replaced by fatty marrow Environmental exposures, such as to drugs, viruses, and toxins, are thought to trigger the aberrant immune response in some patients, but most cases are classified as idiopathic Clinical Manifestations of Anemias  Weakness  Tachycardia  Angina pectoris  Exertional dyspnea  Headache, dizziness, dificulty concentration and fatigue due to hypoxia in the brain  Paresthesia, difficulty pernicious anemia walking in Clinical Manifestations of Anemias  Paleness of the skin, mucous membranes, nail beds and conjunctiva  Koilonychia (spoon-shaped nails) – seen in iron deficiency anaemia  In iron deficiency anemia, low iron concentration in serum-high iron binding capacity and decrease in ferritin level Oral Manifestations of Anemias  Paleness of the oral mucosa  Glossitis, pain, burning, taste disturbance  Agular Chelitis  Unexplained and unresponsive ulcers  Oral candidiasis, especially in iron deficiency  Aphthous ulcers, especially in folic acid deficiency  Trabecular defect on radiography Oral Health Considerations- Anemia Low risk group patients -Normal procedure is applied history of anaemia but symptoms are not observed. The hematocrit level is over 30%. High-risk patients - Dental surgery should not be performed until the blood values and clinical condition return to normal. Hematocrit below 30%, hemoglobin below 9 g/dl Patient that has ongoing bleeding Patient that needs blood transfusions due to anemia  antibiotic prophylaxis in patients with sickle cell anemia and thalassemia References • Michael Glick (ed.); Martin S. Greenberg (ed.); Peter B. Lockhart (ed.); Stephen J. Challacombe (ed.). Burket's Oral Medicine. 13th edition. Wiley-Blackwell. June 2021. ISBN: 9781119597780