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Blood Disorders

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Blood Disorders Ceri Blinsmon Riverside Community College

The three disorders identified in this paper are sickle cell anemia. . There are many types of blood disorders. The purpose of this paper is to define and discuss three different types of blood disorders that a patient may present with.Blood Disorders Abstract 2 Many patients suffer from blood disorders. An important part of this paper is discussing the oral manifestations present in a patient with these specific disorders and the treatment options available. aplastic anemia and hemophilia.

Platelets are also found in blood and they work to maintain hemostasis. sickle cell anemia. Red blood cells work to 3 exchange gases and supply nutrients to the periodontal tissues. Red blood cells with a sickle shape are more easily destroyed than normal red blood cells (Ibsen & Phelan. Anemia can be classified as mild. 2006). Anemia is defined as a deficiency in the quality and quantity of blood. therefore the oxygen content in the blood is decreased. for this paper. in the mouth. severe and life threatening (Lu & Wu. Aplastic anemia is a disease in which the blood cells do not circulate as much because bone marrow activity decreases. Platelets aid in the inflammation process by calling out cells for the healing of wounds. Newman. Takei & Klokkevold. thus not making as many blood cells (Brennan . The book Clinical Periodontology describes the role and purpose of red blood cells in the human body and more importantly. 2004). Patients that present with sickle cell anemia have an abnormal hemoglobin type and the red blood cells appear as a sickle shape. white blood cells and platelets. Because the blood cell is oddly shaped oxygen does not bind in the normal configuration. Three specific blood disorders will be discussed in this paper. aplastic anemia and hemophilia. 2004). When either the red blood cells or platelets are effected havoc can occur in the periodontium (Carranza. Oral pathology for the dental hygienist states that sickle cell anemia is a disease that is most often found in African Americans and is more common in women than men especially women that are younger than age 30. moderate.Blood Disorders Blood Disorders Blood is composed of red blood cells.

. as the maxillary incisors were labially inclined (Licciardello.. Fibrin is needed for coagulation and when not present coagulation can not occur (Ibsen & Phelan. The mandible was rotated posteriorly.. Hemophilia is a disorder in which blood coagulates in a less that efficient time frame (Ibsen & Phelan. 2007).. 2004). 2004).. This is an uncommon disease (Brennan et al. Aplastic anemia is a disease that can be hereditary. primary and secondary.Blood Disorders et al. This occurs because the plasma protein responsible for converting fibrogen into fibrin is deficient (Ibsen & Phelan. There are two different types of hemophilia. benzene exposure. type A and B. and the vertical craniofacial pattern was more pronounced in patients with sickle cell disease. 2001). Bertuna & Samperi. Clinical Manifestations A study done by the European Journal of Orthodontics showed that patients with sickle cell disease presented with a significantly distinct craniofacial structure. 2001). 2001). 2004). insecticides. viruses and hepatitis (Brennan et al. This disease occurs 4 when inadequate numbers of the hematopoietic stem cells made by the hypocellular bone marrow (Brennan et al. Sickle cell anemia and aplastic anemia patients may present with angular . 2004). 2001). Hemophilia is also an inherited disorder (Ibsen & Phelan. 2001). Etiology Sickle cell anemia is an inherited disorder (Ibsen & Phelan. 2004). The decrease in activity causes a decreased production of erythrocytes. granulocytes and platelets (Brennan et al. 2001). Tooth placement irregularities were also noticed. Primary anemia occurs most often in young adults (Brennan et al. but has also been linked to certain medications.. There are two types of aplastic anemia.

. 2006). One treatment being used is hematopoietic stem cell transplantation (Imanguli et al. Other manifestations present were gingival hyperplasia. non herpetic ulcerations. 2004). Guadagnini. spontaneous gingival bleeding. which is the most common oral manifestation of aplastic anemia (Brennan et al. atrophy glossitits and erythematous mucositis (Lu & Wu. 2004). Pavletic. 2006). Patients presenting with hemophilia have an increased risk of hemorrhage after any dental procedure that may produce bleeding (Imanguli et al. Another study done showed that patients presenting with aplastic anemia also could present with petechiae. petechiae and ecchymoses (Imanguli. Oral manifestations of hemophilia include bleeding spontaneously. Common Treatment Modalities There are many treatments currently being used in patients with these specific blood disorders. Most of the oral manifestations that present in patients with bleeding disorders have a differential diagnosis for another type of bleeding disorder. For example patients with hemophilia may present with petechiae.. pallor and leukoplakia (Brennan et al. and that can be a sign of aplastic anemia also (Ibsen & Phelan.. Differential Diagnosis Manifestations of aplastic anemia and sickle cell anemia have a differential diagnosis of those manifestations that present with nutrient deficient anemia (Lu & Wu. 2004). Brahim & Atkinson. This treatment has increased the chances for patients suffering .. herpes. Many are still being researched and many have been proven to be 5 efficient in treatment. 2006). 2001). 2001). oral candidiasis.Blood Disorders cheilitis.

Patients suffering from a blood disorder should have routine dental treatments (Brennan et al. 2004). 2005).Blood Disorders from anemia (Imanguli et al. 2004). Patients used this four times a day for four to eight days along with tranexanic acid as an oral tablet three times a day for five days and showed decreased bleeding after treatment (Franchini et al. 2006). but are serious and should be . 2006). 2004). Consideration should be taken when treating patients suffering from hemophilia because of the increased risk of hemorrhage (Ibsen & Phelan.. Conclusion Research shows that patients that suffer from blood disorders commonly present with oral manifestations. The antifungal treatment is used in treating the patients that present with candidiasis. The manifestations are treatable. but due to the fact that these patients may be immunocompromised the candidiasis infection can easily return. 2001).. 2004).. One treatment for patients that present with hemophilia is a mouthwash comprised of tranexanic acid (Franchini et al. Patients that suffer from this disease may suffer from a range of oral complications (Imanguli et al.. One problem that can occur with this treatment is that the patients may suffer from graft versus host disease. 2005).. (Lu & Wu. candidiasis. The more prevalent include petechiae. 6 Bone marrow transplantation and immunosuppressive therapy are two other types of treatments being used for patients suffering from aplastic anemia (Ibsen & Phelan. Treatments of oral manifestations in patients with these blood disorders are medical therapy along with antifungal therapy as a supplement (Lu & Wu. and spontaneous bleeding.

7 .Blood Disorders examined as such. Routine dental treatment is vital for patients suffering from a blood disorder.

(2004). P.. et al.. G. 238-242. Louis. (29). (2006). Licciardello. St. J. European Journal of Orthodontics. MO: Saunders An Imprint of Elsevier.. A. Oral manifestations in patients with aplastic anemia. MO: Saunders Elsevier An Imprint of Elsevier. & Atkinson. Dental procedures in adult patients with hereditary bleeding disorders: 10 years experience in three italian hemophilia centers. Guadagnini. F. & Samperi. (92)5.. H. and Endodontology. S. Z... Oral Pathology for the Dental Hygienist Fourth Edition (pp 324-330). V. Pillemer. M. Pattacini. and Endodontology.. M. Ibsen. Oral Surgery Oral Medicine Oral Pathology Oral Radiology.C.. Haemophilia. (11). O. Newman.. J. Elsevier. (2005). 504-509. A. Takei. Oral Radiology. V. Rosetti. Chronic graft versus host disease of oral mucosa: Review of available therapies. P. M. Carranza.. Tagliaferri.Blood Disorders References Brennan. et al. J.. M. (2006. C. S.. (2007). & Phelan. M.. R. Nunez. G.. Pozzoli. Franchini. Oral Surgery... (101)2. O. J. Saunders Elsevier. Clinical 8 Periodontology Tenth Edition (pp284-306). Kingman. H. S. Oral Pathology. Oral manifestations of systemic diseases. A. L. Lorenz. . D. Brahim. 503-508.. C. Sankar. T.. Oral Medicine. Pavletic.. & Klokkevold. February). (2001. Baccaglini. Bertuna. A.. St. A. C. Imanguli.. G.. Influence of systemic disorders and stress on the periodontium.. November). Craniofacial morphology in patients with sickle cell disease: A cephalometric analysis. 175-183. Louis.

Initial diagnosis of anemia from sore mouth ad improved classification of anemias by MCV and RDW in 30 patients. S. (2004. & Wu. H.Blood Disorders References Lu. 679-685. 9 . Oral Surgery Oral Medicine Oral Pathology Oral Radiology. and Endodontology. December).. 98(6).

. & Atkinson.Blood Disorders 10 Appendix A Figure 1. 175-183. Guadagnini. February). Chronic graft versus host disease of oral mucosa: Review of available therapies. J. Oral manifestations of ulcerations on the dorsal surface of the tongue that presents in patients suffering from graft versus host disease.. J. C. (2006. . and Endodontology. Z. Oral Radiology. Oral Surgery. From Imanguli. Brahim.. S. M. Oral Pathology. M.. Pavletic. J. (101)2. S. _______________________________________________________________ Note. Oral Medicine.

from http://www. Petechiae seen in the palate of a child that suffers from a blood disorder _______________________________________________________________ Note.jpg .).Blood Disorders 11 Appendix B Figure 2. 2008.dentistry.bham.ac.d. From “ecourse dentistry at birmingham uk” (n. Retrieved April 28.uk/ecourse/cal/stlesions/jpg/pic2.