Blood Disorders

Presented by: Mayra Quiroz, Becca Delord & Marsha Tran

Basics of blood

RED BLOOD CELLS (Erythrocytes)

• most abundant cells in our blood
• produced in the bone marrow
• contain hemoglobin, a protein that carries oxygen to our cells

WHITE BLOOD CELLS (Leukocytes)

• form part of our immune system

PLASMA
• yellowish liquid
• contains electrolytes, nutrients, hormones, clotting factors, and antibodies

PLATELETS (Thrombocytes):
• clotting factors that are carried in the plasma

Complete Blood Cell Count (CBC)

A blood test used to evaluate a patient’s overall health and detect a wide range of disorders
such as anemias and infection.

Sickle cell disease

• Etiology: hereditary form of hemolytic anemia resulting from an autosomal recessive trait
• Occurs in 10% of the African-American population & Mediterranean populations of
Mediterranean origin
• Normal hemoglobin are disc shaped which allows the cells to be flexible so that they can
move through large and small blood vessels
• Sickle hemoglobin can form stiff rods within the cell changing it into a crescent
or sickle shape
• Sickle-shaped cells are not flexible and can stick to vessel walls, causing a blockage that
slows or stops the blood flow preventing oxygen from reaching nearby tissues

Dental Concerns
for patients with sickle cell

1
• Oral Manifestations:
- Necrosis of dental pulp
- Enamel hypomineralization
- Malocclusion
- Pallor of buccal mucosa
- Delayed tooth eruption

• Radiographic Findings:
- Coarse trabecular pattern appearing as horizontal rows between teeth with large narrow
spaces
- Hypercementosis

Treatment & Medications

used for patients with Sickle cell disease

Hydroxyurea
 Increases the amount of fetal hemoglobin (hemoglobin F) in the blood. Increased
hemoglobin F provides protection against the effects of hemoglobin S (sickle
hemoglobin)

Penicillin
 Given to children 2x a day to reduce the change of having a severe infection caused by
the pneumococcus bacteria

Hematopoietic Stem Cell Transplant

 Only cure for SCD
 Stem cells takin from donor’s blood or bone marrow
 Recipient’s stem cells reduced with drugs before injecting donor’s stem cells
 New stem cells will gradually replace recipient’s cells

NSAIDs
 For acute pain

Regular blood transfusion

 Helps increase total number of RBC’s, decrease vaso-occlusion and improve oxygen
delivery to tissues.

Side Effects:
 Hydroxyurea: can cause the white blood cell/platelet count to drop and vomiting
 Penicillin: vomiting
 NSAIDs: vomiting

2
 Appointment Management
for patients with Sickle cell

• Review medical history for any pain medications being taken and current treatment
• Consult the patient’s primary care provider to determine their complete blood count
• Routine use of antibiotics for patient’s highly susceptible to infection
• A stress protocol is necessary to prevent precipitation of a sickle cell crisis
• Schedule appointments during the morning and keep them short
• Use local anesthesia with low doses of vasoconstrictors to avoid intravascular RBC occlusion
• Implement 3-month recall preventive program to minimize oral bacteria and infections
• Avoid aspirin – may cause acidosis in large doses

Neutropenia

 Etiology: Defects in myeloid cells that may be genetic. Secondary neutropenia may develop
from auto immune diseases, chemotherapy therapy, infection or bone marrow transplant

 Occurs when a person’s Absolute Neutrophil Count (ANC) is less that 1,000 because cell
production cannot keep pace with turnover rate or when an accelerated rate of removal of
cells occurs

 Less than 200,000 cases per year in the U.S.

Dental Concerns
for patients with Neutropenia

• Oral Manifestations:
- Oral stomatitis
- Lymph node enlargement
- Oral ulcerations
- Periodontal disease (increased risk)

• When values drop below 500/µL, even normal microbial flora in the mouth can cause
infection

Treatment & Medications

used for patients with Neutropenia

 Use of medications that increase neutrophil counts

 Avoid anyone who is sick to reduce the risk of infection

3
  Bone marrow stimulant: helps produce new blood cells

Antibiotics:
- Vancomycin (Vancocin)
- Meropenem (Merrem)
- Cefepime (Maxipime)

Antifungals:
- Fluconazole (Diflucan)
- Caspofungin (Cancidas)

Penicillin antibiotic:
- Piperacillin (Zosyn)

Side effects:
• Antibiotics:
- vomiting – tooth erosion
- thrush
- mouth sores
- white patches on tongue
• Antifungals:
- sore throat
- ulcers or white spots on the lips, tongue or oral mucosa

Appointment Management
for patients with Neutropenia

 Review medical history to determine any medications being taken and current treatment
 Consult with primary care provider to determine neutrophil count is at a safe level
 Antibiotic prophylaxis may be needed before and after treatment
 More than one toothbrush so that each one dries out between uses, lowering the amount of
bacteria that may survive on a wet toothbrush
 Avoid mouthwashes that contain alcohol since they can irritate sensitive oral tissues
 Use of a mild mouthwash with antibacterial ingredients to help prevent oral infections
 Implement 3-4 month recall visits to keep oral bacteria levels at a minimum

Von Willebrand disease

• Etiology: missing or defective clotting protein in the blood called von Willebrand factor (vWF)

• Most common inherited bleeding disorder occurring in 1% of the U.S. population

4
• Classification:
- Type 1: (most common type) body has lower than normal levels of vWF and factor vIII,
another blood-clotting protein
- Type 2: body makes normal amounts of vWF but does not function properly
- Type 3: (most severe type) body makes very little or none vWF and has low levels of factor vIII
- Acquired VWD: adults who suffer from autoimmune disease, heart disease and certain types
of cancer

Dental Concerns
for patients with von Willebrand Disease

• Oral Manifestations:
- prolonged bleeding
- severe hemorrhage
- purpura of mucous membranes
- gingival enlargement

• When values drop below 500/µL, even normal microbial flora in the mouth can cause
infection

Treatment & Medications

used for patients with von Willebrand disease

Desmopressin Acetate (DDAVP)

- synthetic drugs that makes the body release vWF stored in the lining the blood vessels and
increases factor vIII
- injection or nasal spray

Factor replacement therapy

- replacement of missing factors in blood with plasma derived clotting factor products
through injection
- treats more severe forms of VWD or for people with milder forms who do not respond well
to DDAVP

Antifibrinolytic drugs: (Tranexamic & Aminocaproic acid)

- help slow or prevent the breakdown of blood clots
- injected or taken orally

Fibrin Glue
- fibrin is removed from blood and manufactured as a natural clotting agent
- applied directly to site of bleeding and over a period of 2-4 weeks the fibrin is absorbed in
the body

5
 Side Effects:
• Desmopressin: vomiting
• Antifibrinolytic drugs: vomiting

Appointment Management
for patients with von Willebrand disease

• Review medical history for any medications being taken and current treatment
• Routine examinations and cleanings can generally be performed without raising the factor
level.
• Adequate coverage (i.e., factor concentrate or antifibrinolytic therapy) should be given prior
to and possibly after the dental appointment in those patients who need deep cleaning
• Consult the patient's hematologist before treatment to verify if the patient requires any type
of pre-med
• Obtain pre-operative CBC, platelet count, bleeding time, and prothrombin time
• Non-Aspirin/NSAID containing drugs should be prescribed as post operational analgesics
• The use of ultrasonic instrumentation may reduce the risk of increased bleeding and tissue
trauma
• Implement a 3-4 month recall program to minimize oral bacteria

Questions

• True or False: Sickle-shaped cells are flexible and can easily move through small and large
blood vessels.

• True or False: An Absolute Neutrophil Count of 900 is considered normal.

• What is the most common inherited blood disorder?

_____________________________________