Blood Disorders

By: Suki Misra, Amanda Stout & Brenda

Garcia
 Introduction
• Normal Blood: 55% plasma & 45% formed elements (44% RBCs + 1%WBC)

• Adult blood cells originate in bone marrow

• Plasma: has 90% water & 10% plasma proteins, inorganic salts, gases

• RBC: transport hemoglobin (Hb), its value reflects anemic state- Hb is low or
pathologic condition if Hb is high

• WBC: are phagocytic, immunologic & important component of inflammatory process

• Platelets (thrombocytes): active in blood clotting mechanism & clot dissolution after
healing
 Types of Blood disorders
• Iron-deficiency • Hereditary type
• Pernicious anemia of anemia
• Aplastic anemia • RBCs are sickle-
• thalassemia shaped

Sickle cell
Anemia
disease

Bleeding or
Polycythe coagulation
mia Vera disorders
• Type of blood cancer • Vitamin deficiency
• Bone marrow makes too • Liver disease
many RBCs • Anticoagulation
drugs

Cause of anemia
Blood loss:
Acute- blood loss from trauma or
disease
Chronic- such as iron-deficiency
anemia
Increased hemolysis or
destruction of RBCs:
Hereditary- such as sickle cell
disease
Acquired- such as drugs,
infections, physical or chemical
agents, antibody-mediated
anemia- erythroblastosis fetalis
Anemia
Chronic diseases &
Diminished production of RBCs Genetic disorders
Nutritional deficiency: Chronic disease:
either due to insufficient dietary intake or Second most prevalent
anemia after iron-deficiency
defect in absorption in the GI tract
Examples are- pernicious anemia (B12 anemia
absorption deficiency), iron-deficiency Many chronic diseases are
anemia, celiac disease (sprue) associated with anemia
Bone marrow failure:
Aplastic anemia- inherited or etiology Genetic blood disorders:
unknown. Caused by injury to bone Thalassemia- defect in
marrow by medications, radiation, chemo synthesis of hemoglobin
or infection
Aplastic anemias occur in combination Affects Mediterranean,
with neutropenia and thrombocytopenia African, Middle Eastern and
 Consult with physician to determine of Southeast Asian descent
pre-medication is necessary
Anemia
 Dental Considerations for Anemia
• Thoroughly review the medical history

• CLINICAL SIGNS:
• Extraoral signs: Pale skin, nails, weakness, malaise. easy fatigability, dyspnea on slight
exertion, faintness, brittle nails (“spooning of nails”- loss of convexity)
• Intraoral signs: pale buccal mucosa, glossitis with loss of filiform papillae, painful
burning sensations (glossodynia), angular cheilitis

• TREATMENT:
• Depends on the type of Anemia
• Medication- Oral ferrous iron tablets for iron-deficiency anemia; ***liquid prep for
children may stain teeth, encourage use of straw for administration. Vitamin B12
injections daily for Pernicious anemia. Folic acid supplements for Folate-deficiency
anemia
 Dental consideration for Anemia (cont.)

• Nutritional counseling- educate patients

about the food sources for Iron, Vitamin B 12
and Folic acid.
• For example, Vitamin B12 is obtained mostly
from animal sources and fortified foods such
as meat, clams, liver, fortified breakfast
cereals, fish, poultry, milk, cheese and eggs.
• Folic acid deficiency in pregnant females can
cause neural tube defects in fetus. Spina
bifida (Myelomeningocele) is a severe
condition that affects nerve formation in
spinal cord  paralysis in infants.
 Sickle cell disease
• It is a Genetic, autosomal recessive condition resulting from a
defective Hb molecule

• RBCs take the shape of a “sickle” after defective Hb molecule

loses oxygen

• Affects 10% of African American population & Caucasians of

Mediterranean origin

• “sickle cell trait”- carriers; have fewer symptoms unless

exposed to extreme conditions like high altitudes,
dehydration

• A prenatal diagnosis can be done with 100% accuracy and

genetic counseling is encouraged

• CLINICAL SIGNS & SYMPTOMS:

• Anemia starts within the first 6 months of life
• Life span of RBCs reduces from 90-120 days to 10-15 days
 Sickle cell disease (cont.)
• RBCs are brittle so break apart easily  oxygen deprivation and
fatigue

• RBCs get stuck in the chest, abdomen or joints  pain

• Bone marrow produces increased number of reticulocytes to

counteract the anemia of sickle cell disease

• Vaso-occlusion (blockage) causes dactylitis

• Mortality is due to repeated episodes of vaso-occlusion

infarctions  stroke and organ damage

• Life expectancy is 30 years

• TREATMENT:
• For hypoxia, dehydration and acidosis  oxygen & fluids are
administered
• Pain relief with opioids without depressing breathing
 Sickle cell disease (cont.)
• Antibiotics – treat acute infections
• Regular Blood transfusions
• Stem cell transplant maybe an option

• ORAL IMPLICATIONS:
• Dental pulp necrosis & enamel hypo mineralization
• Osteomyelitis of mandible
• Protrusion of maxilla & mandible
• Pallor of buccal mucosa & numb chin syndrome (mental nerve neuropathy)
• Facial & dental pain

• APPOINTMENT MANAGEMENT: Thoroughly review medical history

• Consult with primary physician for disease control and some patient’s may
require premedication*** due to susceptibility to infections and bacteremia
• Stress- reduction protocol to prevent sickle cell crisis & implement preventive
program
• Avoid long complicated appointments; anesthesia with low dose of
vasoconstrictor to avoid vaso-occlusion of RBCs
 Polycythemia
• Polycythemia is an increase in number and
concentration of RBCs, above normal level.

TYPES: primary and secondary polycythemia

• Primary Polycythemia or Polycythemia Vera is a neoplasm

(cancer) caused by a genetic mutation in which bone
marrow makes too many RBCs. Also, blood viscosity
increases, affecting oxygen transport to tissues.

• Secondary Polycythemia is usually associated with

increased erythropoietin production in response to low
blood oxygen level.

OCCURENCE:
• Diagnosed at an average of age 60
• Affects men more than women
• Develops slowly
 Polycythemia Vera
SIGNS & SYMPTOMS:
• Increase bleeding risk with
spontaneous bleeding of gingiva
• Bruise easily result in
submucosal petechia and
hematoma formation
• Risk of blood clot formation
leading to a heart attack, stroke,
and pulmonary embolism
• Migraines, vertigo and fatigue
• Purple or red areas on the oral
mucosa, gingiva, lips or tongue
TREATMENT:
• Chemotherapy
• Phlebotomy to reduce number of blood
cells and decrease total blood volume,
making easier for blood to function
• Low dose of aspirin to reduce risk of
blood clots. (<100mg/daily)
• Medications:
• Hydroxyurea (Doxia, Hydrea): help
decrease blood cells
• Ruxolitinib (Jakafi): destroy cancer
cells and it used to treat people who
don’t respond or can not take
Hydroxyurea
 Secondary Polycythemia

• Increase of RBC production can • Develops in response to lack of

result from hypoxia from oxygen in tissues
common conditions that lead to
• Associated with heart and lung
oxygen shortage in the blood like:
diseases.
• high altitudes
• emphysema TREATMENT:
• Requires treatment of the
• chronic obstructive pulmonary
underlying cause
disease
• tobacco smoking
 Oral Health Considerations for Polycythemia
• Primary and secondary polycythemia are
associated implications for oral healthcare
• Dental hygienist should consult with primary
care physician or hematologist to obtain
clearance for implementing procedures and
requirement for premedication
• Blood tests may be required before oral
healthcare
• Pay attention to medical and dental history
• Primary and secondary
polycythemia may initially present:
• with spontaneous bleeding from
the purplish or red areas on the
tongue, cheeks, lips and gums
• poor oral hygiene, including
inflamed gingiva and periodontal
disease

• Short appointments, observe tissue after

procedures and document
• Explain and give appropriate advice to patient
that bleeding may occur days after the
appointment
• Instruct patient to self-check mouth for new
signs or symptoms and reporting changes
 Bleeding or Coagulation Disorders
• Blood clotting or hemostasis is the
body’s mechanism for stopping
injured blood vessels from forming
clots.
• Bleeding disorders have in common
the tendency to spontaneous
moderate to excessive bleeding
caused by:
• Trauma
• Surgical procedure
• DH therapy
• Types of Disorders of Coagulation
• Acquired Disorders
• Vitamin K deficiency
• Liver disease
• If liver not functioning properly, clotting factor may be altered
• Anticoagulation drugs
• Heparin, Coumadin (Warfarin), Aspirin
• Hereditary Disorders
• Hemophilia
• Caused by low levels or complete absence of a blood protein
essential for clotting
• Etiology: mutation or deletion of factor VIII or IX in the gene
• Treatment: drugs to decrease bleeding or infusion of platelets
• Management: If uncontrolled bleeding, stop treatment
 Fun facts related to Blood
• In Japan, for matchmaking a person maybe asked for their
blood type to see if they are well-matched.
• Type A blood is a sign you are hard-working, neat, and sensitive.
People with type O are thought to be independent, logical self-
starters.

• Just before his death, doctors drained blood from the first
president of the United State, George Washington to try to cure
him of illness.
• Five pints or about half of his blood was drained in less than a day.
The president didn't recover.

• Brenda insists on announcing that she is B+ and that’s not her

GPA. Suki’s blood type is the same! and Amanda is O- (universal
donor) so be nice to her at all times.
 References

Olga, A. I., & Joan, A. P. (2018). Oral Pathology for the Dental Hygienist with General Pathology
Introductions (7th ed.). St. Louis, Missouri, USA: Elsevier.

Polycythemia Vera. (2017, February 8). Retrieved November 23, 2018, from Mayoclinic:
https://www.mayoclinic.org/diseases-conditions/polycythemia-vera/diagnosis-treatment/drc-20355855

Wilkins, E. M., Wyche, C. J., & Boyd, L. D. (2017). Clinical Practice of the Dental Hygienist (12th ed.).
Philadelphia, PA, USA: Wolters Kluwer.
Questions? (Ask only Brenda)
 Questions for y’all
1. Which of the following is NOT a characteristic of sickle cell anemia?
a. Inherited blood disorder found mostly in African-Americans
b. Individuals can experience weakness, fatigue and joint pain
c. RBC are circular in shape
d. All of the above

2. Which of the following is NOT a cause of iron-deficiency anemia?

A. Chronic blood loss
B. Deficiency in iron intake
C. Increase iron requirement
D. Normal bone marrow function
3. Which of the following is characterized by an abnormal increase in
RBCs?
a. Leukopenia
b. Polydipsia
c. Thrombocytopenia
d. Polycythemia
 BONUS QUESTION

• How many questions can you ask Mrs. Harrell on

Fridays?
a. As many as you want
b. TWO
c. Via telephone (1-800-ASK-HARRELL ext. EagleEye)
d. 57 + 9 in Spanish