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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 of
• Pernicious anemia
anemia • RBCs are sickle-
• Aplastic anemia shaped
• thalassemia
Sickle cell
Anemia
disease

Polycythe Bleeding or
coagulation
mia Vera disorders
• Type of blood • Vitamin deficiency
cancer • Liver disease
• Bone marrow • Anticoagulation
makes too many drugs
RBCs
Anemia
Chronic diseases &
Cause of anemia Diminished production of RBCs
Genetic disorders
Blood loss: Nutritional deficiency: Chronic disease:
either due to insufficient dietary intake or Second most prevalent
Acute- blood loss from trauma or
defect in absorption in the GI tract anemia after iron-deficiency
disease
Examples are- pernicious anemia (B12 anemia
Chronic- such as iron-deficiency absorption deficiency), iron-deficiency Many chronic diseases are
anemia anemia, celiac disease (sprue) associated with anemia

Increased hemolysis or Bone marrow failure:


destruction of RBCs: Aplastic anemia- inherited or etiology Genetic blood disorders:
unknown. Caused by injury to bone Thalassemia- defect in
Hereditary- such as sickle cell
marrow by medications, radiation, chemo synthesis of hemoglobin
disease
or infection
Acquired- such as drugs, Aplastic anemias occur in combination Affects Mediterranean,
infections, physical or chemical with neutropenia and thrombocytopenia African, Middle Eastern and
agents, antibody-mediated  Consult with physician to determine of Southeast Asian descent
anemia- erythroblastosis fetalis 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: TREATMENT:


• Increase bleeding risk with • Chemotherapy
spontaneous bleeding of gingiva • Phlebotomy to reduce number of blood
• Bruise easily result in submucosal cells and decrease total blood volume,
making easier for blood to function
petechia and hematoma formation
• Low dose of aspirin to reduce risk of
• Risk of blood clot formation blood clots. (<100mg/daily)
leading to a heart attack, stroke,
and pulmonary embolism • Medications:
• Hydroxyurea (Doxia, Hydrea): help
• Migraines, vertigo and fatigue
decrease blood cells
• Purple or red areas on the oral • Ruxolitinib (Jakafi): destroy cancer
mucosa, gingiva, lips or tongue 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
oxygen shortage in the blood like: • Associated with heart and lung
diseases.
• high altitudes
TREATMENT:
• emphysema
• 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 • Primary and secondary
• Dental hygienist should consult with primary polycythemia may initially present:
care physician or hematologist to obtain • with spontaneous bleeding from
clearance for implementing procedures and the purplish or red areas on the
requirement for premedication tongue, cheeks, lips and gums
• Blood tests may be required before oral • poor oral hygiene, including
healthcare inflamed gingiva and periodontal
disease
• Pay attention to medical and dental history
• 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 • Types of Disorders of Coagulation
body’s mechanism for stopping • Acquired Disorders
injured blood vessels from forming
• Vitamin K deficiency
clots.
• Liver disease
• Bleeding disorders have in common • If liver not functioning properly, clotting factor may be altered
the tendency to spontaneous • Anticoagulation drugs
moderate to excessive bleeding • Heparin, Coumadin (Warfarin), Aspirin
caused by: • Hereditary Disorders
• Trauma • Hemophilia
• Caused by low levels or complete absence of a blood protein
• Surgical procedure
essential for clotting
• DH therapy • 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

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