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anemia & other blood disease and its manifestations in oral cavity

anemia & other blood disease and its manifestations in oral cavity






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    anemia & other blood disease and its manifestations in oral cavity anemia & other blood disease and its manifestations in oral cavity Presentation Transcript

    • Anemia and other blood diseases
    • HEMATOLOGIC (BLOOD) DISEASES • Bleeding Disorders – Platelet Function – Coagulation Factor • Platelet Deficiency – Thrombocytopenia / Thrombocytopathia • Red Blood Cell (RBC) Disorders – Anemia • White Blood Cell (WBC) Disorders – – – Leukopenia Leukemia (Lymphoma)
    • CLINICAL FEATURES OF BLOOD DISORDERS • Oral Bleeding – – – – – Petechiae / Easily Bruised (Ecchymoses) Bleeding After Brushing Spontaneous Gingival Bleeding Prolonged After Extractions Excessive From Minor Trauma • Other Bleeding: Epistaxis, Hematemesis, Hemoptysis, Hematuria, Melena • Possible Associated Increased Susceptibility to Infection – • Leukemia – HIV – Immunosuppression from Chemtherapy for Organ Transplant or Cancer TX Oral Swelling &/or Ulceration • Long Term Immunosuppression carries increased Risk for Malignancy (Especially lymphoma and leukemia)
    • Clinical Bleeding Petechiae Petechiae and Ecchymoses Ecchymoses
    • Other Clinical Features of Blood Disorders Ulceration Ulceration Atrophy and Pallor
    • PLATELET-ASSOCIATED BLEEDING DISORDERS Thrombocytopenia • Primary or Secondary Deficiency of Platelets – 10 / Idiopathic (Probably Autoimmune) Thrombocytopenic Purpura – 20 / i.e. Leukemia, HIV, Aplastic Anemia • Altered Platelet Function as in ASPIRIN (and other NSAID’s) • von Willebrands disease • Petechiae are Common Finding
    • COAGULATION FACTORASSOCIATED BLEEDING DISORDERS • Hereditary Defects – Hemophilia – Others • Liver Disease – Cirrhosis, Hepatitis • Anti-Coagulant Medication – Coumarin (Warfarin) - Vitamin K Antagonist – Heparin • GI Malabsorption Problems – Fat Soluble Vitamin K Deficiency (Sprue or Biliary Disease)
    • • Clinical: Weakness, Fatigue, Pallor • Decreased Oxygen Carrying Capacity of Blood • Result of: Decreased Number, Size, or Hb Content of RBC’s or of Defective Hb • Secondary to: – Nutritional / Iron Defeciency – RBC loss or destruction (Chronic Bleeding) – Failure of RBC formation (Leukemia) – Hereditary Hb malformation • Oral Features: – Pallor – Bald Tongue • Possible Association with other Disease: Leukemia, Kidney Disease, etc. ANEMIA
    • LEUKOPENIA (Decreased Number of WBC’S) Increased Susceptibility to Infection • Aplastic Anemia – Failure of Formation of All Blood Cells: RBC’s, WBC’s and Platelets • Agranulocytosis – Failure of Formation of Neutrophils • Cyclic Neutropenia – Periodic Suppression of Neutrophil Formation • Associated Oral Ulceration and Infection: – Candidiasis – HSV
    • Oral Ulceration and Infection Secondary to Leukopenia or Leukemia
    • LEUKEMIA Leukemia - Blood Smear • Leukemia - Definition – Malignancies of WBC’s Originating in BONE MARROW – Expression in PERIPHERAL BLOOD Clinical Significance Disease and Treatment Make Patients Anemic and More Susceptible to Infection and Bleeding Decreased RBC Formation, Ineffective Leukocytes (&/or Leukopenia) and Thrombocytopenia Diagnosis by: CBC with Differential and Bone Marrow Biopsy Leukemia
    • There are several management considerations in the dental treatment of patients with hematologic disease. In patients with anemia that is or was associated with stomach ulceration as a source of the GI bleed, aspirin or non-steroidal medication should be avoided. Drugs combined with phenacetin should not be prescribed for patients with anemia caused by glucose-6-phosphate dehydrogenase deficiency. This form of anemia has also been associated with an increased incidence of sensitivity to sulfonamides, aspirin, and chloramphenicol.
    • Patients with sickle-cell anemia should only receive dental treatment when they are not in crisis. Management of caries is extremely important as non-treated caries leading to periapical infection can precipitate a crisis. Infection has to be managed aggressively with local and systemic measures including appropriate dental treatment, antibiotics, and surgical procedures if necessary (i.e. incision and drainage, extraction The presence of angular cheilitis in the patient with iron-deficiency anemia suggests the possibility of a candidiasis which can be effectively managed with the anti-fungal medications previously described.
    • Test with Complete Blood Count (CBC) with Differential White Cell Count (WBC) + Hgb, Hct, and Red Cell Indices: RBC Count - Normal = 4.5-5.0 Million RBC’s / 100 mL WBC Count - Normal = 4 - 6 Thousand WBC’s / 100 mL Neutrophils ~ 60 - 65 % Lymphocytes ~ 30 - 35 % Monocytes ~ 4-6 % Eosinophils ~ 1 - 2 % Basophils ~ 0-1 % Platelets = 150 - 600 Thousand / 100 mL