This document discusses different types of anemia. It provides information on normal hemoglobin levels and defines terms like mean corpuscular volume and hematocrit. It then describes common causes of anemia like iron deficiency, B12/folate deficiency, and chronic blood loss. The document classifies anemias based on red blood cell size and discusses features of microcytic, normocytic, and macrocytic anemia. It outlines evaluation, treatment options, and dental considerations for different anemias.

2.  reduction in the level of haemoglobin levels,
which is usually accompanied by a decrease in
the number of erythrocytes ( RBC’s), resulting
in lowering the O2 capacity of the blood.
Normal Hb concentrations in blood for adults:
 Males : 13.5 g/dl
 Females : 11.5 g /dl

3.  The mean corpuscular volume, or "mean cell
volume" (MCV), is a measure of the average red
blood cell volume that is reported as part of a
standard complete blood count
 The hematocrit (Ht or HCT) or packed cell
volume (PCV) or erythrocyte volume fraction
(EVF) is the percentage of blood volume that is
occupied by red blood cells

4.  1) chronic blood loss and consequent iron deficiency,
usually in women from heavy menstruation
 2) folate and vitamin B12 deficiency ( the 2nd common
cause ).

5.  Classification according to RBC size:
In patients with anemia, it is the MCV measurement that allows
classification as either a
microcytic anemia (MCV below normal range),
normocytic anemia (MCV within normal range)
macrocytic anemia (MCV above normal range).
The normal MCV is 78-99 fL, with smaller cells (<78 fL)
described as microcytic and larger cells (>99 fL) as
macrocytic.

6.  Microcytic anemia : most common usually due to iron
deficiency , occasionally to thalassaemia or chronic
disease.
 Macrocytic anemia: usually caused by vitamin B12 or
folate deficiency ( sometimes that is caused by
pregnancy, chronic haemolysis, malignancy or some
drugs, liver disease , myxoedema or aplastic anemia
 Normocytic anemia : chronic disease like leukaemia ,
chronic inflammatory disease , renal failure , infection,
malignancy and sickle cell anemia

7.  early: asymptomatic.
 pallor of the oral mucosa and conjunctiva,
 tiredness, dyspnoea, tachycardia, murmurs and palpitation.

9.  1) Clinical and laboratory investigation.
( MCV, Hb, blood film )
 2) Hematinics. ( iron or folic acid)
 3) Erythropoietin. (used for anemia in chronic renal
failure or cytotoxic therapy)
 4) Blood transfusion. ( used only when absolutely
nesseccary Hb under 7.0 g/dl)

10.  - some anemias cause oral lesions such as ulcers, glossitis or
angular stomatitis.
 -L.A
 - conscious sedation: only if there is supplemental O2
 - Nitrous oxide : contraindicated in B12 def.
 - G.A : it is vital to ensure full oxygenation.
 - elective operation: Hg more than 10 g/dl.
 - Preoperatively : raise the hemoglobin level if necessary by
transfusion.

11.  1) Iron deficiency anemia.
 2) Vit B12 deficiency.
 3) folate deficiency.

12.  General aspect:
 Most common cause of anemia in the west, as a result of
nutritional deficiency or chronic blood loss.
 Developing countries: malaria and chronic blood loss.
 Main cause of microcytic anemia.
 Clinical features:
 1) impaired excersie capacity.
 2) koilonychia: "spoon nails." It refers to abnormally thin
nails (usually of the hand) which have lost their
convexity, becoming flat or even concave in shape.

14.  Iron salt supplement such as ferrous sulphate, or ferrous
gluconate .
 Oral iron may need to be given for 3 months or more after
the hemoglobin has reached normal levels, to replenish
marrow iron stores.
 Parenteral iron : intramuscular.

15.  L.A satisfactory for pain management
 Conscious sedation: if full oxygenation is possible.
 At early stages: sore tongue can develop if hemoglobin falls
beneath the normal value.
 Severe anemia: atrophic glossitis, soreness of the tongue
with depapillation or colour change.

16.  Candidosis can be aggravated or precipitated by anemia
 Treatment with iron appears to improve the response to
antifungal treatment.
 Angular stomatitis(affects only minority).
 Aphthous stomatitis is sometimes associated with iron
deficiency anemia.

17.  General aspects:
 B12 needed for A.A, DNA/RNA, new cells.
 Found in the diet in the meat.
 Deficiency of vit B12 is usually due to defect in intrinsic
factor( as a result of pernicious anemia or gastrectomy)
 Nitrous oxide is contraindicated if given more than 12
hours, interfere with metabolism of Vit B12.

18.  Pernicous anemia: autoantibodies against gastric
parietal cells, or to the intrinsic factor.
 Clinical features:
 Deficiency develops slowly(liver stores last up to 3 years)
 Neurological symptoms: paraesthesiae in the extremities.
 Treatment : I.M hydroxycobalamin

19.  L.A is satisfactory
 Conscious sedation can be given if the Hb level is
moderately depressed and supplemental oxygen can be
given.
 Nitrous oxide is theoretically contraindicated.
 G.A : if Hb is not low.
 Early B12 def: normal or sore or burning tongue.
 Red sore patches may form on the tongue,(pattern or red
patches without depapillation).

20.  Candidosis can be aggravated or precipitated by anemia
and may be the presenting feature.
 Angular stomatitis (uncommon)
 Aphthous stomatitis is occasionally the presenting feature.

21.  Folic acid is needed A.A/ ,DNA/RNA ,new cells
 Folic acid is found in fresh leafy and other vegetables.
 No body stores of folic acid.
 Most folic acid def. is caused by dietary def.

22.  Folate def. in adluts leads to anemia.
 In pregnancy folate def. leads to neural tube defects or cleft
lip-palate in the fetus.
 Effects of folate def. is very similiar to B12 def.
 Red cell folate are more reliable than serum folate.
 Treatment: folic acid

23.  L.A, conscious sedation, GA: the same as pernicous anemia.
 No contraindication of nitrous oxide.
 Atrophic glossitis is the best known effect of severe anemia.
 Angular stomatitis (affects only a minority).

25.  Inherited abnormality of Hb function
 Defected structure or function of erythrocytes
( spherocytosis, G6DP def.)
 Damage of erythrocytes ( autoimmune, drug
induced, infective)

26. Clinical features :
 Billirubin over production ( Jaundice)
 Spleen enlargement
 Increased RBC turnover to cause in the end an
increase in folic acid demand, and macrocytic
changes occur

27.  Treatment:
 Folic acid
 Transfusion ( risk of iron overload)

28. Dental aspects :
 LA : safest method of pain control
 Conscious sedation: given with supplemental
oxygen if nesseccary
 GA: Contraindecated
 * main concern : sickle cell anemia

29.  The hemoglobin that is present is HbS
 Gross distortion in erythrocyte shape
 Might cause vascular occlusion since
erythrocytes are stiff

30.  Sickle cell anemia Trait:
• Heterozygous
• X10 more common than Sickle Cell Disease
• Asymptomatic
 Sickle cell crises is due to low oxygen tension
 Sickle cell anemia is most common in africans,
afro-caribbeans and middle eastern
 Early mortality rates are high

31.  Clinical Features :
1. Painful crises ( mainly due to infarctions
especially in the spleen , bone, kidney , brain,
lungs, joints.. Etc)
2. Haematological crises
3. Chronic hyperbillrubenemia
4. Infections ( mostly pneumococci, meningiococci,
heamophilus, salmonella)
5. Chronic anemia
6. Sequestration syndromes: chest( gas change
impairment ) , blood, girdle ( bowels)

32.  Family history should be taken
 Take notice if Hb is less than 9 g/dl
 Blood film to follow the shape of RBC’s
 Electrophoresis: 40% Hbs , 60% HbA

33.  Folic acid should be taken regularly
 Monitoring of cells
 Comprehensive care programme
 Blood transfusion ( usually avoided hep. C,
and HIV)
* * Main cause of death: thrombosis , infection
 Prevent trauma, infection, hypoxia, acidosis,
dehydration ( to avoid a crises)

34.  GA : investigate all sickling disorders especially
when the Hb is less than 11 then there’s a
hazard
 Sickle Cell Trait:
GA : few problems, full oxygenation should be
given

35. Sickle Cell Disease:
 LA : preferred to stop the pain
 Avoid prilocain> methaminoglobinemia
 Avoid asprin > acidosis
 Use acetaminophens, codiene
 Conscious sedation : used safely with relative
analgesia
 Elective surgery : only when hemolysis is minimal
 Prophylactic antibiotics: penicillin V ,
clindamycine , should be given before surgery

36.  Painful infarcts in the jaws (radio opacities ) might
be mistaken for osteomyelitis or toothache
 Stepladder trabeculae pattern ( in xrays)
 Skeletal maturation is delayed
 Crises might be predisposing to osteomyelitis
 Hypercementosis might be seen
 Bone marrow hyperplasia leads to enlarged
heamopoietic maxilla with excessive over jet
 Enamel hypo mineralization and calcified pulp
canals

38.  Autosomal dominant inherited disorder
 Alpha and beta globin chains will be produced
slowly thus low HbA
 Erythrocytes fragility will be due to the excess in
the production of the not affected chains
 Characterized by microcytic anemia
 Found in Mediterranean , middle eastern

39.  Thalassemia is divided into :
 Sever ( major, homozygous)
 Mild ( minor , heterozygous)
 Alpha thalassemia: ( alpha chain)
 Beta thalassemia ( beta chain )

40.  Alpha chain deficient
 Found in asians
 No compensatory mechanisms
 Lethal in utero or infancy due to inability of
carrying Oxygen

41.  Mediterranean anemia
 Beta chains
 Homozygous : cooley anemia ( major type)
Severe anemia, failure to thrive,
hepatosplenomegaly, skeletal abnormalities
 Heterozygous : might be asymptomatic

42. HOMOZYGOUS
 Chronic anemia
 Marrow hyperplasia
 Skeletal defomaties
 Splenomegaly
 Cirrhosis
 Gallstones
 Iron overload : will damage the heart and cause
death

43. HETEROZYGOUS:
 asymptomatic
 Or mild hypochromic anemia

44.  Severe microcytic anemia ( confirmed)
 Basophilic stippling of erythrocytes
 Normal or raised serum iron and ferritin
 Normal total iron-binding capacity
 Great increase in fetal Hb
 Some increase in HbA2

45.  Blood transfusions
 Folic acid and chelating agents
 Ascorbic acid
 Hydroxycarbamide
 Splenectomy : if hyper- splenism happens

46.  LA: safe
 Conscious sedation: if oxygen level not less
than 30%
 GA: complicated by the enlargement of maxilla
in intubation, and it is contraindicated in the
presence of severe anemia and cardiomyopathy

47.  Enlarged maxilla ( chipmunk facies)
 Hair-on-end appearance due to expantion of
the diploe
 Less common: parotid swelling , xerostomia
due to iron deposition, sore or burning tongue
due to folate deficiency
 Pneumatization of the sinuses may be delayed
 Spacing of the teeth and forward drift of the
maxillary incisors ( ortho might be
recommended)

48.  SCT with thalassaemia are not usually as ill as
those with isolated sickle cell disease
 They are at the same level of risk from general
anaesthesia as are those with sickle cell disease
 Patients with other combined defects should be
managed in the same way as those with sickle
trait alone

49. General and clinical aspects:
 Hereditary spherocytosis is the main form of
congenital haemolytic anemia in Caucasians
 Autosomal dominant
 Characterized by :
• Heamolytic anemia
• Jaundice
• Splenomegaly
• Gallstones
• Heamochormatosis
• Skin infections

50.  Splenectomy
 Folic acid treatment
Dental Aspects:
LA is safe, conscious sedation and GA may be
given at optimal oxygenation

51.  G6PD deficiency : most common
Caused by:
 Trauma , toxins , complement mediated lysis
and malaria

52.  Pancytopenia with a non-functioning bone
marrow , causes leucopenia ,
thrombocytopenia and refractory anemia

53.  Same as normochromic, normocytic or
macrocytic together.
 Susceptibility to infection and bleeding
 Purpura is the first manifestation

54.  Removal of the cause :
• stop chloramphenicol
• Bone marrow transplant
• Steriods
• Blood transfusion

55.  Prognosis is poor and 50% of the patients die
within 6 months , usually form haemorrhage or
infection.

56. Take consideration of:
 Anemia
 Haemorrhagic tendency
 Hep. B , and other viral infections
 Ulcers
 Susceptibility to infections
 Oral lichenoid lesions
 Sjogren like syndrome
 Gingival swelling

57.  Rare autosomal recessive syndrome where 90%
develop bone marrow failure (the inability to
produce blood cells) by age 40.
 characterized: by:
 Skeletal defects
 Hyper pigmentation
 Pancytopenia
 Susceptible to head and neck carcinoma at early
age as a result of a genetic defect in a cluster of
proteins responsible for DNA repair

58.  Congenital or acquired , refers to a type of
anemia affecting the precursors to red blood
cells but not to white blood cells. the bone
marrow ceases to produce red blood cells.
Associated with:
 thymoma ( tumor of epi. Of thymus)
 Sometimes chronic mucocutaneous candidosis
 Those patients need regular blood transfusions

59.  Infiltration by abnormal cells cause normocytic
anemia and often leucopenia or
thrombocytopenia
 Dental care may be complicated by
susceptibility to infections, haemorrhage or
underlying disease

60. Including:
 Chronic inflammation ( infection or rheumatoid
arthritis )
 Neoplasms ( leukemia)
 Liver disease
Very rarely:
 Hypothyroidism
 Hypopituitarism
 Hypoadernocorticism
 Uraemia
 HIV infection

61. Lana Obeidat
0081663