6. Increased RBCs
Polycthemia
• erythrocyte count
of 6 to 12
million/mm3 with
a hemoglobin
concentration of
18 to 24 g/dL. Hct
also increase.
Causes:
• Hypoxia (high altitude or
vigorous physical activity)
→ ↑ erythropoietin
production by the kidney
→ ↑ RBCs
• Polycythemia vera (primary
proliferative polycythemia)
• Secondary polycythemia
(chronic pulmonary
disease, congenital heart
disease).
10. Bleeding tendency may occur in leukemic pts due to bone marrow
infiltration leading to thrombocytopenia
Increased incidense of infection is a sign of
any immunocompromised patient including
leukemic pts
12. -Lymphadenopathy may be due lymphoma or
lymphoblastic leukemia
1. ↓ Neutrophils, ↑ lymphocytes → Viral infections, ch.
Infection, lymphoblastic leukemia, lymphoma
-Lymphadenopathy may be due mylogenous leukemia
1. ↑ WBC count &neutrophils → Acute bacterial infection,
sterile inf., mylogenous leukemia
13. Leucopenia: ANC
• ANC: Absolute Neutrophil Count
• ANC: 1.500: 7.200 cells/mm3
• ANC calculation: WBC× (%neutrophils+%Bands)
• Leucopnia is caused by:
1. Drugs
2. Bone Marrow suppression
3. Some viral and bacterial infections
4. Radiation
• The most common cause is chemotherapy
14. Leucopenia: Dental precautions
• ANC below 1.500 cells/mm3 predicts the risk of
infection (mild, moderate, or severe).
1. 1.000-1.500 cells/mm3 → mild risk of infection
2. 500-1000 cells/mm3 → moderate risk of infection
3. Less than 500 cells/mm3 → life threatening sepsis risk.
15. Neutropenia: Infection S/S
• oral ulcerations in
Neutropenic patient
(necrosis, severe pain ,
prolonged duration, no pus)
18. For periodontal or
maxillofacial surgery
platelet count should be
above 75.000/mm3
For major surgeries with
general anesthesia
platelet count should be
above 100.000/mm3
Spontaneous bleeding
occurs when the platelet
count is below 20.000/mm3
19. Case 1
• A 27 year old male complains
about bleeding gums and several
recent onset of epistaxis.
Examination revealed a pale
appearance.
• Investigations shows:
Haemoglobin: 8.0g/dl
Haematocrit: 24%
MCV: 88 fl (NR:86-98 fl /cell)
White cell count: 2000 /mm3
Neutrophils: 20%
Lymphocytes: 77%
Platelets: 40.000/mm3
Blood film showed normocytic erythrocytes
The most likely diagnosis is:
1. Iron deficiency anemia
2. Thalasemia
3. Pernicious anemia
4. Aplastic anemia
20. CASE 2
• A 18 year old man
presented with a 3
week history of
generalized gingival
enlargement and
painless cervical
lymphadenopathy.
• Which of the following
investigations should
be performed?
1) Blood glucose level
2) Panoramic x-ray
3) Complete blood count
4) Prothrombin time
21. Case 3
• A 19 years old man presents
immediate profuse bleeding after
extraction of one of his lower
teeth. No local cause has been
identified. On further
questioning, he gives a history of
chronic gastric ulcer.
• Investigation shows:
Hb: 6.7
MCV : 58.0 fl (NR:86-98 fl /cell)
WBC: 13.000 /mm3
Neutrophils : 10.000 /mm3
Platelet: 503.000 /mm3
• The most likely cause of
bleeding is:
1. Thrombocytopenia
2. Iron deficiency
anemia
3. Aplastic anemia
4. Haemophilia
22. Case 4
• A 65-year old lady treated
by antifungal for oral
candidiasis. She reported
being free for 2 weeks but
the lesion recurs .
Investigation shows:
Hb 13.5 g/dl
Platelets 170.000 /mm3
White blood cells 30.000/mm3
Lymphocytes 26.000/mm
Neutrophils 3.200/mm
• What is the possible
cause of recurrence?
Explain.
23. CASE 5
• A 55-year old lady presented
to his dentist with a complain
of burning sensation in her
mouth especially her tongue.
She also reported having
tingling in her feet and hands
and being fatigued.
Investigation shows:
Hb 4.5 g/dl ( no. 11.5-15.5)
Haematocrit 19 (no. 0.38-0.47)
MCV 118 FL (no. 80-96)
MCH 33.0 PG (no. 28-32)
Platelets 95.000 /mm3
White blood cells 8.000/mm3
• What is the cause of
burning? Explain.
24. • A 26-year old man
presented to his dentist
with spontaneous gingival
bleeding. History revealed
six month history of fatigue
and dyspnea:
Hb 7.5 g/dl
Platelets 12.000
White blood cells 300.000/mm3
Neutrophils 34% (normal 60-70%)
Blast 1%
• What is the cause of
bleeding? Explain.
25. • A 15-year old girl presented
to his dentist with a
complain of spontaneous
bleeding and palatal
bruising. She denied having
any trauma but reported
having a mild viral infection
a week ago. Investigation
shows:
Hb 14.5 g/dl
Platelets 15.000 /mm3
White blood cells 7.000/mm3
• What is the cause of
bleeding? Explain.
27. • A 25-year old man presented to his
dentist complaining of parathesia
of his tongue. During examination,
the dentist observed yellowish
discoloration of his sclera, skin and
oral mucosa. He asked for
investigation which shows:
Hb 7.5 g/dl
Reticulocyte 6.28% (NR 0.5-2.4%)
Platelets 266.000
Bilirubin 45 mg/dl (NR0.3-1.0 mg/dl)
AST 36 IU/L (NR 10-40 U/L)
APT 40 IU/L (NR 9-60U/L)
• What is the cause of his
complain? Explain.
28. • A 56-year old man presented to
his dentist. During examination,
he observed yellowish
discoloration of his sclera, skin
and oral mucosa. He asked for
investigation which shows:
Hb 6.5 g/dl
Reticulocyte 6.2% (NR 0.5-2.4%)
Platelets 166.000
Bilirubin 4 mg/dl
AST 20 IU/L (NR 10-40 U/L)
APT 30 IU/L (NR 9-60U/L)
• What is the cause of
yellowish
discoloration? Explain.
29. • A 32-year old man presented to his dentist
with massive submandibular space
infection. History revealed that the patent
is on chemotherapy for lymphoma.
• On examination , he appeared unwell. He
was febrile 39.5 and he was unable to open
his mouth. Investigation revealed:
Hb 11.5 g/dl
Platelets 152.000
White blood cells 2.000/mm3
Neutrophils 10 % (normal 60-70%)
Lymphocytes 80%
• What is the
best action?
Why?
Editor's Notes
Confirm clinical diagnosis
Mean corpuscular volume (MCV) is a measurement of the average size of RBCs. The MCV is elevated when RBCs are larger than normal (macrocytic).
Mean corpuscular hemoglobin (MCH) is the average amount of oxygen-carrying Hgb in a red blood cell.
In some anemias, such as pernicious, the amount of variation (anisocytosis) in RBC size and shape (poikilocytosis) causes an increase in RDW.
Polycythemia is divided into absolute erythrocytosis (a true increase in red-cell mass) and relative erythrocytosis (the red cell mass is normal) e.g dehydration, burns, severe diarrhia
Lowered levels of Hgb are observed in any condition known to cause a decreased RBC count. Some of the more common conditions encountered in clinical dental practice include blood loss (eg, menses) or gastrointestinal bleeding, hemolytic anemia, and any type of bone marrow suppression. Also, a number of conditions result in abnormal types of Hgb, which tend to be fragile and easily destroyed in the vascular system. They include sickle cell anemia, glucose-6-phosphate dehydrogenase deficiency, and thalassemias.
Both glossitis and dysphagia are classic symptoms of iron deficiency anemia.
Oral manifestations of leukemia
The term “agranulocytosis” is used when no neutrophils are seen on a peripheral blood smear. Agranulocytosis is a serious condition characterized by an extremely low leukocyte count and the absence of neutrophils; it most often is caused by a drug or medication that interferes
with cell formation or enhances cell destruction.
