This document provides an overview of common blood disorders, including their causes, symptoms, oral manifestations, and dental considerations. It begins with an introduction to blood and its components and functions. It then discusses various blood disorders that can affect red blood cells (anemia, polycythemia), platelets (thrombocytopenia, thrombocytosis), and white blood cells (leukopenia, leukocytosis). Specific disorders covered in more depth include iron deficiency anemia, hemophilia, and leukemia. The document emphasizes the importance of oral examinations in potentially identifying underlying bleeding disorders and provides guidance for delivering dental care to patients with blood disorders.

1. BLOOD
DISORDERS
Presented by- Dr. Sonal Kale
P.G 1st Year
1

2. Contents2
 Introduction
 Functions of blood
 Components of blood
 Disorders of blood
 Anemia
 Polycythemia
 Thrombocytopenia
 Thrombocytosis
 Leukopenia
 Leukocytosis
 Disease involving specific blood factors

3. INTRODUCTION
3
 Blood is the life-maintaining fluid that circulates
through the body's heart, arteries, veins, and
capillaries.
 Formation of blood prenatally, takes place in
wall of yolk sac; later in liver & spleen ;5th
month onwards red bone marrow.

4. Functions Of Blood
4
 Transportation
 Oxygen and Carbon dioxide between the lungs and rest of the
body.
 Nutrients from digestive tract and storage sites to rest of the
body.
 Hormones from glands to their target cells.
 Protection
 WBCs in blood destroy microorganisms.
 Platelets initiate blood clotting and thus minimize blood loss.

5. 5
 Regulation
 Ph by interacting with acids and bases.
 Water balance by transferring water to and from the tissues.

6. Components of blood
6
 Red blood cells (erythrocytes)- carry oxygen
to and carbon-dioxide from the tissues.
 White blood cells (leukocytes) - help to fight
infection and aid in the immune process.
 Platelets (thrombocytes)- help the blood to clot
 Plasma - helps to maintain blood pressure;
provides proteins for blood clotting; balances the
level of sodium and potassium.

7. DISORDERS OF BLOOD
7
 Blood disorders can affect any of the three
components of blood i.e RBCs, WBCs and platelets.
 RBCs- anemia, polycythemia
 WBCs- leukopenia, leukemia
 Platelets-thrombocytopenia, thrombocytosis

8. Anemia
8
 Defined as a decrease in the amount of red blood cells,
hemoglobin in the blood or decreased ability of the cells
to carry oxygen.
 Types of anemia-
1. Iron deficiency anemia-occurs when the rate of loss
of iron is more than its rate of absorption which may
be because of chronic blood loss, increased use of iron
(pregnancy, children), decreased absorption of iron.
2. Aplastic anemia-occurs when body’s bone marrow
doesn’t make enough new RBCs which may be because
of damage to bone marrow and blood stem cells.

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3. Thalessaemia- disorder which cause the body
to make fewer healthy RBCs and less
hemoglobin because of lack of protein chains.
4. Sickle cell anemia-disease in which body
makes sickle shaped RBCs. These sickle cells
contain abnormal hemoglobin and don’t last
very long(10-20 days).
5. Pernicious anemia-condition in which body
cannot make enough healthy RBCs because of
lack of vitamin B12.

10. 10
6. Haemolytic anemia-occurs when RBCs are
destroyed and removed from the blood stream before
their normal lifespan is up.

11. 11
 Symptoms –
o Pale skin
o Dizziness
o Easy fatigue and loss of energy
o Leg cramps
o Unusually rapid heart beat
o Shortness of breath
o Headache
o Difficulty in concentration
o Tachycardia
o Palpitations

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 Oral manifestation-
o Generalized stomatitis
o Angular cheilitis
o Gingivitis
o Pallor of lips and oral mucosa
o A smooth, read painful tongue
o Burning sensation of tongue
o Atrophy of filiform papillae and later fungiform
papillae
o Disturbed taste sensation
o Candidial infections
o Plummer- Vinson syndrome

13. 13
Angular cheilitis
Red and smooth tongue

14. Dental considerations
14
o Periodontal procedures not recommended.
o Intra muscular injection & nerve block anaesthesia
avoided because of risk of haemorrhage.
o Intraligamentary anaesthesia can be used safely.

15. Treatment for anemia
15
o Treatment of the causative disease
o Vitamin and mineral supplements
o Change in diet
o Blood transfusion
o Bone marrow transplant
o Surgery (to remove the spleen, if related to hemolytic
anemia)
o Antibiotics (if an infection is the causative agent)

16. Polycythemia
16
 Defined as abnormal increase in the number of RBCs
in the peripheral blood, with an increased
hemoglobin level
 Causes –
Primary and Secondary
increase in production of absolute increase in
RBCs due to increased RBC mass due to
proliferative activity of enhanced stimulation
bone marrow of RBC production

17. 17
 Symptoms
o Tender redness of palms and soles
o Itching
o Joint pains
o Abdominal pain
o Bruising
o Bleeding from nose
o Bluish color of the skin

18. 18
 Oral manifestations
o Purplish or red areas on the cheeks, gums, lips, oral
mucosa and tongue.
o Gingiva is engorged and swollen
o Spontaneous bleeding of the gingiva
o Submucosal petechiae, echymosis and hematoma
Purplish/red area on
tongue

19. 19
Engorged and
swollen gingiva
Submucosal petechiae and
echymosis

20. 20
Gingival bleeding

21. Dental consideration
21
o Dental treatment presents a risk because of possibility
of bleeding/ thrombosis.
o Pre operative myelosuppressive treatment

22. Disorders of platelets
22
 Platelets help in healing of wound and prevent
bleeding by forming blood clots.
 Normal range- 1,50,000-4,50,000platelets per
micro liter of circulating blood.
 Disorders of platelets are- thrombocytopenia and
thrombocytosis

23. 23
Thrombocytopenia
Decrease in the number of circulating blood
platelets
Causes –
o Pregnancy
o Autoimmune disease (Immune
thrombocytopenia)
o Bacteria infection
o Viruses (chicken pox, mumps, rubella)
o Anemia (aplastic anemia)
o Medications

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 Symptoms
o Ease of excessive bleeding(purpura)
o Petechiae
o Prolonged bleeding from cuts
o Occasional bleeding from the gums,
digestive tract, urinary tract
o Bleeding from nose(epitaxis)

25. 25
 Oral manifestation
o Spontaneous gingival bleeding
o Edematous enlargement of gingiva
o Hyperaemia of gingiva
o Petechiae and echymosis on soft palate and buccal
mucosa
(Guzaldemir E.the role of oral hygiene in a patient with idiopathic thrombocytopenic purpura. Int J Dent Hyg. 2009)

26. 26Hyperaemia of
gingiva
Petechiae and echymosis
of soft palate

27. Dental consideration
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o Drug such as Aspirin should be avoided
o Platelet transfusions are best during major surgeries

28. Treatment
28
o No specific treatment of the disease
o Spleenectomy may be beneficial
o Bed rest & blood transfusions

29. 29
Thrombocytosis
Characterized by increase in the number of
circulating blood platelets.
Causes
o Infection
o Inflammatory disorders(arthritis, connective tissue
disorder)
o Acute or chronic blood loss
o Tissue damage from trauma and surgery
o Rebound following chemotherapy

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 Symptoms
o Headache
o Light headedness, dizziness
o Weakness
o Chest pain
o Temporary vision changes
o Numbness and tingling of hands and feet
 Oral manifestation
o Spontaneous gingival bleeding
o Excessive and prolonged bleeding after
extraction

31. Disorders of WBCs
31
 Leukopenia
Abnormal reduction in the number of WBCs in the
peripheral blood stream. This decrease
predominantly involves granulocytes.
1. Agranulocytosis – characterized by decrease
number of circulating granulocytes.
Causes-
Infections-viral, bacterial
Exposure to certain drugs
Exposure to radiations

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 Symptoms
o High fever accompanied by chills and sore throat
o Weakness
o Regional lymphadenopathy
o Infection of any organ may be rapidly progressing.
 Oral manifestation
o Necrotizing ulcerations of oral mucosa, tonsils,
pharynx, gingiva and palate
o The lesions appear ragged and covered with gray or
black membrane
o Excessive salivation

33. 33
Necrotizing ulceration
of oral mucosa
Lesion covered with
gray membrane

34. Treatment
34
o Not specific; should consist recognition & withdrawal
of causative drugs
o Antibiotics to control infection
o Topical application of antibacterial mouth rinses
o Topical neomycin, bacitracin, nystatin
o Contraindication:- oral surgical procedures(extraction)

35. Leukocytosis
35
 Abnormal increase in the number of circulating
WBCs
 Leukemia- acute and chronic
 Causes
o Acute infections including localized infections of fungi,
virus, parasites
o Rheumatic fever, diptheria, small pox
o Inflamatory conditions such as coronary thrombosis,
burns, collagen vascular disease
o Allergic disorders like bronchial asthma, urticaria
following irradiation

36. 36
 Acute leukemia-signs/symptoms
o Fever
o Weight loss
o Bone pains
o Weakness
o Splenomegaly
o Hepatomegaly
o Lymphadenopathy
o Purpura

37. 37 Chronic leukemia- signs/symptoms
o Fever
o Weight loss
o Anorexia
o Bleeding
o Thrombocytopenia
o Splenomegaly
o Hepatomegaly
o Lymphadenopathy

38. 38
 Oral manifestations
o Gingival bleeding
o Gingival hyperplasia
o Petechiae and purpura will be seen
o Ulcerations of the mucosa
o Candidiasis
o Loosening and exfoliation of the teeth
o Leukemic deposits on mucosa
o Leukemic infiltration of salivary glands

39. 39Gingival
hyperplasia
Petechiae of oral
mucosa

40. Dental consideration
40
o Dental treatment should be carried out after
consultation with physician
o Preventive oral health care essential
o Due to bleeding tendencies, abnormal susceptibility to
infections- strict asepsis is indicated.

41. Hemophilia
41
 Inherited bleeding or coagulation, disorder.
 Persons with hemophilia lack the ability to stop bleeding
because of the low levels, or complete absence, of specific
proteins, called "factors," in their blood that are necessary
for clotting.
 Proper clotting of blood helps prevent excessive bleeding.
 Types of hemophilias –
 hemophilia A - lack of factor VIII
 hemophilia B - lack of factor IX

42. Causes
42
 Hemophilia types A and B are inherited diseases passed on
from a gene located on the X chromosome. Females carrier
of hemophilia has the hemophilia gene on one of her X
chromosomes, and there is a 50 percent chance that she
may pass the defective gene to her male offspring.
 Males who inherit the defective gene will develop
hemophilia. Males with hemophilia do not pass the gene to
their sons; however, they do pass the gene to their
daughters.

43. Symptoms
43
o Excessive, uncontrollable bleeding
o Bleeding may occur even if there is no injury. Often occurs
in the joints and in the head.
o Bruising - Occur from small accidents, which can result in
a large hematoma.
o Bleeds easily - Tendency to bleed.
o Bleeding into a joint - Hemarthrosis can cause pain,
immobility, and eventually deformity if not medically
managed properly.

44. 44
o Bleeding into the muscles - Bleeding into the
muscles can cause swelling, pain, and redness.
o Bleeding from injury or bleeding in the
brain - Bleeding from injury or spontaneously in
the brain, is the most common cause of death in
children with hemophilia and the most serious
bleeding complication.
o Other sources of bleeding - Blood found in
the urine or stool may also be a symptom of
hemophilia.

45. Dental consideration
45
• Local anaesthesia, blocks, infiltration anesthesia should
not be used in absence of factor VIII.
• Intraligamentary local anaesthesia are safe
• Extractions & dentoalveolar surgeries should be
carefully planned- preoperative transfusion of whole
blood or factor 8

46. Implication
46
 The public health professional deals with a large group of population
during health camps. These blood disorders have many oral
manifestations. So being a public health dentist evidence of petechiae,
ecchymoses, hematomas or excessive gingival bleeding should direct
the practitioner’s attention toward a possible underlying bleeding
disorders. This will help in early diagnosis of the disorder.
 The suspected patients can be referred to the physician for further
diagnosis.
 Patients with suspected disease should be motivated and educated for
rendering treatment.
 Health programs can be undertaken to improve their health. Vitamins
and iron supplements can be given to them through these programs.


47. References47
 Guzaldemir E. The role of oral hygiene in a patient with idiopathic
thrombocytopenic purpura. Int J Dent Hyg. 2009;7:289-93
 Shafer. Diseases of blood and blood forming organs. In, Rajendran R.
Textbook of oral pathology, 6th edition. New Delhi, Elsiever,
2009;754-85
 Sembulingum K, Sembulingum P. Blood Function And Composition.
Essentials of medical physiology, 6th edition. New Delhi, Jaypee
brothers, 2012;58-61
 Mohan H. Diseases of blood and lymph nodes. Essential pathology for
dental students, 2nd edition. New Delhi, Jaypee brothers, 2002;424-
502
 Ghom AG. Blood disorders.Textbok of oral medicine, 2nd edition. New
Delhi, Jaypee brothers, 2010;894-925

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