This document provides an overview of blood dyscrasias (disorders of blood cells). It begins with an introduction to dyscrasia as a concept from ancient Greek medicine meaning "bad mixture." The document then discusses the history of dyscrasias and provides classifications of blood dyscrasias including disorders of red blood cells, white blood cells, hemoglobin, hemostatic mechanisms, and more. Several specific red blood cell disorders are described in detail, including iron deficiency anemia, vitamin B12 deficiency anemia, folic acid deficiency anemia, aplastic anemia, polycythemia, and hereditary spherocytosis. Management and dental considerations are provided for many of these conditions.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
direct filling gold... material aspect, types, condensation, cavity design, modifications. detaied seminar for post gradutes.... any doubts or suggestions contact dr.mb@hotmail.com
Definition
General properties
Composition
Function of saliva
Formation of saliva
Method for collecting saliva
Advantages
Limitations
Analysis of saliva done for the diagnosis of systemic disease
Definition:
by Stedmann’s & Lipincott medical dictionary.
A clear, tasteless, odourless, slightly acidic (pH 6.8) viscous fluid, consisting of the secretion from the parotid, sublingual, submandibular salivary glands and the mucous glands of the oral cavity.
General properties
Volume: 1000 to 1500 mL of saliva is secreted per day and, it is approximately about 1 ml/ minute.
Contribution by each major salivary gland is:
i. Parotid glands: 25%
ii. Submandibular glands: 70%
iii. Sublingual glands: 5%.
Reaction: Mixed saliva from all the glands is slightly acidic with pH of 6.35 to 6.85.
Specific gravity: It ranges between 1.002 and 1.012.
Tonicity: Saliva is hypotonSalivary flow
The average person produces approximately 0.5 L – 1.5 L per day
Unstimulated Flow (resting salivary flow―no external stimulus)
Typically 0.2 mL – 0.3 mL per minute
Stimulated Flow (response to a stimulus, usually taste, chewing, or medication [eg, at mealtime])
Typically 1.5 mL – 2 mL per minute
A well pictured presentation on Endodontic Instrumentation for UG students. Best for getting a good grip on the topic as a whole. Meant to supplement not substitute standard texts.
Tooth resorption is the progressive loss of dentine and cementum by the action of osteoclasts. This is a physiological process in the exfoliation of the primary dentition, caused by osteoclast differentiation due to pressure exerted by the erupting permanent tooth
Introduction
Classification
Composition
Properties Of GIC
Clinical Application Of GIC & GIC In Endodontics
Contraindication Of GIC
Types Of GIC
Recent Advances
Conclusion
References.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
direct filling gold... material aspect, types, condensation, cavity design, modifications. detaied seminar for post gradutes.... any doubts or suggestions contact dr.mb@hotmail.com
Definition
General properties
Composition
Function of saliva
Formation of saliva
Method for collecting saliva
Advantages
Limitations
Analysis of saliva done for the diagnosis of systemic disease
Definition:
by Stedmann’s & Lipincott medical dictionary.
A clear, tasteless, odourless, slightly acidic (pH 6.8) viscous fluid, consisting of the secretion from the parotid, sublingual, submandibular salivary glands and the mucous glands of the oral cavity.
General properties
Volume: 1000 to 1500 mL of saliva is secreted per day and, it is approximately about 1 ml/ minute.
Contribution by each major salivary gland is:
i. Parotid glands: 25%
ii. Submandibular glands: 70%
iii. Sublingual glands: 5%.
Reaction: Mixed saliva from all the glands is slightly acidic with pH of 6.35 to 6.85.
Specific gravity: It ranges between 1.002 and 1.012.
Tonicity: Saliva is hypotonSalivary flow
The average person produces approximately 0.5 L – 1.5 L per day
Unstimulated Flow (resting salivary flow―no external stimulus)
Typically 0.2 mL – 0.3 mL per minute
Stimulated Flow (response to a stimulus, usually taste, chewing, or medication [eg, at mealtime])
Typically 1.5 mL – 2 mL per minute
A well pictured presentation on Endodontic Instrumentation for UG students. Best for getting a good grip on the topic as a whole. Meant to supplement not substitute standard texts.
Tooth resorption is the progressive loss of dentine and cementum by the action of osteoclasts. This is a physiological process in the exfoliation of the primary dentition, caused by osteoclast differentiation due to pressure exerted by the erupting permanent tooth
Introduction
Classification
Composition
Properties Of GIC
Clinical Application Of GIC & GIC In Endodontics
Contraindication Of GIC
Types Of GIC
Recent Advances
Conclusion
References.
Plasma cell disorders is a difficult topic where most residents and students confuse with regarding to differentiating between various types of para-proteinemias or plasma cell dyscrasias. This simple presentation will highlight the key points in differentiating, diagnosing these orders. Initial management principles are discussed as well.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
5. History
• The concept of dyscrasia was developed by the Greek
physician Galen (130–199 AD), who elaborated a model
of health and disease as a structure of elements,
qualities, humors, organs, and temperaments.
Health was understood in
this perspective to be a
condition of harmony or
balance among these
basic components,
called eucrasia.
Disease was interpreted as the
disproportion of bodily fluids
or four humours: phlegm,
blood, and yellow and black
bile. The imbalance was
called dyscrasia.
7. Erythrocytes or RBCs
• Circular, biconcave cell.
• Doesn’t contain a nucleus,
ribosomes, or mitochondria.
• Contains Hb which is
interwoven in the stroma.
• The functions of RBCs include:
• Carriage of O2 from the lungs to
peripheral tissues.
• Carriage of CO2.
• Approx. 5 x 106 /cumm
• Approx. life span- 120 days.
8. Haemoglobin • Present in RBCs.
• Required for:
• O2 transport
• Co2 transport
• Acts as a blood buffer
• Each molecule has 2
ingredients- haem and
globin.
• Haemoglobin is a
conjugated protein.
9. Leucocytes or WBCs
• Leukos= white + cytes= cells
• Their fundamental job is to:
• provide defence against:
• Bacteria
• Viruses
• Fungi
• Parasites
• Remove debris(dead cells) and foreign protein.
• Produce chemicals that produce inflammation.
16. Iron Deficiency Anaemia
• Most common
anaemia.
• Microcytic
hypochromic type of
anaemia.
• Women are affected 4
times more frequently
than men.
CAUSES
• Nutritional Deficiencies
• Chronic Blood loss
• Malaria
17. Systemic features
• None in the early stages
Cardiorespiratory
• Dyspnoea
• Tachycardia
• Palpitations
Cutaneous
• Pallor
• Koilonychia-
spoon shaped nails
19. General Management
• Administration of 300 mg ferrous sulphate orally, 3 times
daily for 10 days.
• Mild gastrointestinal intolerance is the side effect.
• Takes 10 to 20 days for the hematocrit to normalize.
• Parenteral administration reserved for patients who do
not respond to oral therapy.
20. Dental Considerations
• Local Anesthesia
adequate for pain control.
• Atrophic glossitis –
soreness of tongue with
depapillation or colour
change- best known
effect of severe anaemia.
• Candidiasis may be a
presenting feature
caused by candida
albicans which may be
promoted by anaemia
itself.
21. Periodontal Manifestations
• IDA-CP patients exhibited a higher gingival index,
bleeding on probing, probing pocket depth, and
percentage (%) of sites with a clinical attachment
loss (CAL) of ≥6 mm than CP patients.
• In patients with significant anaemia, elective
periodontal surgical procedures should be avoided
as they may cause bleeding problems and also poor
wound healing.
Impact of iron deficiency anemia on chronic periodontitis and superoxide dismutase activity: a cross-sectional
study. Souvik Chakraborty, Shikha Tewari1, Rajinder Kumar Sharma, Satish Chander, Narula1, Pratap Singh
Ghalaut, Veena Ghalaut. Journal of Periodontal Implant Sci 2014;44:57-64.
23. Vitamin B12 Deficiency
Anaemia
CAUSES
• Auto immune- Pernicious Anaemia (due to atrophy of
gastric mucosa).
• Poor Intake- specially in vegetarians.
• Malabsorption
• Congenital
• Gastrectomy
• Ileal disease
• Drugs (rare)
• Colchicine
• Neomycin
24. General Features
Slow to develop
because liver stores last
upto 3 years.
• Weakness
• Fatigue
• Light-headedness,
• Rapid heartbeat
• Rapid breathing
• Pale color to the skin
• In addition,
neurological symptoms
particularly
paresthesia of the
extremities may
develop.
25. Oral Manifestations
• A physically normal,
sore or burning tongue
can be caused by early
Vitamin B12 deficiency.
• Tongue may appear
fiery or beefy red and
the tip and margins
show papillary atrophy.
• Candidiasis can be
precipitated by
anaemia.
• Apthous stomatitis
occasionally presenting
feature.
27. General Management
• Parenteral course of Vitamin B12 sufficient to provide
daily requirement of 2 to 5 µg until abnormality is
corrected.
• This regimen is followed by monthly intra muscular
injections ( 50 to 100 µg) for the rest of patients life.
28. Dental Considerations
• Local anaesthesia satisfactory.
• Conscious sedation- Nitrous oxide is contraindicated.
• General anaesthesia should be postponed until a low
haemoglobin has been remedied.
29. Folic Acid Deficiency Anaemia
• Needed by the body
to
• synthesize and
breakdown amino
acids
• Synthesize DNA / RNA
• Essential for the
maturation of
erythrocytes.
• Laboratory picture is
that of megaloblastic
anaemia.
30. Folic Acid Deficiency Anaemia
CAUSES
• Mostly dietary deficiency
• Malabsorption
• Coeliac disease and Crohn’s disease
• Increased demands
• Pregnancy
• Patients under going long term renal dialysis
• Drugs
• Alcohol- interferes with metabolism and absorption of folic
acid.
• Barbiturates
• Phenytoin
31. General Features
• Folate deficiency leads to anaemia
• fatigue
• dizziness
• feeling cold
• irritability
• headache
• difficulty breathing
• pale skin
• GI symptoms such as
• Nausea, vomiting
• Abdominal pain
• Diarrhea, especially after meals
• Anorexia also is common.
• In combination with the above symptoms, may lead
to marked weight loss.
32. Oral Manifestations
• In early deficiencies
• Soreness of tongue without depapillation or colour change
• In severe anaemia
• Atrophic Glossitis is the best known effect
• Angular Stomatitis is also a well known sign
33. General Management
• Oral folic acid (1 mg tablet daily) is effective in reversing
megaloblastic anaemia caused by folate deficiency.
• If the underlying cause of deficiency is irreversible (e.g.
intestinal disease), maintenance therapy is necessary.
• The patient should be given education emphasizing the
origin of the dietary deficiency.
34. Dental Considerations
• Local anaesthesia is satisfactory.
• Conscious sedation can be given if the haemoglobin
level is only moderately depressed and supplemental
oxygen can be given.
• General Anaesthesia should be postponed until a low
haemoglobin has been remedied.
35. Aplastic anaemia
• Pancytopenia with a non
functioning bone marrow.
• Rare disease causing
leucopenia,
thrombocytopenia and
refractory anaemia.
CAUSES
• Idiopathic
• Chemicals such as
benzene
• Drugs
• Hepatic viruses
• Irradiation
36. General features
Features of anaemia
• Purpura – usually
the first
manifestation
• Suseptibility to
infection
• Suseptibility to
bleeding
38. General Management
• First line treatment for aplastic anemia consists
of immunosuppressive drugs, typically either anti-
lymphocyte globulin or anti-thymocyte globulin, combined
with corticosteroids and cyclosporine.
39. Dental Considerations
• Treatment modifications need to take into consideration:
• Anaemia
• Haemorrhagic tendencies
• Susceptibility to infections
• Effects of corticosteroid therapy
• Hepatitis B and other viral infections
• Local anaesthesia is satisfactory.
• Conscious sedation and general anaesthesia should be
avoided
41. Polycythemia
• Polycythemia may be
defined as an abnormal
increase in the
erythrocyte count in the
peripheral blood, usually
accompanied by an
increase in hemoglobin.
• Opposite of anaemia
• RBC count and Hb
concentration both rise.
42. Polycythemia
• It can be:
• Primary aka
Polycythemia Vera
• Due to malignant changes in
erythrocyte producing cells.
• Secondary
• Where there is an excess
need of RBCs for survival.
Eg at high altitudes, COPD
and cyanotic heart diseases.
43. Systemic features
• Headache
• Dizziness
• Vertigo
• Tinnitus
• Hemorrhages
• Ruddy cyanotic skin
seen on the face and
extremities
• Splenomegaly is a
common finding on
physical
examination.
44. General Management
• Goal of medical therapy is to reduce erythroid over
production and to lower blood viscosity.
• When the hematocrit rises above 60%, blood is removed
usually about 500 ml initially, by phlebotomy every 2 to 3
days until hematocrit is controlled.
• Thereafter ,maintenance therapy consists of long term
phlebotomy or myelosuppressive therapy.
• Long term myelosupression by chemo therapy or
irradiation is efficient.
45. Oral manifestations
• Facial plethora (red
florid complexion)
is a cardinal sign
particularly evident
around the ears,
nose and lips.
• Oral mucosa may
have cyanotic or
purplish
appearance.
47. Periodontal Manifestations
• The gingivae
appears congested
and edematous
and may bleed
spontaneously
because of
hyperviscosity and
hypertension.
• Gingival
enlargement may
be seen.
49. Hereditary Spherocytosis
• also known
as Minkowski–
Chauffard syndrome
• Intrinsic defect in RBC
membrane that
renders it spheroidal,
less deformable and
vulnerable to spleenic
sequestration and
destruction.
• Mutations disrupt
vertical interactions
between spectrin
meshwork and intrinsic
membrane proteins.
51. General features
Signs and symptoms are highly variable
• Include mild pallor
• Intermittent jaundice
• Splenomegaly.
52. Oral Manifestations
• Manifest in the
mucosa as
deposition of blood
pigments during
episodes of jaundice
or in acute infections.
• Severe dental
infection may trigger
an attack requiring
hospitalisation.
53. General Management
• Splenectomy is frequently performed and is invariably
successful in correcting the haemolysis of erythrocytes.
• Gall Bladder is also removed if symptomatic or diseased.
(affected in about half of the patients).
55. Haemoglobinopathies
• They are genetically determined disorders of
haemoglobin production.
• Each of the haemoglobin peptide (globin) chains has a
unique amino acid sequence that can be altered as a
result of DNA mutations.
• Haemoglobinopathies are mostly seen in non –
caucasians.
56. Sickling Disorders
• It is an autosomal
recessive disorder.
• Erythrocytes distort into
cresent or sickle shape.
• HbS haemoglobin
present instead of HbA.
• 2 α chains as usual but in
the β chains, in position
6, valine instead of
glutamic acid is present.
• Sickling of RBCs leads to
stasis, hemolysis and
microthrombosis of
blood.
57. General Features
6 main problems:
• Painful Crises
• Usually due to infarction brought on by infection,
dehydration, hypoxia, acidosis or cold.
• Form mainly in spleen, bones and joints, brain, kidney,
lungs, retinae and skin.
• Haematological crises
• Caused by parvovirus infection.
• Can be: haemolytic, aplastic or sequestration.
• Chronic Anaemia
• Chronic hyperbilirubinaemia
• Infections- pnuemococci, meningococci, haemophilus
and salmonellae
• Sequestration syndromes
58. Oral Manifestations
• Pallor of the oral
mucosa.
• Slow tooth
development and
eruption.
• Hypoplasia of
enamel secondary
to anemia.
60. General Management
• Painful and febrile crises of sickle cell anemia are
managed with analgesics, sedatives, bed rest and fluids.
• When vaso- occluson develops, transfusion therapy is
advocated.
• Whole blood or packed cells are used to increase the
erythrocyte count and to promote tissue oxygenation.
61. Dental Considerations
• Sickle cell anaemia with Hb less than 11 gm/dl presents
a hazard for general anaesthesia.
• Local anaesthesia is the preferred mode for pain control.
• Conscious sedation can be used safely.
• Preferable to avoid Prilocaine which in overdose may
cause methaemoglobinaemia.
• Aspirin is best avoided- may cause acidosis in large
doses.
• Prophylactic antibiotics should be given and infections
may be treated vigorously.
• Elective surgery should be carried out in the hospital and
the anaemia should be corrected pre operatively with the
Hb brought upto 10gm/dl.
62. Thalassaemias
• These are autosomally dominant, inherited
disorders in which either alpha or beta globin chains
are synthesized at a low rate, thereby lessening the
production of Hb A.
• Characterized by hypochromic microcytic anaemia.
• They may be
• Severe- major thalassemia
• Mild – minor thalassemia
• May affect
• alpha chain- alpha thalassemia
• Beta chain- beta thalassemia
63. Beta- Thalassemia
• Results from depressed
production of beta
chains.
• Homozygous beta
thalassemia (Cooley’s
anaemia or thalassemia
major) is characterized
by:
• Increasingly severe
anaemia
• Hepatosplenomegaly
• Skeletal Abnormalities
• Heterozygotes for beta
thalassemia may be
asymptomatic.
64. Oral manifestations
• Marked
overdevelopment of
maxilla and mandible.
• The osseous changes
cause
• prominent cheekbones,
• sunken root of the nose,
• labial inclination of the
maxillary incisor,
• inadequate lip seal.
These lead to the
description “chipmunk”
or “rodent facies”.
• The oral mucosa may
be pale, owing to
anaemia or yellow
tinged due to jaundice.
65. General Management
• Treatment includes blood transfusions to temporarily
control anemia.
• Repeated transfusions accelerate development of
electromyocardial instability.
• Iron chelating agents have been used to improve serum
iron balance in these patients.
• In select cases, splenectomy may be helpful.
• Prognosis for thalassemia major is unfavorable and no
successful therapy is available.
• Death usually occurs early.
• Thalassemia minor often requires no specefic therapy
unless haemoglobin levels drop.
66. Dental Considerations
• Patients undergoing repeated transfusions are at a risk
of Hepatitis B, C and HIV carriage.
• Since splenectomy results in an immune defect, it is
prudent to cover surgical procedures with prophylactic
anti- microbials.
• Local anaesthesia is safe.
• Conscious sedation may be given with oxygen levels not
less than 30%.
• General anaesthesia may be complicated by
enlargement of the maxilla (difficulty in entubation).
67. Periodontal Considerations
• Severe gingivitis is
evident if the patient is
subjected to
splenectomy.
• The colour of gingiva
sometimes tends to
be dark due to high
ferritin levels in the
blood.
• Periodontitis, gingivitis
etc. are very
dangerous foci of
infection in these
immune impaired
individuals. This
situation is worsened
in the presence ofDental considerations in Thalassemic patients Dr Sakshi Madhok, Dr Saksham Madhok. (IOSR-
JDMS)Volume 13, Issue 6 Ver. IV (Jun. 2014), PP 57-62.
70. Leukaemias
• Leukemias are potentially lethal diseases in which there
is neoplastic proliferation of bone marrow WBCs.
• They are classified by:
• Clinical course- acute or chronic
• Cell of origin- lymphoblast or non lymphoblast
• Dental management of such patients is often
complicated by bleeding tendencies and susceptibility to
infection.
71. Acute Lymphoblastic
Leukemia
• Most common malignant disease of children.
• Usually in childhood but can affect any age group.
CAUSES
• Ionizing radiation
• Exposure to benzene
73. Oral manifestations
• Oral bleeding and
petechiae are typical
manifestations
• Oral pallor
• Gingival swelling
(sometimes)
• Mucosal or gingival
ulceration
• Pericoronitis
• Cervical
lymphadenopathy
• Oral and Peri- oral
Herpetic infections
• Candidiasis caused by
Candida albicans
74. General Management
• Treatment of choice is with prednisolone.
• Other anti leukemic agents like anthracycline antibiotic
are added if needed.
75. Dental considerations
• Preventive oral health care is essential and conservative dental
treatment may be possible.
• Surgery should be deferred except in emergencies .
• Regional local anaesthetics contra indicated if there is severe
haemorrhagic tendencies.
• Conscious sedation is usually possible.
• Anaemia is a contradiction to general anaesthesia however iv
sedation may be used.
• Because of dangers of infection and hemorrhage desmopressin
or platelet or blood infusions may be needed pre operatively.
• Antibiotic coverage should be started pre operatively and
continued till the wound heals.
• Any extraction sockets should not be packed as they predispose
to infection.
• Aspirin and other NSAIDs should not be given since they can
aggravate bleeding.
76. Acute Myeloid Leukemia
• Most common leukemia in adults
CLINICAL FEATURES
• Anaemia
• Lymphadenopathy
• Splenomegaly
• Infections
• Fever
• Bruising and bleeding tendencies
• Night sweats
• Lethargy
• Weight loss
77. Oral manifestations
• Oral bleeding and
petechiae are typical
manifestations
• Mucosal pallor
• Mucosal or gingival
ulceration
• Pericoronitis
• Cervical
lymphadenopathy
• Gingival swelling
(sometimes)- occurs
due to abnormal
response to dental
plaque
78. General Management
• Less responsive to therapy and continues to be lethal for
the majority affected.
• Remission is the result of intensive treatment with
cytosine arabinoside, together with anthracycline
antibiotic, daunorubicin and sometimes methotrexate.
79. Dental considerations
• Preventive oral health care is essential and
conservative dental treatment may be possible.
• Surgery should be deferred except in emergencies .
• Antibiotic coverage should be started pre operatively
and continued till the wound heals.
80. Chronic Lymphocytic
Leukemia• Primary disease of older persons.
• The cause of CLL remains unknown.
CLINICAL FEATURES
• Many are asymptomatic.
• In others,
• Fatigue
• Fever
• Weight loss
• Anorexia
• Lymphadenopathy
• Haemorrhage
81. Oral manifestations
• Gingival bleeding
• Oral petechiae
• Oral ulceration
• Herpes simplex
infection may occur
• Candidiasis is
common
• Bleeding
tendencies
• Liability to
infections
82. General Management
• The chemotherapeutic agent used in the treatment of
CLL is the alkylating agent chlorambucil.
• This agent may be given with prednisone, especially if
autoimmune hemolytic anemia and thrombocytopenia
are present.
• This therapy reduces nodal and spleen size and
improves the quality of life.
83. Dental considerations
• Local anaesthesia is satisfactory.
• Conscious sedation may been given.
• General anaesthesia should be carried out in a hospital.
84. Chronic Myeloid Leukemia
• Most dramatic white cell disorder.
• Proliferation of myeloid cells in the bone marrow,
peripheral blood and other tissues.
CLINICAL FEATURES
• Anaemia
• Weight loss
• Joint pains
• Splenomegaly
• Hepatomegaly
• Rarely lymphadenopathy
85. Oral manifestations
• Pallor of mucosa
due to anaemia
• Disturbance of
taste
• Xerostomia
• Oral hemorrhages
• Swelling of salivary
glands
86. General Management
• Treatment of CML is with the alkylating agent busulfan or
with hydroxyurea.
• These cytotoxic drugs reduce peripheral blood counts
and spleen size, making the patient less symptomatic.
87. Dental considerations
• Treatment planning should take into consideration:
• Bleeding tendencies
• Liability to infection
• Anaemia
• Susceptibility to hepatitis B, C and HIV infection.
88. Periodontal Considerations
• Periodontal manifestations consist of leukemic infiltration,
gingival bleeding. Their expression is more common in
acute forms of leukemia than in chronic forms.
LEUKEMIC INFILTRATION
• Leukemic cells can infiltrate the gingiva and less
frequently the alveolar bone.
• Gingival infiltration results in leukemic gingival
enlargement.
• Clinically, the gingiva appears:
• Bluish red and cyanotic
• Rounding and tenseness of the gingival margin
• Increase in size, mostly in the interdental papilla & partially
covering the crowns of the teeth..
89. Periodontal Considerations
BLEEDING
• Gingival hemorrhage is a common finding in leukemic
patients.
• It is caused by the thrombocytopenia resulting from
replacement of bone marrow cells by leukemic cells and
from the inhibition of normal stem cell function by
leukemic cells
90. Leukemic gingival
enlargement• Most important oral sign
of leukemia.
• True enlargement occurs
in acute leukemia and
seldom in chronic
leukemia.
• It may be
• diffuse or marginal
• localized or generalized.
• Normal contours of
gingiva are lost.
• It may appear as
• A diffuse enlargement
• An oversized extension of
the margins
• A discrete tumor like
interproximal mass
91. Leukemic gingival
enlargement
• Stippling is replaced
by spongy, swollen
tissue that tends to
peel away from the
teeth and bleed easily.
• The consistency is
moderately firm, bit
there is a tendency
towards friability.
• Progressive disease
produces purple, shiny
and hemorrhagic
gingiva.
• Purpuric features like
petechial lesions and
ecchymosis are
common.
92. LYMPHOMAS
• Malignant lymphomas are solid neoplastic growths of
lymphoid cells that arise in reticuloendothelial and
lymphoid tissue.
• They spread to distant lymphoid sites, such as liver,
spleen and bone marrow.
• Originate in the lymph nodes but can arise extra nodally.
• Several types of malignant lymphomas occur, however
those of primary interest are
• Hodgkin’s Lymphoma
• Non – Hodgkin’s Lymphoma
• Burkitt’s Lymphoma
93. Hodgkin’s Lymphoma
• It is a neoplastic
disorder originating in
lymphoid tissue.
• The disease classically
begins as a painless,
enlarging mass that
appears in the neck or
mediastinum of adults.
• Initially arises at a single
site and subsequently
spreads to contiguous
lymphoid structures.
• Characterized by a
neoplastic proliferation of
large multi nucleated
reticulum cells known as
Reed Stenberg Cells.
94. • Progressive
painless swelling of
the cervical lymph
nodes.
• Generalized itching
• Cyclic elevations of
body temperature
• Chills and night
sweats
• Weight loss
96. General Features
• Painless
lymphadenopathy –
presenting feature.
• Enlarged lymph
nodes are firm,
rubbery and mobile.
• Rapid nodal growth
may impair lymphatic
drainage, resulting in
lymphadema, pain,
parasthesia and skin
infiltrations
97. Oral Manifestations
• Lymphoid tissue of
Waldeyer’s Ring
frequently involved
site.
• Infiltration results in
non tender
enlargements of
tonsillar tissue or the
posterior palate.
• The surface of these
swellings may be
erythematous,
ulcerated or necrotic.
98. Oral Manifestations
• When palate is the sole
site of primary
lymphoma, it is
sometimes referred to as
lymphoproliferative
disease of the palate.
• The enlargement is slow
growing, soft, spongy
and relatively painless.
• The surface is non
ulcerated and often
lumpy, with red surface
telangiestasia.
• As the disease
progresses the colour
changes from pink to
blue purple
99. Periodontal Manifestations
• In rare cases, oral Non- Hodgkins Lymphoma can mimic
other, more common disorders and can appear as a
gingival mass.
• Lymphomas of the gingiva are frequently treated for
months as a pulpal or periodontal problem before the
correct diagnosis is made.
100. Dental Considerations
• Preventive dental measures are most important in
patients with lymphoma.
• Generally speaking, patients in a state of remission can
receive routine dental care.
• However, patients with acute signs or symptoms of
lymphoma should receive only conservative emergency
dental care.
• When invasive procedures are required in the patient
with lymphoma, a bleeding time determination and
consultation with oncologist are recommended.
• Patient undergoing chemotherapy or radiation therapy
should be observed for xerostomia or radiation caries.
102. Haemostasis
• Normal Haemostasis
depends on a complex
interaction of the blood
vessels, platelets, fibrin
coagulation and
deposition and fibrinolytic
proteins.
• Heamostasis consists of
3 reactions:
• Primary- vascular phase
• Secondary- platelet phase
• Tertiary- coagulation phase
All of which occur at the same
time.
103. Primary Haemostasis
• Primary haemostasis is by
vasoconstriction after injury.
• This reduces the outflow of
escaping blood after injury.
• Circulating platelets are
exposed to subendothelial
collagen, which causes the
release of intra- cytoplasmic
granules that stimulate
platelet aggregation and
helps to form the soft primary
plug.
Abnormalities in primary
haemostasis
• Abnormal platelet number or
function
• Abnormal von willebrand
factor
104. Secondary Haemostasis
• The aggregation of
platelets is the second
phase of haemostasis.
• Therefore it is aka ‘the
platelet phase’.
Abnormalities in
secondary haemostasis
• Defects in the
coagulation cascade
cause more serious
bleeding than do
defects of primary
haemostasis.
• They include bleeding
into cavities (chests,
joints, cranium).
105. Tertiary Haemostasis
• It is the third and
final phase.
• It is divided into 2
pathways:
• The extrinsic
pathway
• The intrinsic
pathway
106. Bleeding Disorders
CAUSES
Defects in haemostasis, leading to bleeding disorders can
comprise:
• Platelet activation and function
• Anti – thrombin function
• The more common causes include
• Warfarin- which interferes with clotting factor production
• Vitamin K blockage
• Aspirin – one tablet of which impairs platelet function for
almost 1 week.
107. General Features
• Deep haemorrhage
into muscles, joints
or skin.
• Bleeding from and
into mucosae and
skin (‘bruising’)-
suggests purpura.
108. Localized Oral Purpura
• Blood blisters are
occasionally seen,
typically in older
persons in the
absence of obvious
trauma.
• These blood blisters
are often in the
palate and may
sometimes be 1 cm
or more in diameter
and after rupture
may leave a sore
area for a time.
110. Platelet Disorders
• Platelet disorders may be the result of
• alteration in platelet numbers,
• either decreased (thrombocytopenia)
• increased (thrombocythemia),
• altered platelet function (thrombocytopathia).
• Platelet disorders may be:
• Quantitative- Thrombocytopenic purpura
• Qualitative- Disorders of platelet function
111. Causes
• Failed platelet production
• Thrombocytopenia
• von Willebrand’s disease.
• Excessive platelet Destruction
• Idiopathic Thombocytopenic Purpura
• DIC
• Abnormal platelet Function
• Abnormal platelet Regulation
112. Thrombocytopenic Purpura
• Thrombocytopenia is a bleeding disorder characterised
by a platelet count below the normal range.
• Reduced counts may be due to:
• Failure of platelet production
• Disordered platelet distribution
• Increased platelet destruction.
• It may be:
• Auto- immune or Idiopathic
• Drug induced
113. Idiopathic Thrombocytopenic
Purpura
• Aka auto – immune
thrombocytopenic
purpura.
• ITP is one of the
most common
causes of
thrombocytopenia.
• Is auto immune and
can lead to purpura
and prolonged
bleeding.
114. Drug Induced
Thrombocytopenic Purpura
• Reactions of drugs
or toxins resulting in
a low platelet count
and bleeding
tendency.
• Common offenders
are:
• Quinidine
• Quiunine
• Sulfonamides
• Heavy alcohol
consumption.
115. General Features
• Hallmarks are:
• Abrupt appearance of
petechial hemorrhages.
• Purpura
• Bruises after trauma
• Petechiae cover
extensive surface area
appearing rash like,
but are tender and do
not itch.
• Located chiefly on
arms, lower leg, upper
chest and neck.
• In severe cases-
mucosal bleeding of
the GIT may occur.
116. Oral Manifestations
• Include petechiae
• Ecchymoses
• Post operative
haemorrhage.
• Sumucous purpura
may be conspicous
and sometimes
seen as
“blackcurrant jelly”
blood blisters.
117. Dental Considerations
• Regional local anaesthetic block injections can be given.
• Major surgery requires platelets more than 75x 10 9 /l.
• Conscious sedation can be given.
• General anaesthesia can be given in an hospital.
• Avoid aspirin and other NSAIDs.
118. Periodontal Considerations
• Gingiva is soft,
swollen and friable.
• Bleeding occurs on
the slightest
provocation and is
difficult to control.
• The severity of the
gingival condition is
dramatically
alleviated by
removal of the local
factors.
120. Haemophilia
• X linked disorder resulting from a deficiency in clotting
factor VIII (Hemophilia A or classic) or factor IX
(Hemophilia B or Christmas Disease) .
• Affects males, females are carriers.
• 3 forms of hemophilia are seen:
• Severe- < 1% of normal factor VIII
• Moderate – 1% - 5%
• Mild – 5% – 25%
121. General Features
• Characterized by
severe, persistent
bleeding.
• Hemorrhage into soft
tissue, muscles,
organs and joints.
Clinically these are
prominent as
hematomas and
hemarthroses.
• Excessive bleeding
after trauma.
Intractable oozing or
rapid blood loss one
hour or more after
injury.
• Sometimes
spontaneous bleeding.
122. Oral Manifestations
• Petechiae
• Ecchymoses
• Spontaneous
gingival bleeding can
occur
• Prolonged massive
bleeding even from
simple tooth
exfoliation or
extraction.
• Associated with
anaemia induced
pallor and
pseudoaphthae.
123. Dental considerations
• Local anaesthetic injections or surgery can be followed
by persistent bleeding for days.
• The hemorrhage cannot be controlled by pressure alone.
• Bleeding tendency may be aggravated by NSAIDs.
• In all but severe haemophiliacs, non surgical dental
treatment can usually be carried out under antifibrinolytic
cover.
• Extractions and dentoalveolar surgery should be
carefully planned. A factor VIII level between 50 and
75% is required.
• Mild hemophiliacs requiring such surgeries can be
managed usually without factor replacements.
Desmopressin and tranexamic acid are primary
alternative.
• Post operative suturing is desirable. Vicryl sutures are
124. Periodontal considerations
• Periodontal health is of critical importance for the
hemophiliac for 2 primary reasons:
• Hyperemic gingival contribute to spontaneous and
induced gingival bleeding.
• Periodontitis is leading cause for tooth morbidity
necessitating extractions.
• In all but severe hemophiliacs, scaling can be
carried out without LA.
• Periodontal surgery requires LA and factor VIII
replacement to a level between 50 to 75%
Naveen Kumar J, Anil Kumar R, Varadarajan R, Sharma N. Specialty dentistry for the hemophiliac: Is there a
protocol in place?. Indian J Dent Res 2007;18:48-54
125. von Willebrand’s disease
• Due to inherited
deficiency in vWF.
• Most common
inherited bleeding
disorders.
• Affects both males
and females.
126. General Manifestations
• Generally, bleeding
manifestations are
mild.
• Epistaxis
• Bleeding from the
mucous membrane
• Purpura of mucous
membrane and skin
• Menorrhagia in
females
127. Oral Manifestations
• Gingival bleeding is
the most common
finding- in about 30
– 40% of the
diseased.
• Uncontrollable
bleeding during
dental procedures
like gingival
manipulation and
pulpectomy.
128. Dental Considerations
• Aspirin and NSAIDs should be avoided.
• Local infilteration anaesthesia should generally be used.
• Nerve block anaesthesia is generally contra indicated
because injections delivered into loose alveolar tissue
(highly vascular regions) may produce bleeding or a
dissecting hematoma that could obstruct the patient’s
airway.
• Conscious sedation can be given, but care must be
taken not to damage the vein.
• General anaesthesia must be given in hospital.
• Intubation is a possible hazard because of the risk of
submucosal bleeding in the airway.
129. Periodontal Considerations
• Gingival haemorrhage
is more common than
in haemophilia.
• Even minor gingival
manipulation can lead
to uncontrollable
bleeding.
• Cryoprecipitate or
other anti fibrinolytic
agents shoulld be
administered to
minimize bleeding.
• Post operative diet
should be soft and
semi solid to minimize
trauma to the gingiva.
134. Guidelines for Hemorrhagic
Dental Procedures
• Should be avoided when patients conditions are poorly
controlled.
• Provide prophylactic antibiotics to prevent infection when
open wounds are present.
• Obtain pre operative CBC, DLC, platelet count, bleeding
time, PT and APTT. Any abnormal values mandate a
consultation.
• Oral surgical procedures should be done only if
absolutely necessary and in a hospital setting.
• Single dental extractions should be performed as
opposed to multiple extractions.
• Pay meticulous attention to good technique and primary
closure.
135. Guidelines for Dental
Emergencies
• Pallative emergency treatment only.
• Dental infections should be treated aggressively with
antibiotics and drainage.
• Surgical procedures should be avoided until control of
disease can be assessed with blood profiles.
• Non – Aspirin or Non- NSAID containing drugs should be
prescribed as post operational analgesics.
• If the patient comes back with bleeding-
• Debride the wound site and remove any clot.
• Control the bleeding by packing the socket with absorbable
microfibrillar collagen or thrombin soaked gauze.
136. Conclusion
• Recording a proper history including past medical and
dental history and family history of the patient goes a
long way in helping the clinician in managing patients
with bleeding disorders.
• It not only helps in reaching to a proper diagnosis of the
patient’s condition but also in forming a holistic treatment
plan that is beneficial for the patient.
• Knowledge of the signs and symptoms, both oral and
systemic of these diseases enable the clinician in
diagnosing cases in which the patient does not have any
information about the presence of such disease.
137. References
1. Concise medical physiology, Chaudhuri, IV edition.
2. Robbin’s Basic Pathology, Seventh Edition.
3. Medical Problems in Dentistry; Crispian Scully, Roderick A. Cawson; V
edition.
4. Carranza’s Clinical Periodontology, X edition.
5. Color Atlas of Oral Diseases; George Laskaris; III edition
6. Oral Diagnosis, Oral Medicine and Treatment Planning, Bricker,
Langlais, Miller, II edition.
7. Impact of iron deficiency anemia on chronic periodontitis and
superoxide dismutase activity: a cross-sectional study. Souvik
Chakraborty, Shikha Tewari1, Rajinder Kumar Sharma, Satish Chander,
Narula1, Pratap Singh Ghalaut, Veena Ghalaut. Journal of Periodontal
Implant Sci 2014;44:57-64.
8. Naveen Kumar J, Anil Kumar R, Varadarajan R, Sharma N. Specialty
dentistry for the hemophiliac: Is there a protocol in place?. Indian J
Dent Res 2007;18:48-54
9. Dental considerations in Thalassemic patients Dr Sakshi Madhok, Dr
Saksham Madhok. (IOSR-JDMS)Volume 13, Issue 6 Ver. IV (Jun.
2014), PP 57-62.
Editor's Notes
Formed elements(because they have definite form under the microscope)
No nucleus- cant divide, no ribosome- no prtn sysnthesis, no mitochondria- no TCA cycle so no ATP production
Haem is an iron containing compound belonging to class of compounds- protoporphyrins.
Globin belongs to a class of prtns called globulins. So Hb is a conjugated prtn.
Globin molecule has 4 polypeptide chains- 2 alpha chains (141 amino acids) and 2 beta chains (146).
With each chain one molecule of haem is attached.
Each haem molecule can combine with one molecule of oxygen… thus one hb molecule can combine with 4 molecules of O.
In red blood cells, the enzyme carbonic anhydrase catalyzes the conversion of dissolved carbon dioxide to carbonic acid, which rapidly dissociates to bicarbonate and a free proton:CO2 + H2O → H2CO3 → H+ + HCO3-.
Histidine residues in hemoglobin can accept protons and act as buffers. Deoxygenated hemoglobin is a better proton acceptor than the oxygenated form.
Granulocytes- cytoplasm has granules
neutrophils-halmark of acute inflammation-attack and destroy the invading bacteria by producing oxidants h2o2; lowering pH within the bacteria -
Eosinophils- are immune system components responsible for combating multicellular parasites- coarse eosinophilic granules
Basophils- s shaped nucleus, Basophils appear in many specific kinds of inflammatory reactions, particularly those that cause allergic symptom
Lymphocyte- include natural killer cells (NK cells) (which function in cell-mediated, cytotoxic innate immunity), T cells (for cell-mediated, cytotoxic adaptive immunity), andB cells (for humoral, antibody-driven adaptive immunity). They are the main type of cell found in lymph, which prompted the name lymphocyte.
Monocyte- part of innate immune system-Monocytes have bean-shaped nuclei that are unilobar.
heamatologic diseases that have potential for significant health problems can be categorised into 3 main categories
Anemia is the most common disorder of the blood affecting about a quarter of people globally.
Anemia is a decrease in amount of red blood cells (RBCs) or the amount of hemoglobin in the blood resulting in a decrease in the oxygen carrying capacity of the blood.
The name is derived from Ancient Greek anhaimia, meaning "lack of blood", from an-, "not" + haima, "blood".
A pt is considered anemic if his Hb is less than 12 gm% or RBCs are less than 5 million/cumm
Vit b9 = folic acid
Vit b 12= cyanocobalamin
Carp mouth- narrowed mouth opening
It is a disease of late adult life resulting from def of vit B 12.
It is a form of megaloblastic anaemia.
Megaloblastic anemia is an anemia (of macrocytic classification) that results from inhibition of DNA synthesis during red blood cell production.
Sources- eggs, lean meat, green leafy veggies, milk
Nitrous oxide administration for more than 12 hrs interferes with vit b 12 metabolism and neurological function
Thymocytes are hematopoietic progenitor cells present in the thymus.[1]
The primary function of thymocytes is the generation of T lymphocytes (T cells)
Thymopoiesis is the process in the thymus by which thymocytes differentiate into mature T lymphocytes.
An ecchymosis is a subcutaneous extravasation of blood larger than 1 centimeter.
Purpura measure 0.3–1 cm (3–10 mm), whereas petechiae measure less than 3 mm, and ecchymoses greater than 1 cm.
An ecchymosis is a subcutaneous extravasation of blood larger than 1 centimeter.
Purpura measure 0.3–1 cm (3–10 mm), whereas petechiae measure less than 3 mm, and ecchymoses greater than 1 cm.
In HS rbcs hav reduced membrane stability and consequently lose membrane fragments after their release in to the periphery while retaining most of its volume. As a result their surface area to volume ratio decreases until they assume the smallest possible diameter for a given volume ie a sphere.
Spleenic destruction occurs because normal rbcs have discoid shape which allows changes in cell shape but in HS rbcs are spheroidal and have less membrane plasticity and they cant leave the spleenic cords… whr they are destroyed by macrophages.
In HS rbcs hav reduced membrane stability and consequently lose membrane fragments after their release in to the periphery while retaining most of its volume. As a result their surface area to volume ratio decreases until they assume the smallest possible diameter for a given volume ie a sphere.
Spleenic destruction occurs because normal rbcs have discoid shape which allows changes in cell shape but in HS rbcs are spheroidal and have less membrane plasticity and they cant leave the spleenic cords… whr they are destroyed by macrophages.
When exposed to hypoxia, it produces crystalls called tectoids, within the RBCs.
This leads to increased fragility of the RBC.
Spleenic infarcts lead to auto spleenectomy
Infections due to spleenic infarction
Sequestration syndromes in the chest and in spleen
Alpha th- deficiency of alpha chains.in major alpha thalessemia- No compensatory mech for loss in alpha chain production so tetramers of the beta and gamma chains combine to form Hb H and Barts both of which are ineffective oxygen carriers. Thus this condition is lethal in utero
Busulfan suppresses platelet count. Less in Hydroxyurea
Vicryl sutures were used, as it avoids need for the postoperative removal [11] and the possibility of bleeding when the suture is removed.
Catgut may react.