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    Blood

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    Babak Barghy
    HEMATOLOGIC (BLOOD) DISEASES Blood diseases can affect the red blood cells, white blood cells, platelets, or coagulation factors. Common blood diseases include anemia, which decreases red blood cell count or hemoglobin levels; leukemia, a cancer of the white blood cells; and thrombocytopenia, a low platelet count. Oral manifestations of blood diseases can include bleeding, pallor, ulceration, and infection. Complete blood count testing is used to diagnose blood diseases by measuring components like red and white blood cell counts, hemoglobin, and platelet level.

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    Blood

    Uploaded by

    Babak Barghy
    133 views44 pages
    HEMATOLOGIC (BLOOD) DISEASES Blood diseases can affect the red blood cells, white blood cells, platelets, or coagulation factors. Common blood diseases include anemia, which decreases red blood cell count or hemoglobin levels; leukemia, a cancer of the white blood cells; and thrombocytopenia, a low platelet count. Oral manifestations of blood diseases can include bleeding, pallor, ulceration, and infection. Complete blood count testing is used to diagnose blood diseases by measuring components like red and white blood cell counts, hemoglobin, and platelet level.

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    its about blood cell disease in dentistry

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    HEMATOLOGIC (BLOOD) DISEASES Blood diseases can affect the red blood cells, white blood cells, platelets, or coagulation factors. Common blood diseases include anemia, which decreases red blood cell count or hemoglobin levels; leukemia, a cancer of the white blood cells; and thrombocytopenia, a low platelet count. Oral manifestations of blood diseases can include bleeding, pallor, ulceration, and infection. Complete blood count testing is used to diagnose blood diseases by measuring components like red and white blood cell counts, hemoglobin, and platelet level.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    133 views44 pages

    Blood

    Uploaded by

    Babak Barghy
    HEMATOLOGIC (BLOOD) DISEASES Blood diseases can affect the red blood cells, white blood cells, platelets, or coagulation factors. Common blood diseases include anemia, which decreases red blood cell count or hemoglobin levels; leukemia, a cancer of the white blood cells; and thrombocytopenia, a low platelet count. Oral manifestations of blood diseases can include bleeding, pallor, ulceration, and infection. Complete blood count testing is used to diagnose blood diseases by measuring components like red and white blood cell counts, hemoglobin, and platelet level.

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    of 44

    HEMATOLOGIC (BLOOD) DISEASES

    CBC
    WBC count RBC count WBC differential Hemoglobin (HGB) Hematocrit (HCT)
    % of volume occupied by RBCs

    Red cell indices


    Mean cell volume (MCV)
    average size of RBC

    Mean cell hemoglobin (MCH)


    average amount of hemoglobin in an average RBC

    Mean cell hemoglobin concentration (MCHC)


    average concentration of hemoglobin/unit of volume in an average RBC

    Major Determinants of Disease


    Blood cells have a short life span & require continuous replacement Most diseases of blood cells feature too many or too few cells because of an imbalance in the production or loss of cells Hemoglobin must be properly assembled & produced for effective O2 transport White blood cells are critical in the defense against infection Diseases of lymphoid cells differ importantly from diseases of myeloid cells Malignancies of myeloid cells are associated with circulation of malignant cells in the blood (leukemia) Malignancies of lymphoid cells are associated with malignant cells in the blood (leukemia) or masses in lymph nodes & other tissue (lymphoma) Most diseases that affect platelets cause a low platelet count

    Diseases of blood frequently affect soft and hard tissues of mouth with different characteristics.

    Oral manifestation of blood disease affect : colour of the mucosa hypertrophy of gingiva mucosal destruction in the form of ulceration ,bleeding and hemorrhage colour of the tooth with red discolouration lymphnode affect the bone with decreased density and enlarged marrow space.

    Every dentist should be familiarized the


    wide variety of oral manifestations of the

    blood diseases to differentiate from other


    diseases.

    Diseases of blood can be classified as follows: (1) Cellular defects (2) Coagulation defects

    (1) Cellular defects:


    a) RBC (erythrocytes) Increased : Polycythemia Decreased : Anaemia 1. Pernicious anaemia 2. Aplastic anaemia 3. Thalassemia 4. Sickle cell anaemia 5.Erythroblastosis fetalis. 6. Iron deficiency anaemia.

    b) WBC
    Increased
    Physiological - leucocytosis Pathological 1. Leukemia 2. Infectious mononucleosis Decreased 1. Leucopenia 2. Agranulocytosis 3. neutropenia

    c. Thrombocytes
    Decreased Thrombocytopenic purpura Defective Thrombocytopathic purpura

    Blood Dyscrasias
    Sites of blood cell formation

    HEMATOLOGIC (BLOOD) DISEASES


    Bleeding Disorders
    Clotting Factor Disorders Platelet Function Disorders

    Blood Dyscrasias

    (Formed Elements)

    Red Blood Cell (RBC) Disorders White Blood Cell (WBC) Disorders Platelet Deficiencies

    HEMATOLOGIC (BLOOD) DISEASES


    Bleeding Disorders
    Platelet Function - Associated Coagulation Factor - Associated

    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 - See Bleeding Protocol
    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 - See Immunosuppression Protocol
    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

    Bleeding(and sometimes Swollen) Gums


    Leukemia Hemophilia

    Clinical Photos

    Leukemia

    Leukemia

    Other Clinical Features of Blood Disorders


    Ulceration Atrophy and Pallor

    Ulceration

    TESTING FOR BLEEDING DISORDERS


    Prothrombin Time (PT) (Extrinsic Pathway) DBL N ~ > 25 sec. (N=12-14 sec.) (Activated)Partial Thromboplastin Time (APTT) (Intrinsic Pathway) DBL N ~ > 50 sec. (N=25-35 sec.) International Normalized Ratio (INR) > 3.0 (N=1.0-2.0) Bleeding Time > 10 min. (N~5 min.) Clotting Time > 10 min. (N = < 5 Minutes) Platelet Count as Part of CBC with Differential WBC < 20 - 40K (N=150-500K/mm3) INR = PTR ISI = (ProThrombinRatio) ISI = (Patients PT/ControlPT)ISI Normal INR = 1.0-2.0

    ISI = International Sensitivity Index (for Lab Thromboplastin)

    Bleeding Time

    N ~ 5 min.

    Clotting Time

    N = < 5 Minutes

    Thrombocytopenia Thrombocytopathia (Thrombasthenia)


    Primary or Secondary Deficiency of Platelets
    10 / Idiopathic (Probably Autoimmune) Thrombocytopenic Purpura 20 / i.e. Leukemia, HIV, Aplastic Anemia

    PLATELET-ASSOCIATED BLEEDING DISORDERS

    Altered Platelet Function as in ASPIRIN (and other NSAIDs) von Willebrands disease Petechiae are Common Finding

    Platelet Adhesion, Aggregation and Blood Clotting

    COAGULATION FACTORASSOCIATED BLEEDING DISORDERS


    Hereditary Defects
    Hemophilia A (VII), B (IX), or C (XI) Other: Parahemophilia (V) and Afibrinogenemia (I)

    Liver Disease
    Cirrhosis, Hepatitis (I and II) + (VII, IX, and X)

    Anti-Coagulant Medication
    Coumarin (Warfarin) - Vitamin K Antagonist (II, VII, IX, and X) Heparin - Anti-Thrombin / Plasma Thromboplastin

    GI Malabsorption Problems
    Fat Soluble Vitamin K Deficiency (Sprue or Biliary Disease)

    Diseases of the Formed Elements


    Anemia Leukopenia Leukemia (Thrombocytopenia)

    Blood Dyscrasias

    Test with Complete Blood Count (CBC) with Differential White Cell Count (WBC): RBC Count - Normal = 4.5-5.0 Million RBCs / 100 mL WBC Count - Normal = 4 - 6 Thousand WBCs / 100 mL Neutrophils ~ 60 - 65 % Lymphocytes ~ 30 - 35 % Monocytes ~ 4-6 % Eosinophils ~ 1 - 2 % Basophils ~ 0-1 % Platelets = 150 - 600 Thousand / 100 mL

    Anemia
    Abnormally low hemoglobin Caused by
    decreased numbers of RBCs decreased amount of hemoglobin both

    Sign of an underlying condition Diagnose


    CBC

    Clinical: Weakness, Fatigue, Pallor Decreased Oxygen Carrying Capacity of Blood Result of: Decreased Number, Size, or HgB Content of RBCs or of Defective HgB Secondary to:
    Nutritional / Iron Defeciency RBC loss or destruction (Chronic Bleeding) Failure of RBC formation (Leukemia) Hereditary HgB malformation

    ANEMIA

    Oral Features:
    Pallor Bald Tongue

    Possible Association with other Disease: Leukemia, Kidney Disease, etc.

    Anemia Classification
    Size of RBCs
    Microcytic (Small) Macrocytic (Large) Normocytic (Normal Size)

    Concentration of Hgb
    Hypochromic (Less) Hyperchromic (More) Normochromic (Normal)

    Microcytic / Hypochromic
    Chronic Blood Loss, Iron Deficiency, Thalassemia

    Macrocytic (Megaloblastic) / Hyperchromic


    Vit B12 (Pernicious) or Folic Acid Deficiency

    Normocytic / Normochromic
    Hemolytic, Aplastic, Myelophthisic, Acute Blood Loss, Chronic Renal Failure

    RBC count (RBC) - # RBCs / 100 mL of Blood (NORMAL = 4.5-5.0 Million / 100 mL) Hematocrit (Hct) - % of (RB) Cells By Volume (NORMAL = 36-45%) Hemoglobin (Hgb) - mg / 100 ml of Blood (NORMAL = 13-15 mg/dL) Mean Corpuscular Volume (MCV) Hct/RBC - Normal = 90 (+or- 10) cubic microliter Mean Corpuscular Hemoglobin (MCH) Hgb/RBC - Normal = 30 (+or- 3) picograms Mean Corpuscular Hgb Concentration (MCHC) Hgb/Hct - Normal = 33 (+or- 2) %

    Determination of RBC Indices

    LEUKOPENIA (Decreased Number of WBCS) Increased Susceptibility to Infection


    Aplastic Anemia
    Failure of Formation of All Blood Cells: RBCs, WBCs 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 - Definition
    Malignancies of WBCs Originating in BONE MARROW Expression in PERIPHERAL BLOOD

    Leukemia - Blood Smear

    Leukemia - Classification
    Acute Lymphocytic Leukemia (ALL) Chronic Lymphocytic Leukemia (CLL) Acute Myelogenous Leukemia (AML) Chronic Myelogenous Leukemia (CML) Children Elderly All Ages Adults

    Clinical Significance
    Disease and Treatment Make Patients Anemic and More Susceptible to Infection and Bleeding Decreased RBC Formation, Ineffective Leukocytes (&/or Leukopenia) and Thrombocytopenia

    Leukemia

    Diagnosis by: CBC with Differential and Bone Marrow Biopsy

    LYMPHOMA
    Cancer of Lymphocytes Lymph Nodes or Extranodal Soft Tissue (including mouth) - NOT Blood or Bone Marrow Classified by:
    Hodgkins Disease (with REEDSTERNBERG CELLS) VS. NonHodgkin Lymphoma Type of Lymphocyte: B-cell; Tcell; etc. Maturity of Malignant Cells

    Non-Hodgkin Lymphoma

    THE END

    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 RBCs / 100 mL WBC Count - Normal = 4 - 6 Thousand WBCs / 100 mL Neutrophils ~ 60 - 65 % Lymphocytes ~ 30 - 35 % Monocytes ~ 4-6 % Eosinophils ~ 1 - 2 % Basophils ~ 0-1 % Platelets = 150 - 600 Thousand / 100 mL

    Bruch, Treister, 2010. Clinical oral medicine and pathology, p 79.

    Bruch, Treister, 2010. Clinical oral medicine and pathology, p 152.

    Oral lymphomas may present before, concomitantly with, or after lymph node expression.

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