HAEMATOLOGIC DISORDER ( I )

1) RBCs Disorders
2) WBCs Disorders
3) Bleeding & Clotting Disorders

I. RBCs Disorders ( Erythro = Red )

- Anemia
Defintion: as reduction in the O2 carrying capacity of the blood –related to
decrease in NO. of circulating RBCs & reduction of the Quantity of haemoglobin

General clinical features of anemia

 Pallor
 Fatigue
 Lassitude
 Tachycardia
 Palpitation
 Breathlessness
 Specific features of anemia
Iron deficiency anemia Pernicious anemia Sickle cell anemia Thalassemia Aplastic anemia
 ↓Hb level Definition: Definition: Hereditary Thalassa= Sea. Rare bone marrow
Autoimmune disease, disease : Sickling of RBCs , Deficient in synthesis Aplasia
 Koilonychia loss of production of mutation of HB( 80-90% is of GLOBIN in HB. NO WBCs –NO
intrinsic factor & vitamin HBs ), Hemolytic anemia Leading to RBCs RBCs –NO
 Glossitis
B12 mal-absorption - (Jaundice ) hemolysis. PLATELETS
 Dysphagia RBCs maturation
Infarction - Chronic Jaundice
 Associated with  Degeneration of Spinal - Leg ulcers - Hepatosplenomegally (RBCs )
Plummer Vinson cord - Pain :Chest –spleen – → additional sites of
syndrome:  Numbness of liver-Cerebral damage blood production
a) Glossitis extremities tendency (platelets)
f
b) Atrophy of O.M  Muscular weakness Bone lesions the parotid (iron
c) Atrophy of  Paraplegia - Thinning of lower border of deposition)
the mandible infection ( WBCs )
pharyngeal M.  Optic atrophy
d) Atrophy of - Hair on end appearance Radiograpgh:
esophageal M. Oral manifestation: - Stepladder appearance Hair on end
Red Sore tongue + (alveolar bone ) appearance
atrophy of filiform papillae **Sickle cell crisis**
Recurrent aphthousulcer
Management
1.Eliminate the cause I.M injection of Vitamin 1.General anesthesia should Life-long blood Bone marrow
2.Ferrous sulphate B12 be avoided ( as G.A may lead transfusions and transplantation
tablets (600mg daily for hydroxyl –cobalamine to shortage of O2 ) require chelation
3 months) 2.Antibiotic therapy ( to avoid therapy to remove the In dental treatment:
Folic deficiency: sickling crises ) excess iron Intra-ligamentary
Folic acid 5mg daily – 3.Avoid elective dental surgery injection is more
orally 4.NSAIDs for painful bone Defintion of chelation: suitable
5.Hospitalization in severe Extraction of metal and
painful Crises biological fluid
Sickle Cell CRISIS may occurred due periodontal infection
(+ + Rigidity + + Sickling + + Kidney & cerebral infarction + + Osteoporosis in
bone)

Hair on end appearance

(Numerous white hair-like shadows arising from the inner table of cranial vault -elongated
trabeculae perpendicular to bone surface)

Stepladder Alignment of Bone Trabeculae →→

 II. WBCs Disorders
Agranulocytosis Cyclic neutropenia Leukemia Multiple myeloma Lymphomas
Characterized by a Periodic / Neoplastic proliferation of  Immature B cells are formed in Malignant tumors
great ↓ in NO. of monthly decrease WBCs & characterized by the the bone marrow (Myelo = originate in lymph nodes
circulating neutrophils of Neutrophils presence of immature cells in marrow) & lymphoid tissues
Neutropenia ….. If < (every 21 days) the peripheral
 Malignant Collections of Hodgkin's
500 neutrophils / Granulocyte circulation and
abnormal plasma cells Children
microliter precursors bone marrow No mouth lesion
accumulate in the Bone marrow
Agranulocytosis …. If disappear from Painless L.N
where they interfere with the
< 100 neutrophils / bone marrow Hematopoietic stem cell
production of normal blood cells enlargement
Microliter Oral A) Myeloid cells ex neutrophils Fever & Malaise
B) Lymphoid cells ex T-Cells & (Cervical L.N.)
The patient is extremely manifestation B-cells multinucleated
susceptible to infection  Recurrent oral Types
ulceration (resembling an "owl's
 Malaise I. Acute Leukemia
 Fever & Chills  (major a) Acute myeloblastic leukemia
eye" appearance )
Aphthous Reed Sternberg cells
 Pharyngitis (3-5years)
ulcers) Non -Hodgkin's
 Oral necrosis b) Acute Lymphoblastic
 Aggressive leukemia( adult ) Adults
 & Ulceration
periodontitis General manifestation of Mouth lymphomas:
Oral manifestation Leukemia Soft painless (extra
Oral painful necrotic a) Anemia nodular ) swelling (
ulcers b) Increase susceptibility to gingiva–tongue –palate )
(palatal) infection Oral manifestation of Multiple  (Cervical L.N. & mouth
without c) Bleeding tendency myeloma lesion)
erythema!! Oral manifestation of acute 1.Jaw lesions : ( mandible ) more common than
Necrotizing ulcerative Leukemia →Painful swelling, + teeth Hodgkin's
gingivitis (NUG) 1. Gingival swelling mobility More aggressive than
Halitosis 2. Oral ulceration 2. Soft tissue lesions : Hodgkin's
Osteoporosis 3. Leukemic deposits Oral Amyloidosis.. Nodules in the No Reed–Sternberg
cheeks, tongue & lips cells
4. Excessive bleeding gum 3. Hemorrhage : ↓ Platelets Burkett's
5. Delay healing 4. Susceptility to infection Lack of Abdominal lymphoid
6. Cervical lymphadenopathyantibodies …. Bacterial infection tumor (linked with virus
7. Osteolytic lesions infection AIDs)
Dental management of Multiple rapidly growing
Dental management of acute
myeloma mandible
Leukemia
 Antibiotics to control infection
 Meticulous Oral hygiene
 Platelet count, bleeding time, Management of
 Mouth rinse Lymphomas
Prothrombine time
(Chlorhexidine0.2%)
 Medical consultation of renal 1. Irradiation ( localized
 Antibiotics to control disease )
& cardiac function
infection 2. Chemotherapy
 Accidental discovery of jaw
 Folinic acid: control oral treatment ( generalized
lesion may be the first
ulceration disease )
evidence of the disease
IF Dental considerations
Extraction must be done … 1. Dentist may discover
blood transfusion & massive the disease (early
antibiotic are required detection) by routine
II. Chronic Leukemia Cervical L.N examination
Oral manifestation of Chronic
2. Extra –nodular lesion
Leukemia
Of Non -Hodgkin's may
Oral manifestation in chronic
appear in the palate (
leukemia & acute leukemia are
painless –bluish , slowly
the same But generally chronic
growing lesion ) – Biopsy
leukemia are much less severe
is diagnostic
- Routine dentistry can be
done
- Similar precautions as in
acute leukemia