Seminar Topic:"ORAL ASPECTS OF BLOOD "ORAL ASPECTS OF BLOOD

DISORDERS"DISORDERS"Presented by :

Aanshika TiwariAanshika TiwariJR-1

ORAL ASPECTORAL ASPECTof of

BLOOD DISORDERSBLOOD DISORDERS

BLOODBLOODBlood is type of liquid connective tissue.Total Blood volume makes of 6-8% of the body's weight.

BLOOD COMPOSITIONBLOOD COMPOSITIONLiquid plasma (55-60%)Formed element (40-45%) - it include :

RED BLOOD CELLS WHITE BLOOD CELLS PLATELETS

ANEMIA - abnormal reduction in number of RBCClassification

According to etiology -1. Loss of blood -

acute or chronic post nemorrhagic anemia.2. Excessive destruction of RBCs

* extracorpuscular causes- Infection- Drugs- Trauma to RBC* Intracorpuscular causes- Hereditary- Aquired

DISEASE OF RBCDISEASE OF RBC

3. Impaired blood production- Iron deficiency- Vit B12 deficiency

4. Inadequate production of mature RBCs- a plastic anemia- Leukemia- Sarcomas

IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA* Chronic, microcytic hypochromic* Occurs either due to inadequate absorption

or excessive loss of iron form the body. Clinical Manifestation

- Fatigue - Lack of energy- Palpitation- Pallor of skin - Spoon shape Nail- Brittle hair and nail

One Manifestation-- Pallor of oral mucosa and gingiva - Glossopyrosis - Glossodynia- Dysphagia- Angular chalets- Smooth tongueA manifestation of iron deficiency anemia is Plummer Vinson syndrome.

DIAGNOSIS-Reduced hemoglobin levelTotal RBC deceased.MCV, MCH, MCHC-reduced.

Management-Iron supplement3-4 tablet/day - 6 month

-- Also called - Addison's AnemiaAlso called - Addison's AnemiaPrimary anemiaPrimary anemia

-- Impaired RBC maturation, insufficientImpaired RBC maturation, insufficientvit B12 due to defective intrinsic factor. vit B12 due to defective intrinsic factor.

Clinical feature- Clinical feature- Males>FemaleMales>Female

Fatigue, pallor, vomiting, dyspneaFatigue, pallor, vomiting, dyspneaHeadache, weight loss, dry, yellow skin.Headache, weight loss, dry, yellow skin.Tingling sensation in hand and feet Tingling sensation in hand and feet

Pernicious AnemiaPernicious Anemia

Oral Manifestation -Oral Manifestation -

Glossitis.Glossitis.Beefy Red tongueBeefy Red tongueXerostomiaXerostomiaHunter’s glossitisHunter’s glossitis

DIAGNOSIS-DIAGNOSIS- Decreased total WBCDecreased total WBC

Decreased total RBCDecreased total RBCelevated MCV, MCHCelevated MCV, MCHCBlood smear show - Hyper chromic Blood smear show - Hyper chromic Macrocytic RBCMacrocytic RBCSchilling's testSchilling's test

TreatmentTreatment- Vit B12- 100 mg IM- 30 days- Vit B12- 100 mg IM- 30 days

APLASTIC ANEMIAAPLASTIC ANEMIA- Rare life threatening disease.- Characterised by pancytopenia- Due to lack of bone marrow activity.Etiology-Infection

Radiation Drugs & Chemical

Clinical Features- No age predilection Occurs in young adultWeakness, headache, dyspneaFatigue, tendency to bleeding, InfectionSevere/fatal hemorrhages.

ORAL MANIFESTATION-PetechiaeEcchymosisPurpuric spotSpontaneous gingival bleedingGingival hyperplasia

Diagnosis: RBC below 1 million/mm3WBC 2000/mm3Platelet below 20,000/mm3

Management-ATG is treatment of choice10-20mg/kg diluted in 500 ml normal

saline I.V over 4-6 hours once a day for 10 consecutive days.

Prednisone 40 mg

HEMOLYTIC ANEMIAHEMOLYTIC ANEMIADue to increased hemolysis in body.Causes - Arsenic, lead like metal

Erythroblastic fetalis Clinical features- Pallor, weakness

Jaundice, ulcersDyspnea.

Oral manifestation-Discoloration of teethPallor oral mucosa.

Diagnosis- Hemoglobin level reducedRBC survived Rate- 12 dayUnconjugated serum bilirubin

raised fecal urobilinogen-raised.

Treatment - Blood transfusionFolic acid.

Rare disorder associated with pancytopenia, bone marrow hyperplasia, congenital anomalies.

Clinical feature- Common in children Brown pigmentation of

skin Hyperplasia of liver &

spleen Microcepahly, squint

Mental Retardation

FANCONI'S ANEMIAFANCONI'S ANEMIA

One Manifestation- Gingival bleeding Frequent oral cavity Infection.

Diagnosis- Pancytopenia Congenital anomaly Same as of aplastic

anemic

Management - Antithrombolytic agent.

In patient with anemia that is or was associated with stomach ulceration apirin and NSAIDS should be avoided.

Infection has to be managed with local and systemic measures including appropriate dental treatment,antibiotic and surgical procedure

SIKCLE CELL ANEMIAInherited defect in synthesis of hemoglobin and RBC assume a crescent shape.

Clinical feature- Pallor, loss of appetite ,Jaundice

Loss of consciousnessfever swelling of joint

Oral Manifestation- Yellowish mucosa

Paraesthesia Decreased bone density

Diagnosis- Total RBC count decreased

Hb% - decreased

•Management-prophylactic penicillin therapy-indicated for patient age of 6 month -6 years•Folate replacement •To treat sickle crisis i.v fluids oxygen and antibiotic are given.

THALASSEMIA•Cooley anemia • mediterranean hemolytic disorder

• Chronic, inherited hemolytic disorer characterized by fragile RBC called as "target cells“

* Their is insufficient synthesis of α & β chain of Hemoglobin.

Clinical feature- Commonly detected in two years of life Jaundice Fever chills anemiaHepatosplenomegalyChipmunk facies Mongoloid facies

Diagnosis- thin RBC Safety pin cell WBC raised

Treatment -Blood transfusion Splenectomy,

Chelating agent

POLYCYTHEMIA

Abnormal increase in the number of RBCs.Type-

Polycythemia vera Ralative polycythemia Secondary ploycythemia

POLYCYTHEMIA VERAAlso called as- Osters disease. Polycythemia rubra

veraExcess of RBC'sClinical features- Middle age

Dyspnea, dizzinessTinnitus Weight lossExcessive sweating

Skin appear flushed Spleen palpable Veins dark burning of hand & feet

One Manifestation- Purplish red discoloration of eyes,oral mucosa,gingiva and tongue.

Profuse bleeding gingiva

ruddy cyanosis.

Diagnosis - RBC count 8-12 million/mm³Hemoglobin- 18-20g/100mlPlatelet count increased

Treatment -Venesection Radioactive phosphorus

ERYTHROBLASTOSIS FETALIS

Congenital hemolytic anemia of new born which occur due to Rh incompatibility.Pathogenesis- If mother is Rh negative but fetus is Rh-positive, then the mother's blood can develop antibodies against Rh factor of fetus.Oral Manifestation- Black, brown

Discoloration of deciduous teethEnamel hyperplasia - ring likedefect termed as - Rh-hump.

WBC DISORDERSClassification

QuantitativeDecrease in number : Neutroperia

Leuckopenia Increase in number : Lymphocytosis

Neutrophillia Granulocytosis

Qualitative : Lazy lucocyte syndromeChediak-Higasi SyndromeLymphomaLeukemia

Neutropenia reduced number of neutrophills

May be mild Moderate, Severe

Etiology- Infection Drugs like - sulfonamide Chloramphenicol deficiancy of vit B12

Clinical feature-Women > Man high fever, sore throat,

necrotic ulcerationOral manifestation - Excessive Salivation

Oral ulcer, gingivitis and gingival ulceration

Diagnosis Reduced WBC

Management- Removal of cause, Antibiotic

Lazy Leukocyte Syndrome

Loss of function of neutrophil

Clinical feature : Apparent at age of 1 -2 years stomatitis bronchitis otitis media periodontitis.

Management : Antibiotic to control the infection

Chedak- Higashi Syndrome-

Congenital defect of granulocyte

Clinical feature-Albinism Recurrent infection HepatosplenomegalyLymph-node enlargement

Oral Manifestation: Ulceration, Gingivitis, Peiodontitis Management : Antibiotic

Ascorbic acid

LEUKEMIASMalignant disease of blood forming organincreased WBC.It account 8% of all human cancer.

Etiology - Radiation Chemicals Chromosomal abnormality Immune deficiency

Classification : Acute Leukemia Chronic Leukemia

Clinical Feature: aged between 2-4 yrs or above 65 year

M > F Fatigue, headache Weight loss Lymphadenopathy

pain

Oral Manifestation - Gingival hyperplasia MucositisInterdental papillae

enlargementOsteomyelitisHemorrhage Necrotic ulcerOral infection Numb chin syndrome

Diagnosis- WBC - Low Platelet low,

Hemoglobin low Chest X-ray- mediastinal

involvement Treatment- Chemotherapy Blood transfusion

MULTIPLE MYELOMA

Malignant neoplasm of bone marrow

Clinical feature- 40-70 year, M > F Site- skull, clavicle, jaw,

bleeding tendency pathological fracture

Oral Manifestation - Mandible > Maxilla Pain, swelling Unexplained mobility of

teethUlceration (red and round) Egg shell creakingTongue enlargement

Radiographic Feature-Punch-out radiolucencyOral, Cystic Shapethinning of cortical border

Diagnosis- Russell bodies Bence-Jones proteins

Treatment- Chemotherapeutic agent Management of anemia Radiotherapy

LYMPHOMAS

Lymphoid tissue malignant neoplasm They are two broad groups - Hodkins lymphoma Non-Hodkins lymphoma

NON-HODKINS LYMPHOMAAffects -B- lymphocyte

Type- Nodular, DeffuseClinical feature : Middle aged, M > F

Head and neck are common site Hard palate, buccalVestibule-other internal sitePain, fever, dysphagia, ascites,

Hepatosplenomegaly

Oral Manifestation- Rare, it present arises from tonsils. Paraesthesia, pain, proliferation of palate.

HODKINS LYMPHOMAFirst described by Hodkin in 1832.Rare disorder characterized by RS giant cell in lesionClinical Feature - 15-35 Years

M > F Persistent lymphadenopathy

pain, pruritis, edema,spleen, lung, liver affected

Treatment- Chemotherapy, Radiotherapy

BURKITS LYMPHOMAHighly aggressive from of NHL caused of E-Barr Virus Peak incidence in children between 6-9 years

Maxilla > Mandible Rapid growing jaw tumor,Parsthesia Swollen, ulcerated gums.Painless expansile swelling starry sky appearance of macrophages

Radiographically present as large, irregular radiolucent area with moth eaten appearanceChemotherapy is best treatment.

PLATELET DISORDERS Purpura Thrombocytosis Clinical features -

PetechiaeEcchymosisEpistexis

Oral Manifestation- eccohymosis & petichiae at hard and soft palate,Gingival bleedingManagement - Corticosteroids

Splenectomy Transfusion

Hemophilia

A disorder of blood coagulation Results in severely prolonged clotting

time Due to a deficiency in plasma proteins

involved in coagulation

ORAL MANIFESTATION

Spontaneous gingival bleeding, petechiae, and ecchymosis

Diagnosis and Treatment of Hemophilia The bleeding time and PT in

hemophilia are normal; the PTT is prolonged.

Diagnosis involves identifying the missing factor; treatment involves replacing it.