Transcript HEMATOLOGIC (BLOOD) DISEASES

HEMATOLOGIC
(BLOOD) DISEASES
Text Reading Assignment:
Chapter 7 - Bleeding Disorders
Chapter 8 - Blood Dyscrasias
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
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–
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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)
Go To
Basic
Disease
Clinical Bleeding
Petechiae
Petechiae and Ecchymoses
Ecchymoses
Clinical Photos
Bleeding(and sometimes Swollen) Gums
Leukemia
Hemophilia
Leukemia
Leukemia
Other Clinical Features of
Blood Disorders
Ulceration
Ulceration
Atrophy and
Pallor
HEMATOLOGIC (BLOOD) DISEASES
Health History Correlation
HEALTH HISTORY
University of the Pacific School of Dentistry
Patient Name:
Soc. Sec. No.:
Birth Date:
I. CIRCLE APPROPRIATE ANSWER (leave Blank if you do not understand question):
1. Yes
No
Is your general health good?
2. Yes
No
Has there been a change in your health within the last year?
3. Yes
No
Have you been hospitalized or had a serious illness in the last three years?
If YES, why?
4. Yes
No
Are you being treated by a physician now? For what?
Date of last medical exam?
Date of last Dental exam
5. Yes
No
Have you had problems with prior dental treatment?
6. Yes
No
Are you in pain now?
II. HAVE YOU EXPERIENCED:
7. Yes
No
Chest pain (angina)?
8. Yes
No
Swollen ankles?
9. Yes
No
Shortness of breath?
10. Yes
No
Recent weight loss, fever, night sweats?
11. Yes
No
Persistent cough, coughing up blood?
12. Yes
No
Bleeding problems, bruising easily?
13. Yes
No
Sinus problems?
14. Yes
No
Difficulty swallowing?
15. Yes
No
Diarrhea, constipation, blood in stools?
16. Yes
No
Frequent vomiting, nausea?
17. Yes
No
Difficulty urinating, blood in urine?
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Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
Dizziness?
Ringing in ears?
Headaches?
Fainting spells?
Blurred vision?
Seizures?
Excessive thirst?
Frequent urination?
Dry mouth?
Jaundice?
Joint pain, stiffness?
III. DO YOU HAVE OR HAVE YOU HAD:
29. Yes
No
Heart disease?
30. Yes
No
Heart attack, heart defects?
31. Yes
No
Heart murmurs?
32. Yes
No
Rheumatic fever?
33. Yes
No
Stroke, hardening of arteries?
34. Yes
No
High blood pressure?
35. Yes
No
Asthma, TB, emphysema, other lung diseases?
36. Yes
No
Hepatitis, other liver disease?
37. Yes
No
Stomach problems, ulcers?
38. Yes
No
Allergies to: drugs, foods, medications, latex?
39. Yes
No
Family history of diabetes, heart problems, tumors?
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Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
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No
No
No
No
No
No
No
AIDS
Tumors, cancer?
Arthritis, rheumatism?
Eye diseases?
Skin diseases?
Anemia?
VD (syphilis or gonorrhea)?
Herpes?
Kidney, bladder disease?
Thyroid, adrenal disease?
Diabetes?
IV. DO YOU HAVE OR HAVE YOU HAD:
51. Yes
No
Psychiatric care?
52. Yes
No
Radiation treatments?
53. Yes
No
Chemotherapy?
54. Yes
No
Prosthetic heart valve?
55. Yes
No
Artificial joint?
56.
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Yes
Yes
Yes
Yes
Yes
No
No
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Hospitalization?
Blood transfusions?
Surgeries?
Pacemaker?
Contact lenses?
V. ARE YOU TAKING:
61. Yes
No
62. Yes
No
Recreational drugs?
Drugs, medications, over-the-counter medicines
(including Aspirin), natural remedies?
63.
64.
Yes
Yes
No
No
Tobacco in any form?
Alcohol?
Are you or could you be pregnant or nursing?
66.
Yes
No
Taking birth control pills?
Please list:
VI. WOMEN ONLY:
65. Yes
No
VII. ALL PATIENTS:
67. Yes
No
If so, please explain:
Do you have or have you had any other diseases or medical problems NOT listed on this form?
To the best of my knowledge, I have answered every question completely and accurately. I will inform my dentist of any change in my health
and/or medication.
Patient’s signature:
Date:
RECALL REVIEW:
1. Patient’s signature
Date:
2. Patient’s signature
Date:
3. Patient’s signature
Date:
Go To
Health
History
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 = (Patient’s 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
PLATELET-ASSOCIATED
BLEEDING DISORDERS
Thrombocytopenia
Thrombocytopathia (Thrombasthenia)
• Primary or Secondary Deficiency of Platelets
– 10 / Idiopathic (Probably Autoimmune)
Thrombocytopenic Purpura
– 20 / i.e. Leukemia, HIV, Aplastic Anemia
• Altered Platelet Function as in ASPIRIN (and
other NSAID’s)
• 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)
Blood Dyscrasias
Diseases of the Formed Elements
•
•
•
•
Anemia
Leukopenia
Leukemia
(Thrombocytopenia)
Test with Complete Blood Count (CBC) with Differential White Cell Count (WBC):
RBC Count - Normal = 4.5-5.0 Million RBC’s / 100 mL
WBC Count - Normal = 4 - 6 Thousand WBC’s / 100 mL
Neutrophils ~ 60 - 65 %
Lymphocytes ~ 30 - 35 %
Monocytes
~ 4-6 %
Eosinophils ~ 1 - 2 %
Basophils
~ 0-1 %
Platelets = 150 - 600 Thousand / 100 mL
• Clinical: Weakness, Fatigue, Pallor
• Decreased Oxygen Carrying Capacity
of Blood
• Result of: Decreased Number, Size, or
HgB Content of RBC’s or of Defective
HgB
• Secondary to:
– Nutritional / Iron Defeciency
– RBC loss or destruction (Chronic
Bleeding)
– Failure of RBC formation (Leukemia)
– Hereditary HgB malformation
• Oral Features:
– Pallor
– Bald Tongue
• Possible Association with other
Disease: Leukemia, Kidney Disease,
etc.
ANEMIA
Anemia Classification
• Size of RBC’s
– 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
Determination of RBC
Indices
• RBC count (RBC) -
# RBC’s / 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)
LEUKOPENIA
(Decreased Number of WBC’S)
Increased Susceptibility to
Infection
• Aplastic Anemia
– Failure of Formation of All Blood Cells: RBC’s, WBC’s
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 - Blood Smear
• Leukemia - Definition
– Malignancies of WBC’s Originating in BONE
MARROW
– Expression in PERIPHERAL BLOOD
• Leukemia - Classification
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–
–
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
• Diagnosis by: CBC with Differential and Bone
Marrow Biopsy
Leukemia
LYMPHOMA
• Cancer of Lymphocytes
• Lymph Nodes or Extranodal
Soft Tissue (including
mouth) - NOT Blood or Bone
Marrow
• Classified by:
– Hodgkin’s 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 RBC’s / 100 mL
WBC Count - Normal = 4 - 6 Thousand WBC’s / 100 mL
Neutrophils ~ 60 - 65 %
Lymphocytes ~ 30 - 35 %
Monocytes
~ 4-6 %
Eosinophils ~ 1 - 2 %
Basophils
~ 0-1 %
Platelets = 150 - 600 Thousand / 100 mL