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

 Bleeding Disorders

HEMATOLOGIC (BLOOD) DISEASES

Platelet Deficiency

Platelet Function - Associated Coagulation Factor - Associated Thrombocytopenia / Thrombocytopathia Anemia

Red Blood Cell (RBC) Disorders

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

HIV Immunosuppression from Chemtherapy for Organ Transplant or Cancer TX

Leukemia

Long Term Immunosuppression carries increased Risk for Malignancy (Especially lymphoma and leukemia)

Oral Swelling &/or Ulceration

Go To Basic Disease

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

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? 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? 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? V. ARE YOU TAKING: 61. Yes No 62. Yes No Please list: VI. WOMEN ONLY: 65. Yes No VII. ALL PATIENTS: 67. Yes No If so, please explain: Recreational drugs? Drugs, medications, over-the-counter medicines (including Aspirin), natural remedies? 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 56. 57. 58. 59. 60. 63. 64. Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No No No No No No 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? AIDS Tumors, cancer? Arthritis, rheumatism? Eye diseases? Skin diseases? Anemia? VD (syphilis or gonorrhea)? Herpes? Kidney, bladder disease? Thyroid, adrenal disease? Diabetes? Hospitalization? Blood transfusions? Surgeries? Pacemaker? Contact lenses? Tobacco in any form? Alcohol?

Go To Health History

Are you or could you be pregnant or nursing?

66.

Yes

No

Taking birth control pills?

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. Patients signature: RECALL REVIEW: 1. Patients signature 2. Patients signature 3. Patients signature Date: Date: Date: Date:

 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)

TESTING FOR BLEEDING DISORDERS

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 Liver Disease
Hemophilia A (VII), B (IX), or C (XI) Other: Parahemophilia (V) and Afibrinogenemia (I) Cirrhosis, Hepatitis (I and II) + (VII, IX, and X) Coumarin (Warfarin) - Vitamin K Antagonist (II, VII, IX, and X) Heparin - Anti-Thrombin / Plasma Thromboplastin Fat Soluble Vitamin K Deficiency (Sprue or Biliary Disease)

Anti-Coagulant Medication

GI Malabsorption Problems

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

 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 Pallor Bald Tongue

ANEMIA

Oral Features:

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

Anemia Classification
Size of RBCs
Microcytic (Small) Macrocytic (Large) Normocytic (Normal Size) Hypochromic (Less) Hyperchromic (More) Normochromic (Normal)

Concentration of Hgb

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)

Determination of RBC Indices

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)

Mean Corpuscular Hemoglobin (MCH)

Hgb/RBC - Normal = 30 (+or- 3) picograms

Hct/RBC - Normal = 90 (+or- 10) cubic microliter

Mean Corpuscular Hgb Concentration (MCHC)

LEUKOPENIA (Decreased Number of WBCS) Increased Susceptibility to Infection

Aplastic Anemia Agranulocytosis
Failure of Formation of All Blood Cells: RBCs, WBCs and Platelets Failure of Formation of Neutrophils Periodic Suppression of Neutrophil Formation Candidiasis HSV

Cyclic Neutropenia

Associated Oral Ulceration and Infection:

Oral Ulceration and Infection Secondary to Leukopenia or Leukemia

 Leukemia - Definition

LEUKEMIA

Leukemia - Blood Smear

Malignancies of WBCs Originating in BONE MARROW Expression in PERIPHERAL BLOOD Acute Lymphocytic Leukemia (ALL) Chronic Lymphocytic Leukemia (CLL) Acute Myelogenous Leukemia (AML) Chronic Myelogenous Leukemia (CML) Children Elderly All Ages Adults

Leukemia - Classification

Clinical Significance

Leukemia

Diagnosis by: CBC with Differential and Bone Marrow Biopsy

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

LYMPHOMA
Cancer of Lymphocytes Lymph Nodes or Extranodal Soft Tissue (including mouth) - NOT Blood or Bone Marrow Classified by:

Non-Hodgkin Lymphoma

Hodgkins Disease (with REEDSTERNBERG CELLS) VS. NonHodgkin Lymphoma Type of Lymphocyte: B-cell; Tcell; etc. Maturity of Malignant Cells

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