Upload
aanshika
View
92
Download
0
Embed Size (px)
Citation preview
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.