7. hematologic ds dental managment Flashcards
(37 cards)
CBC includes:
- Hb
- Hematocrit
- WBC
- Platelet
- RBC indices
Hb [] in men and women
<13.5 g/dL in men
or
<12.0 g/dL in women
hematocrit in men and women
<41% in men
or
<36% in women
microlytic anemia includes
- iron deficiency anemia
- thalassemias (inherited blood disorder have less hb than normal)
macrocytic anemia includes
- pernicious anemia
- folate deficiency
- B12 deficiency
normocytic anemia includes
- hemolytic anemia
- sickle cell anemia
iron deficiency anemia
category
causes
labs
more common in W of childbearing ages and children
category: microcytic anemia
causes: blood loss, poor iron intake, poor iron absorption, or incr. demand for iron.
labs: serum iron, ferritin, TIBC, transferrin.
folate deficiency
category
causes
labs
category: macrocytic anemias
causes: it is not stored in the boyd in large amounts, need continual dietary supply. If deficient during pregnancy it causes neural tube defects in baby.
labs: serum folate levels
cobalamin deficiency
aka b12 deficiency
category: macrocytic anemias
causes: pernicious anemia (deficiency of intrinsic factor which is necesary for b12 absorption) and nitrous oxide (irreversible inactivation of b12)
labs: serum b12
oral manifestations of anemia
atrophic glossitis with loss on tongue papillae, redness or cheilosis
mucosal pallor
anemia and dental management
- generally tolerate routine dental tx well
- avoid long use of nitrous oxygen exposure with b12 def pts
- severe anemia avoid strong narcotics, defer routine dental care, use pulse oximeter and supplemental oxygen
*
signs and symptoms of sickle cell anemia
- jaundice, pallor
- leg ulcers
- cardiac failure or stroke
- delays in growth and dev
- pain (abdominal or bone)
- sickle cell crisis- prolonged pain (caused by infection, high altitude, dehydration, and trauma)
oral manifestations in sickle cell anemia
- mucosal pallor or jaundice
- papillary atrophy
- delayed tooth eruption
- aseptic bone and pulpal necrosis
- osteomyelitis
- neuropathy
radiographic sickle cell anemia manifestations
- INCREASED widening and decrease number of trabeculations
- trabeculation and lamina dura seem more prominent
- hair on end xray
dental managment for pts with sickle cell anemia
- routine care, emphasis on good oral hygiene so do not get any infections
- anesthetics: do not use LA with epi, avoid prilocaine, use epi 1:100,000 no stronger concentration
- monitor O2 levels if give N2O, keep oxygen greater than 50%
- for pain management consult primary care for opioid contract
aplastic anemia is due to
bone marrow failure resulting in pancytopenia
tx with hematopoietic cell transplant
aplastic anemia oral manifestations
anemia: atrophic glossitis with loss of tongue papillae, redness or cheilosis and mucosal pallor
thrombocytopenia: petechia, spontaneous or prolonged bleeding
neutropenia: infection and ulceration due to redcution of WBC
platelet disorders: thrombocytopenia
normal
severe
caused by decreased production, destruction, medications and blood loss
normal: 150,000 to 400,000
severe <50,000
thrombocytopenia oral manifestations
petechia
spontaneous gingival bleeding
prolonged bleeding after procedures
platelet disorder: von willebrand ds
- misisng or defective VWF clotting protein
- the most common inherited clotting disorder.
3 types
- tx with DDAVP desmopressin
von willebrand ds platelet disorder anesthetics
avoid block injections and have local hemostatic measures
inherited coalgulation hemophilia
factor A (8) and B (9) deficiency, x linked recessive
Mild severity for: A is (6 to 30%) or b is 49%
severe is less than 1%
Tx: factor infusions, DDAVP (A)
medication related bleeding disorders - plavix (clopidogrel)
an antiplatelet agent, reduces the risk of MI and stroke. Increased risk of bleeding and bruising.
medication related bleeding disorders: plavix (clopidogrel)
- its an anti platelet agent that reduces risk of MI and stroke
- it can increase risk of bleeding and bruising
- dental managment is to look at medication list
