Oral Manifestations of Haematological Disease

Question 1

Infections in Immunocompromised patients

Answer 1

Susceptible to disease and infection by fungi,

Question 2

Herpes simplex

Answer 2

Has greater effect in
Immunocompromised
Neutropenic

Question 3

Bleeding disorders

Answer 3

thrombocytopenia 
haemophilia 
warfarin
other inherited disorders
scurvy - gingival inflammation

Question 4

Immune thrombocytopenic purpura

Answer 4

Conjunctival haematoma

indicates low platelet count

Question 5

Glandular fever

Answer 5

PEtichiae

Swelling

Question 6

Aplastic anaemia

Answer 6

platelets <10
spontaneous bleeding from gums
ulcer

Question 7

Acute myeloid leukaemia

Answer 7

Bruising

Mucosal purpura

Question 8

Haemophilia

Answer 8

Exaggerated injury
Mouth heamatoma - can occlude mouth
Oral hairy leukoplakia - white patch on side of tongue in HIV+ patients

Question 9

Poor dentition

Answer 9

Reluctance to have procedures
Fear of bleeding out
Given pre treatment infusion of Factor VIII given

Question 10

Ehlers-Danlos syndrome

Answer 10

Hyper extensive skin

Collagen is abnormal

Question 11

Infiltration of disease

Answer 11

Tonsillar lymphoma
Gum hypertrophy e.g acute monocytic leukaemia - M5
macroglossia due to amyloid deposition

Question 12

Other disorders

Answer 12

Angular stomatitis in iron or B12/iron deficiency (oral ulcers)
Smooth tongue ^^
Cyanosis
Hereditary haemorrhage telangiectasia - spots on lips and cheeks
Maxillary hypertrophy due to extramedullary haemopoiesis in thalassaemia major
Cyanosis due to congenital heart disease
Hereditary angioneurmtic oedema

Question 13

History taking - presenting complaint

Answer 13

Most important part!!
Explore in detail
Ask relevant positive and negative questions

Question 14

Presentations of complaint

Answer 14

Referral from haematologists

• immunocompromised patients
• patients with known bleeding disorders
• patients on oral anticoagulants

General patients seen routinely

• is there a bleeding disorder
• is there a haematological disorder

Question 15

Haematology directed questions

Answer 15

Anaemia
- tiredness
- shortness of breath
- chest pain 
 Infections 
Bleeding problems 
thrombosis

Question 16

Questions for bleeding disorders?

Answer 16

Easy bruising? 
Bleeding after cuts?
Nosebleeds? Epistaxes
Bleeding post extraction 
Menorrhagia 
Bleeding after surgery

Question 17

Systems
Past MH
Family history
social history

Answer 17

Drug history
Allergies
Smoking
Alcohol