Blood 2

Question 1

Where are red cells derived from?

Answer 1

Bone marrow

Question 2

What is the function of RBC?

Answer 2

Transport oxygen to tissues

Question 3

Define Anaemia

Answer 3

Reduction of haemoglobin in the blood

Question 4

What is the normal Hb for males and females?

Answer 4

> 13.5 g/dl males
11.5 g/dl females

Question 5

What is MICROcytic anaemia?

Answer 5

small RBC (<80 fl)

Question 6

What is NORMOcytic anaemia?

Answer 6

normal RBC (80 - 96 fl)

Question 7

What is MACROcytic anaemia?

Answer 7

large RBC (>96 fl)

Question 8

Give an example of MICROcytic anaemia

Answer 8

Iron deficiency (Ferritin)

Question 9

Give an example of MACROcytic anaemia

Answer 9

Folate deficiency
Vit B12 deficiency

Question 10

Give an example of NORMOcytic anaemia

Answer 10

Sickle cell disease

Question 11

What are the 3 causes of Anaemia?

Answer 11

1. Reduced production
2. Increased losses
3. Increased demand

Question 12

Give some examples of how reduced production causes Anaemia

Answer 12

Marrow failure –> Reduced normal red cells

Abnormal globin chains
Chronic inflammatory disease –> Reduced Hb
Deficiency state

Question 13

Give some examples of how increased losses causes Anaemia

Answer 13

Bleeding
Abnormal red cells = autoimmune or hereditary
Hereditary:
-Sickle
- G6PD
- Spherocytosis

Question 14

Name 4 conditions that results in loss RBC

Answer 14

• Menstrual blood loss
• Peptic ulcer
• Haemorrhoids
• Bowel carcinoma

Question 15

Name 2 examples of Increased demand

Answer 15

• Pregnancy
• Malignant disease

Question 16

List some signs of Anaemia

Answer 16

-Pale conjunctiva
-smooth tongue
-beefy tongue (fissured tongue)
-oral ulceration
-candida infection
-angular cheilitis

Question 17

How big is minor oral ulceration?

Answer 17

less than 10mm diameter

Question 18

How big is major oral ulceration?

Answer 18

more than 10mm diameter

Question 19

What are the 4 symptoms of Anaemia?

Answer 19

Fatigue
Dizzy
Shortness of Breath
Palpitation

Question 20

Name ways to Investigate Anaemia

Answer 20

• Full blood count
• Haematinics
• Endoscopy/Renal function/Faecal occult blood/Bone marrow examination
• Micro swab/Smear/Rinse

Question 21

How do you treat Anaemia?

Answer 21

Treat the cause e.g.
-Ferritin deficiency = Ferrous Sulphate tablets
-Folate deficiency = Folic Acid tablets
-Vit B12 deficiency = intramuscular injections

Question 22

What is the dental relevance of Anaemia?

Answer 22

• Diagnosis
• Reduced O2 carrying capacity – sedation and GA risks
• Burning mouth/glossitis
• Candidosis
  may need to liase with General Medical Practitioner.

Question 23

Abnormal Globin chains leads to what 2 conditions?

Answer 23

Thalassaemia
Sickle Cell Disease

Question 24

How does Thalassaemia occur?

Answer 24

• Normal haem production
• Genetic mutation of globin chain – causing haemolysis
• Alpha = Asians
• Beta = Mediterranean
• Mainly seen in those from Mediterranean area

Question 25

What is the difference between minor thalassaemia vs major thalassaemia?

Answer 25

* Minor = ‘Trait’ heterozygotes = mild anaemia (persistent microcytic) * Major = homozygotes = usually beta = severe microcytic anaemia, enlarged liver and spleen, bone changes = large osteoporotic bones = obliterated maxillary sinuses

Question 26

What are the clinical effects of thalassaemia?

Answer 26

* Chronic anaemia * Marrow hyperplasia (skeletal deformities) * Splenomegaly * Gallstones * Cirrhosis (liver)

Question 27

What is the dental relevance of thalassaemia?

Answer 27

* Xerostomia (iron deposition in glands) * GA and sedation considerations

Question 28

What is Sickle Cell Anaemia?

Answer 28

* Mutation in HBB gene - beta-haemoglobin * 13,000 Anaemia v 250,000 Trait * Most common in those of African descent * HbA = Normal HbS = Abnorma

Question 29

What type of inheritance pattern is Sickle cell?

Answer 29

Autosomal Recessive pattern

Question 30

What are the 3 types of Sickling crises?

Answer 30

* Painful * Aplastic * Sequestration

Question 31

What is 'Painful' Sickling Crises?

Answer 31

Blockage of blood vessels and leading to bone marrow infarcts.

Question 32

What is the 'Aplastic' Sickling Crises?

Answer 32

Bone marrow stops producing RBC

Question 33

What is the 'Sequestration' Sickling Crises?

Answer 33

sickle cells pooling in spleen, liver and lung- often requires splenectomy

Question 34

what is the consequence of splenectomy?

Answer 34

reduces resistant to infection

Question 35

How does Sickling Crises occur?

Answer 35

Deoxygenated HbS ↓ Sickle Shape ↓ Haemolysis --> Anaemia ↓ Blood viscosity ↓ Tissue ischaemia

Question 36

How do you diagnose Sickle cell?

Answer 36

* Thorough history – medical and family * Full blood count (Hb) * Haemoglobin electrophoresis * Bone infarcts – appears similar to osteomyelitis radiographically

Question 37

What is the dental relevance of Sickle cell?

Answer 37

* Caution with GA and Sedation * Treat infection quickly * Prevention is key * No need for antimicrobial prophylaxis * Treat sickle cell trait patients as normal

Question 38

How do you treat sickle cell trait pts?

Answer 38

as normal