Haematology and Oncology Flashcards
(41 cards)
1
Q
Describe what causes disorders of haematology
A
- May be inherited or acquired conditions
- Associated with vascular defects, platelet defects or coagulation disorders
2
Q
Name 3 inherited platelet disorders
A
- Idiopathic Thrombocytopenic Purpura (ITP)
- Glanzmann’s Thromboasthenia
- Bernard-Soulier Syndrome
3
Q
Name 4 acquired platelet disorders
A
- Chronic renal failure
- Drug induced (aspirin)
- Viruses (HIV)
- Bone marrow failure
4
Q
Describe the dental management of a patient with inherited platelet disorders
A
- Liaise with haematology regarding current platelet activity
- Avoid trauma and use local measures
- Manage bleeding with tranexamic acid
- Minor surgery may be covered with desmopressin
- Avoid aspirin due to anti-platelet activity
5
Q
What is a clotting disorder?
A
Normal vascular vasoconstriction and platelet response but defect in clotting cascade
6
Q
Name 3 inherited clotting disorders, in order of most to least common
A
- Von Willebrand’s disease
- Haemophilia A
- Haemophilia B
7
Q
Describe 4 potential systemic therapies used to manage bleeding disorders
A
- Desmopressin (mimics vasopressin action)
- Tranexamic acid (antifibrinolytic)
- Recombinant Factor VIII
- Human Plasma Factor VIII
8
Q
Describe von Willebrand’s disease
A
- Affects around 1% of population
- Affects males and females equally
- Dominant inheritance pattern
- VWF is carrier protein for factor VIII which aids platelet adhesion and aggregation
- Humate-P most common vWF concentrate
9
Q
Describe the clinical presentation of von Willebrand’s disease
A
- Bleeding from mucous membranes, GI bleeding, epistaxis, purpura of skin and mucous membranes
- Mild forms may go undetected until trauma (tooth extraction)
10
Q
Describe the treatment of Von Willebrand’s disease
A
- Desmopressin (via nasal spray)
- Type 3 managed as severe Haemophilia A
- Can only use human factor VIII replacement
11
Q
Describe the dental management of von Willebrand’s disease
A
- Seek advice from haematology
- Risk assess procedure with severity of disease
- Ask about previous extractions
- Prevention is key
- Atraumatic technique where possible
12
Q
Describe haemophilia A
A
- Factor VIII deficiency
- Prevalence of 1 in 10,000 affected
- Sex-linked recessive although spontaneous mutations may occur
- Female carriers may exhibit some symptoms and required Factor VIII cover
13
Q
Describe the diagnosis of haemophilia A
A
- Prolonged APTT
- Low factor VIII
14
Q
Describe 3 possible treatments of Haemophilia A
A
- Desmopressin
- Factor VIII
- Tranexamic acid
NB: No one size fits all so liaise with haematology
15
Q
Describe dental management of patient with haemophilia A
A
- Careful history taking
- Liaise with haematology to raise existing Factor VIII if necessary
- Multiple extractions or minor surgery in risky site best managed in hospital
- Prevention is key
- Infiltrations or intrapulpal injections safer than blocks
- Bleeding into larynx or pharynx after IDB can obstruct airways
16
Q
Describe haemophilia B
A
- Hereditary bleeding disorder caused by lack of factor IX
- Inherited X-linked recessive trait, with defective gene located on the X chromosome
- Managed in same way as haemophilia A
17
Q
Describe challenges in dental management of haemophilia
A
- Poor mobility in older patients due to haemoarthrosis
- Before 1990 many patients received contaminated blood products which led them to acquire haemophilia
- Universal precautions
- Develop auto-antibodies to Factor VIII (cover no longer works)
18
Q
Describe how chemotherapy works
A
- Targets neoplastic cells rapidly dividing therefore cells which divide rapidly under normal circumstances also affects e.g. bone marrow cells therefore reduced platelet count
19
Q
Describe leukaemia
A
- Acute or chronic
- Cell of origin lymphoblast or non lymphoblast
- Acute leukaemias account for 50% malignant disease in children
- Chronic leukaemias characterized by excess of mature leukocytes in blood
20
Q
Describe how leukaemia occurs
A
- Abnormal blood cells are produced in the bone marrow
- Crowd out normal blood cells
- Abnormal white blood cells increases infection
- Impairs ability to produce red blood cells and platelets
21
Q
Name 3 medical managements of leukaemia
A
- Chemotherapy
- Radiotherapy
- Bone marrow transplantation
22
Q
Name 5 dental considerations for patients suffering from leukaemia
A
- Bleeding tendencies
- Susceptibility to infection
- Chemotherapy may result in mucositis
- Manifest as gingival bleeding or swelling
- Render dentally fit prior to treatment and prevention
23
Q
Describe lymphoma
A
- Abnormal lymphocytes become lymphoma cells which multiply and collect in lymph nodes
- Painless swellings
- Tumours affect lymphatic system
- Hodgkin’s or Non-Hodgkin’s
24
Q
Describe 3 ways lymphomas are treated
A
- Radiotherapy
- Chemotherapy
- Steroids
25
Describe multiple myeloma
- Disseminated plasma cell malignancy
| - Mainly affects middle aged and elderly
26
Name 4 possible outcomes of multiple myeloma
1. Plasma cells produce antibodies so susceptibility of infection
2. Malignant cells release osteoclast activating actors therefore bone resorption and pain
3. Bone destruction therefore hypercalcaemia
4. Suppression of haemopoiesis therefore anaemia and bleeding tendency
27
Describe the treatment of multiple myeloma
- Chemotherapy +/- bone marrow transplantation
| - Bisphosphonate medication to prevent bone fracture
28
Describe 4 dental implications of multiple myeloma treatments
1. Anaemia, infections and bleeding
2. Osteolytic lesions which may affect mandible
3. Effects of chemotherapy
4. Bisphosphonates and OCN
29
Describe the presentation of OCN
- Pain (not always)
- Soft tissue swelling
- Infection
- Tooth mobility
- Exposed bone
30
Describe 3 treatment options of OCN
1. Local debridement
2. Antibiotics
3. Careful monitoring
31
Name 4 ways to reduce the risk of osteonecrosis
1. RCT preferable to extractions
2. Management of PDL
3. Consider antibiotic prophylaxis where extractions unavoidable
4. Prompt treatment with antibiotics
32
Describe the main principles of oral health care plan in oncology patients
1. Stabilise oral disease to avoid complications during or following treatment
2. Reduce risk of oral infections
3. Enhance quality of life for patient
33
Describe management of oncology patients prior to therapy
- Oral examination and preventive advice
- Smooth of any sharp teeth or restorations
- Radiotherapy can result in xerostomia
- Extractions at least 10 days prior to therapy
34
Describe prevention of ORN
- Extractions completed at least 10 days before radiotherapy
- Minimise oral trauma (dentures etc)
- Prevention of caries and periodontal disease
- Hyperbaric oxygen therapy when extractions necessary
35
Describe management of oncology patients during therapy
- Avoid dental care where at all possible
- Prevention and support
- Management of side effects of radio and chemotherapy
36
Name 4 common side effects of radiotherapy and chemotherapy
1. Mucositis
2. Xerostomia
3. Trismus
4. Oral infections e.g candida
37
Describe mucositis
- Painful ulcers and raw tissues
| - Presents with redness, swelling, burning pain, difficulty opening and speaking
38
Describe the symptomatic relief of mucositis
- Difflam (benzydamine hydrochloride)
- Lignocaine solution (severe mucositis)
- Oral cooling
- Gelclair and biotene
39
Describe xerostomia
- Increase in caries, periodontal disease and oral infections
- Denture intolerance and discomfort
- Use of saliva replacement therapy
40
Describe the management of oncology patients post therapy
- Hygienist support
- Manage xerostomia
- Manage trismus with jaw exercises
- Treat opportunistic infections
- Avoid extractions
41
Describe radiation caries
High prevalence of decay and root caries due to:
Xerostomia
High sugar intake (sugar tastes stronger)
Oral sensitivity prohibiting effective brushing
