Hematologic Diseases Flashcards by Michael McMahan

_____: Reduction in the oxygen carrying capacity of
RBCs; deficiency in red blood cells or of
hemoglobin in the blood

anemia

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Classification of \_\_\_\_\_\_
– Causes 
• Blood Loss
• Inadequate production
• Excess destruction 
– Morphology
• Normocytic
• Microcytic
• Macrocytic

anemia

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Lab Test for anemia: 
\_\_\_\_\_\_\_\_ (\_\_\_\_ \_\_\_\_ \_\_\_\_) 
• Hb*
• Hematocrit*
• WBC
• Platelet
• RBC indices*

CBC (Complete Blood Count)

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Concentration of hemoglobin

Hb for CBC test

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Packed cell volume

Hematocrit for CBC test

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_____ _______ withinn the CBC

MCV (mean corpuscular volume)
MCH (mean cell hemoglobin)
RDW (red cell distribution width)
MCHC (mean cell hemoglobin concentration)

RBC indicies

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The following are examples of what size type of Anemia??
– Iron Deficiency Anemia
– Thalassemias

microcytic

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The following are examples of what size type of Anemia??

– Pernicious Anemia
– Folate Deficiency
– B12 Deficiency

Macrocytic

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The following are examples of what size type of Anemia??

– Hemolytic Anemia
– Sickle Cell Anemia

normocytic

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______ _____ Anemia

• Microcytic anemia
• More common in women of
childbearing age and children
• Causes: blood loss, poor iron
intake, poor iron absorption, or
increased demand for iron
• Labs: Serum iron, ferritin, TIBC,
transferrin

Iron Deficiency Anemia

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____ ______ Anemia

Macrocytic
– Not stored in the body in large amounts; continual
dietary supply is needed

– Deficiency during pregnancy causes neural tube
defects in the child

– Labs: Serum folate level

Folate Deficiency

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______ ______ Anemia

-macrocytic

– Pernicious Anemia
• Deficiency of intrinsic factor which is necessary
for B12 absorption

– Nitrous Oxide
• Irreversible inactivation of B12
• Neurologic symptoms
– Labs: Serum B12

Cobalamin (B12) Deficiency

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___ ____ is contradindicated for pts with B12 definiency because it causes the Irreversible inactivation of B12

Nitrous Oxide

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________ Manifestations of Anemia

– Symptoms: Fatigue, weakness,
palpitations, SOB, angina, tingling of fingers and toes
– Signs: pallor, splitting and
spooning of fingernails

systemic

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_______ manifestations of Anemia

– Atrophic glossitis with loss on
tongue papillae, redness or cheilosis
– Mucosal pallor

Oral

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t/f: anemic pts Generally tolerate routine dental treatment well

true

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t/f: Severe anemia (cardiopulmonary symptoms)
– Defer routine dental care
– Pulse oximeter and supplemental oxygen
– Avoid strong narcotics

true

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______ _____ _____:

• Autosomal recessive inherited
disorder
• RBC sickling in low oxygen or low
blood pH environments
• Erythrostasis, increased blood
viscosity, reduced blood flow,
vascular occlusion, hypoxiamore
sickling

Sickle Cell Anemia

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The following are systemic Signs and Symptoms what what Disease?

– Result of chronic anemia and small blood vessel
occlusion
– Jaundice, pallor
– Leg ulcers

– Cardiac
• Cardiac failure • Stroke

– Delays in growth and Development

– Pain
• Abdominal
• Bone (aseptic necrosis)

– Sickle cell crisis
• Prolonged (hours-days) severe pain which pay require
hospitalization for pain management • Causes: infection, higher altitude (hypoxia), dehydration,
trauma

Sickle Cell Anemia

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the following are oral manifestations of which disease??

– Mucosal pallor or jaundice
– Papillary atrophy
– Delayed tooth eruption
– Aseptic bone and pulpal necrosis 
– Osteomyelitis
– Neuropathy

Sickle Cell Anemia

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What are the radiohgraphic findings of Sickle Cell Anemia

• Increased widening and
decreased number of
trabeculations

“Stepladder” trabeculae
“Hair on end”

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– Routine care during non-crisis states
– Keep appointments short to reduce stress
– Emphasis on oral hygiene instructions to reduce risk of infection
• If infection occurs, consider IM or IV antibiotics

Dental Management of sickle cell anemia

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– Anesthetic:
• Avoid prilocaine
• Epinephrine 1:100,000-no stronger concentration
• May consider using LA without epinephrine
– Monitor oxygen saturation, when using nitrous oxide, provide
oxygen at greater than 50% with high flow rates
– Antibiotic prophylaxis for major surgical procedures
– Pain management: consult their primary care or hematologist
(opioid contract)

Dental Management of Sickle cell anemia

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this type of anemia is Bone marrow failure resulting in

pancytopenia (decrease in all three blood cell types)

Study These Flashcards

Aplastic anemia

How do you treat aplastic anemia?

– Hematopoietic cell transplant

Oral manifestations of ____ ____ ``` – Anemia • Atrophic glossitis with loss on tongue papillae, redness or cheilosis • Mucosal pallor ``` – Thrombocytopenia • Petechia, spontaneous orprolonged bleeding – Neutropenia • Infection - Viral, fungal, bacterial • Ulceration

aplastic anemia

_____________ – Low platelet levels (CBC) • Normal: 150,000-400,000 • Severe: <50,000 – Causes: decreased production, destruction, medications, blood loss – Prolonged bleeding, petechia

Thrombocytopenia

Oral manifestations of ______ • Petechia • Spontaneous gingival bleeding • Prolonged bleeding after procedures

Thrombocytopenia

t/f: Before a treatment of a pt with Thrombocytopenia, it is important to have a recent CBC test with a platelet level of >50,000

true

t/f: avoid block injections for pts with Thrombocytopenia

true

– Missing or defective VWF (clotting protein) • Required for platelet adhesion – Most common inherited clotting disorder (1% US population) – Type 1 (20-50% normal levels), Type 2 (qualitative) , Type 3 (quantitative, severe symptoms) – SS: epistaxis, petechia, ecchymosis, excessive/prolonged bleeding from invasive procedures, hemarthrosis – Tx: DDAVP (desmopressin)

Von Willebrand Disease

t/f: Avoid block injections for pts with Von Willebrand Disease. DO not be afraid to treat these pts. Well controlled pts know how to treat their bleeding.

true

``` _______ – Hemophilia A (Factor 8 deficiency) and B (Factor 9 deficiency) 1%-5%, severe <1% • X-linked recessive – Severity • Mild 6%-30% (A)or 49% (B), moderate – SS: prolonged or spontaneous bleeding, ecchymosis, hemarthrosis – Tx: factor infusions, DDAVP (A) ```

Hemophilia

``` –Antiplatelet agent –Reduce risk of MI and stroke –Increased risk of bleeding and bruising –Dental Management • Medication list to evaluate bleeding risk – Other anticoagulants • Local measures – Low risk of bleeding far outweighs interrupting Plavix treatment ```

Plavix (clopidogrel)

``` – Vitamin K antagonist – For patients with Afib, heart failure, prosthetic heart valves, stroke/MI history... – Common side effect: bleeding – Monitoring • PT/INR goals: 2.0-3.0 • Higher in patients with prosthetic heart valves (3.0-3.5) – Antidote • Vitamin K ```

Coumadin (warfarin)

–Dental Management • Dental procedures are generally considered low risk of bleeding – Thromboembolic risk vs procedural bleeding risk – Discussion with patients MD for procedures with higher risk of bleeding • Review INR (within 24 hours) – INR: 2.0-3.0 dental treatment • Local hemostatic measures • Medications – Many medication interactions due to narrow therapeutic range – Avoid cytochrome P-450 inhibitors (ex. fluconazole) and inducers

Coumadin (warfarin)

``` ______ meds: –Direct inhibitor of factor Xa and thrombin –Class of newer anticoagulants • Alternative to warfarin –Highly effective –No lab monitoring –Reversal agent –More expensive ```

Direct Oral Anticoagulants (DOAC) and Direct | Thrombin Inhibitors

The following are used as _____: - Gauze - Gelfoam - Cellulose (surgicel and oxycel) - Thrombin - Tranexamic acid - Amicar

Local hemostatic agents

What 3 hematologic diseases are nerve blocks contraindicated?

VWD Thrombocytopenia Hemophilia

``` • Cancer of WBCs • Affects bone marrow and circulating blood • Proliferation of WBCs which can be non-functional (blasts) or overtime overcrowd/suppress normal marrow production ```

Leukemia

``` • Causes Include: • Radiation • Chemotherapy • Genetic • Down syndrome • Diagnosis • CBC • Blood smear • Molecular studies • Treatment • Chemotherapy • Radiation • Targeted therapy • Hematopoietic stem cell transplant ```

Leukemia

``` • Signs and Symptoms • Fatigue, malaise, petechiae, ecchymoses, fever • Related to functional or treatment related neutropenia and thrombocytopenia • Oral Manifestations • Leukemia infiltrate • Spontaneous gingival bleeding • Oral ulceration (neutropenic ulcer, mucositis) • Infection • Viral, fungal, bacterial • Lymphadenopathy (chronic) ```

Leukemia

• Dental Management • Urgent referral to PCP or emergency room for leukemic infiltrate-CBC, smear, flow cytometry • If Dx known: • Thorough medical history • Discussion with oncologist • Current status and goals (comprehensive vs. palliative) • Dental office vs hospital • Timing of dental care-not on active chemotherapy for routine care • Labs • CBC • Platelet: may require platelet transfusion due to thrombocytopenia • ANC-may require antibiotic prophylaxis for neutropenia (>500) • Confirm patient is afebrile • Local hemostatic measures for patients with thrombocytopenia

Leukemia

``` • Cancer of lymphoid organs and tissues • Hodgkin Lymphoma • Reed-Sternberg cell • Young adults • LAD • Non-tender, firm • >50% affect mediastinal or neck nodes • Non Hodgkin Lymphoma (NHL) • Median Age: 67 • B-symptoms • Fever, night sweats (drenching), weight loss (unintentional >10%) • Over 20 types • Diffuse Large B-cell (DLBCL) • Follicular ```

Lymphoma

* Causes Include * Autoimmune diseases * Hepatitis C * EBV * Sjogren syndrome * Diagnosis * Bone marrow or lymph node biopsy * MRI for staging * Treatment * Chemotherapy * Radiation * Immunotherapy * Stem cell transplant * Watching

Lymphoma

``` • Oral Manifestations • LAD (Waldeyers ring, neck) • Extranodal involvement • Oral Ulceration • Localized infiltrate • Osteolytic radiographic lesions • Infection • Viral, fungal, bacterial • Treatment related • Head and Neck Radiation (lymphomas in head and neck region only) • Hyposalivation • Trismus • Osteonecrosis ```

Lymphoma

• Dental Management – Similar to leukemia but risk for neutropenia and thrombocytopenia is lower and generally treatment related (chemotherapy, radiation) – Thorough medical history – Discussion with oncologist • Current status and goals (comprehensive vs. palliative) • Dental office vs hospital • Timing of dental care-not on active chemotherapy for routine care – Labs • CBC – Platelet: may require platelet transfusion due to thrombocytopenia – ANC-may require antibiotic prophylaxis for neutropenia (>500) – Confirm patient is afebrile – Local hemostatic measures for patients with thrombocytopenia

Lymphoma

``` • Cancer of plasma cells – Prevents normal production of antibodies • Signs and Symptoms – Hypercalcemia – Renal damage – Anemia – Bone pain – Infection • Treatment – Chemotherapy (RVD) – Bisphosphonates – Hematopoietic Stem Cell Transplant ```

Multiple myeloma

Which hematologic disease shows punched out radiolucencies?

Multiple myeloma

``` • Oral Manifestations – Plasmacytoma – Lytic bone lesions – Infection • Viral, fungal, bacterial – Treatment Related • Neuropathy • MRONJ (IV Zometa) • Radiographic – Thick lamina dura – Persistent extraction site – Sclerosis – Sequestra – Fracture ```

Multiple myeloma

``` • Dental Management – Disease related management • Soft tissue swelling, radiographic findings • Infection management • Pre-bisphosphonate exam – Medication related • MRONJ – Bisphosphonate history (number of doses, active) – Chlorhexidine rinses – Oral Hygiene – Antibiotic regimen – Sequestration • Surgical Procedures – Informed consent – As atraumatic as possible – Thorough post surgical instructions including chlorhexidine rinses and antibiotic prophylaxis – Re-eval after surgical procedures to ensure healing ```

Multiple myeloma

• Infusion of stem cells to re-establish hematopoietic function in patients whose bone marrow or immune system is damaged or defective • Treatment for solid or hematologic malignancies or other hematologic disorders

Hematopoetic Stem Cell Transplant

________ Evaluation: Dental Screening Goals • Remove active foci of infection and limit potential foci of infection • Dentition to be stable for at least 12 months – Urgent care only for 12 months post transplant – Risk of salivary GVHD and hyposalivationcaries • Patient education about home care • If planned correctly, pre-transplant evaluation + patient compliance=dental maintenance

Pre-Transplant

Screening ______ HSCT • Comprehensive hard and soft tissue exam • Full mouth series of radiographs • Treatment – Scaling and prophylaxis – Removal of caries • Restorations • Endodontic therapy • Extractions – Extraction of all hopeless teeth & 3rd molars with hx periocoronitis • Including teeth with questionable or poor prognosis – Caries risk assessment and need for adjuncts (fluoride) – Dental management based on primary disease

Dental Screening Pre-HSCT

___ graft: | Your Own bone marrow

Autologous

___ graft: | Someone else's bone marrow

Allogeneic

___ graft: | Twin's bone marrow

Syngenic

``` Oral Manifestations of ________ • Mucositis – Acute; resolves after engraftment • Bleeding – Petechiae, ecchymosis, hematoma • Infection – Viral (ex. HSV) – Fungal (ex. candidiasis) – Bacterial • Medication side effect/toxicities – Gingival hyperplasia (cyclosporine) – Oral ulceration (sirolimus) • Graft versus host disease – Mucosal (lichenoid changes) – Salivary-hyposalivation, caries • Increased risk of oral cancer ```

Oral Manifestations HSCT

• Dental Management ____ HPCT Transplant – Thorough medical history • Original diagnosis, date of transplant, immune suppression, GVHD – Thorough clinical exam • Hyposalivation, caries, infection, GVHD, oral cancer – Discussion with oncologist • Current status and goals (comprehensive vs. palliative) • Dental office vs hospital – Labs • CBC-may require platelet transfusion due to thrombocytopenia • ANC-may require antibiotic prophylaxis for neutropenia – Medications • Immune suppression (dose and length of tx) • Bactrim-myelosuppression • Avoid medications that are cytochrome P450 inhibitors for patients on immunosuppressants with low therapeutic index (ex. tacrolimus and fluconazole)

After transplant

Hematologic Diseases Flashcards

(59 cards)