RBC Disorders

Question 1

hemoglobin

Answer 1

oxygen-carrying molecule

Question 2

normal RBC

Answer 2

33% Hb by weight

Question 3

anemia

Answer 3

reduction in oxygen-carrying capacity of the blood

Question 4

cause of anemia

Answer 4

1. decreased RBC prod
2. blood loss
3. destruction of circulating RBCs

Question 5

pts with what type of disease are also prone to becoming anemic?

Answer 5

renal disease

Question 6

why do pts with renal disease prone to becoming anemic?

Answer 6

b/c kidneys help make RBCs

Question 7

med management of anemic pts

Answer 7

eliminate underlying cause

Question 8

Hb goal of anemic pts

Answer 8

> 11 g/dL

Question 9

can you txt anemic pts?

Answer 9

all dental care appropriate unless pt is symptomatic (SOB)

Question 10

sickle cell trait

Answer 10

pt carries 1 gene for HbS (heterozygous)

Question 11

what percent of African Americans are carriers for the sickle cell trait?

Answer 11

8-10%

Question 12

sickle cell disease

Answer 12

1 gene from each parent for HbS (homozygous)

Question 13

pathophysiology of sickle cell disease

Answer 13

cellular rigidity and membrane damage cause RBCs to become IRREVERSIBLY SICKLE-SHAPED due to crystallization of HbS

Question 14

what happens in response to the physiologic changes of the sickle cell disease?

Answer 14

• deoxygenated blood
• decreased blood pH
• dehydration

Question 15

T/F: pts with sickle cell disease are very sensitive to sickling stimuli?

Answer 15

true

Question 16

what percent of Hb is HbS in pts with sickle cell disease?

Answer 16

> 80%

Question 17

is sickle cell trait symptomatic?

Answer 17

no, typically asymptomatic

Question 18

are pts carrying the sickle cell trait as sensitive to the sickling stimuli?

Answer 18

no, they’re less sensitive

Question 19

what percent of Hb in pts carrying the sickle cell trait is HbS?

Answer 19

20-45%

Question 20

are pts carrying the sickle cell trait at risk for adverse effects during dental txtment?

Answer 20

no

Question 21

effects of RBC sickling

Answer 21

• erythrostasis
• increased blood viscosity
• reduced blood flow
• hypoxia
• RBC adhesion
• vascular occlusion
• further sickling

Question 22

sickle cell crisis

Answer 22

periods where body is stressed out causing cells to sickle

*pts in horrible pain

Question 23

do pts who has had splenectomy need antibiotic prophylaxis?

Answer 23

• yes, needed before any type of invasive dental txtment

- work with PCP

Question 24

can routine dental care be given to pts with sickle cell disease?

Answer 24

yes, but during non-crisis periods

Question 25

dental mods for pts with sickle cell disease

Answer 25

- stress-reduction protocol - profound local anesthesia - nitrous oxide sedation - consult with physician prior to any surgical procedures

Question 26

what is the minimum percent of oxygen concentrations in nitrous oxide sedation given to pts with sickle cell disease?

Answer 26

at least 50% | *low O2 conc. can get cells more sickle

Question 27

what analgesics can be given to pts with sickle cell disease for post-op pain?

Answer 27

- NSAIDs - Tylenol - +/- codeine

Question 28

why do we aggressively txt odontogenic infections in pts with sickle cell disease?

Answer 28

infection can trigger a crisis | *infections throws off pH balance of blood

Question 29

how do you txt odontogenic infections in pts with sickle cell disease?

Answer 29

- remove offending source - incision and drainage - systemic antibiotics adequate fluid intake to avoid dehydration

Question 30

how do you txt cellulitis in pts with sickle cell disease?

Answer 30

inpatient management so send them to the ER