Blood Disorders

By Kimmie Poe, Jenny Shoemaker, and Kimberly Temple

Blood is a fluid connective tissue that serves as a transport medium for
cellular nutrients, such as respiratory gases like oxygen and carbon dioxide,
as well as metabolites for the entire body.
Normal Blood Composition:
55% Plasma fluid
45% formed elements consisting of:
44% erythrocytes (RBC or corpuscles)
1% leukocytes (WBC)
One drop of blood contains: 5 million Red Blood Cells, 7500 White
Blood Cells, 300,000 platelets
Origin of Blood Cells:
Adult blood cells originate in bone marrow
Hemocytoblast: the stem cell origin
Erythrocytes and granulocytes leave the bone marrow as mature cells
and enter the circulating blood
Agranulocytes (lymphocytes and monocytes) leave the bone marrow
as immature cells and go to lymphoid tissue to mature
Immature cell forms predominate in certain blood diseases and cancers
There are three main types of formed elements present in blood
1. Plasma
2. Red Blood Cells
3. White Blood Cells
Plasma
1. Plasma is a straw-colored fluid that transports nutrients, hormones, and
waste products.
Consists of:
Plasma is 90% water
10% consists of plasma proteins, inorganic salts, gases and
substances
2.Red Blood Cells (erythrocytes)-contain blood protein hemoglobin,
which plays an important role in oxygen transport. Erythrocytes are
produced by the red bone marrow. When erythrocytes are no longer useful,
they are destroyed by macrophages in the spleen, liver, and bone marrow
3. White Blood Cells also known as leukocytes, have a primary function
of fighting disease in the body.

Platelets
Thrombocytes also known as platelets are the smallest formed elements
of the blood.
Small round or oval element w/o a nucleus
size of RBC
Manufactured in the bone marrow
Close blood capillaries at time of injury
Active role in blood clotting mechanism
Blood Disorders of RBCs
Anemias sometimes referred to as tired blood is a reduction of the
hemoglobin concentration, the hematocrit, or the # of RBCs to a level below
that which is normal for the individual.
Oxygen is ESSENTIAL in all body tissues for normal maintenance!
Clinical characteristics of Anemia
Types:
Pale thin skin
Irondeficiency
Weakness, malaise, easy fatigability
Pernicious Anemia
Dyspnea on slight exertion, faintness
Aplastic Anemia
Headache, vertigo, tinnitus
Sickle
Cell Anemia
Dimness of vision, spots before the eyes
Brittle nails with loss of convexity
Iron-Deficiency Anemia
The hemoglobin is deficient and the RBC corpuscles are smaller than normal
Causes:
Malnutrition or malabsorption
Chronic infection
Increased demand of body for iron Ex: Pregnancy
Chronic alcoholism
Chronic blood loss
Occurrence: younger population and females
Pernicious Anemia
Vitamin B12 deficiency caused by:
-Decreased intake
-Increased requirement

-Impaired absorption of B12

Due to deficiency of intrinsic factor:
-Failure to produce intrinsic factor
Lack of production of intrinsic factor
-Chronic atrophic gastritis
-Surgical removal of partial or all of the stomach
Occurrence and in what population: people over 40 years of age
Treatment of condition:
Vitamin B12 administered by injection twice weekly controlled, then
monthly
Good dietary sources of B12
Aplastic Anemia

Decrease in all circulating blood cells because of a severe depression in

bone marrow activity
The cause is unknown
Chemotherapy, radioactive isotopes, radium, or radiant energy have
been associated with the development of aplastic anemia.

Occurence and in what population: Occurs most frequently in young

adults
Treatment of condition:
Primary aplastic anemia is usually progressive and fatal
Medications: NONE LISTED
Sickle Cell Disease (SCD)

An inherited disorder of the blood

It is the most common genetic disorder of the blood

Precipitating Factors
Hypoxia, dehydration, sudden changes in temperature
Physical activity (tissue anoxia), extreme fatigue, acidosis
Stress/anxiety, pregnancy, trauma
Cold causes vasoconstriction which slows the blood flow
Occurence and in what population:
African-American population and in whites of Mediterranean origin
Sickle Cell Anemia
Radiographic
Decrease radiodensity; increased osteoporosis

Step-ladder pattern
Significant bone loss; periodontitis in children
Thinning of the border of the mandible
Oral manifestation
Generalized pallor of tissue
Jaundice color (Liver disease)
Delayed eruption , malocclusion and dentin hypomineralization
Facial and dental pain
Prevention:
Use folate supplement
Administer pneumococcal polyvalent vaccine to children
Allogeneic stem cell transplantation may provide a cure for young
patient
Daily penicillin until age 6 year to prevent infection
Life span of red blood cell is 90 to 120 days, in sickle cell anemia it is
10 to 15days
Treatment of condition:
Supportive and palliative treatments include those for specific symptoms
during crises
Oxygen therapy and blood transfusions are not used for routine pain
episodes but may have limited selective use.
Medications used in treatment:

Pain meds

Antibiotics

Chemotherapy
Management of Patient with Anemia

Physician consultation
Teach/supervise preventive program
Short appointment
Stress reduction protocol
Prophylactic antibiotic
Use local anesthetic with low dose of vasoconstrictor
Use nitrous oxide
Maintain frequent recalls
Supplemental oxygen is frequent recommended
Bisphosphonates therapy; treatment before

Blood Disorders of WBCs

Leukopenia:
A decrease in total number of white blood cells
Leukocytosis:
Increase in number of circulating white blood cell
Lymphocytopenia:

Abnormally low number of lymphocyte in the blood

Leukemia:
A form of blood cancer in which a white blood cell becomes malignant and
multiplies inside bone marrow
Lymphoma:
A form of blood cancer that develops in the lymph system
Hodgkin's and Non-Hodgkins
Leukopenia

Decrease in WBCs results when cell production cannot keep up with

turnover rate/accelerated rate of removal of cells occurs in disease
states
Usually occurs in addition to aplastic anemia
Occurrence
Specific infections
Disease or Intoxification of bone marrow
Agranulocytosis (malignant Neutropenia)
Treatment
Steroids, vitamins, therapies, sleep

Leukocytosis
Increase in # of circulating WBCs
Caused by inflammatory and infectious states
Trauma, exertion
Extreme causeLeukemia
Malignant neoplasms of immature WBCs that multiply and become
cancerous
Can lead to death without aggressive treatment
Medications:
Treatment tailored from the etiology
In most cases: treatment for leukocytosis is not necessary

Lymphocytopenia
Abnormally LOW number of lymphocytes in blood
Etiology:
Infectious diseases, such as AIDS, viral hepatitis, tuberculosis, and
typhoid fever.
Treatment depends on CAUSE
Gamma Globulin
Treatment:
Mild: no treatment
Infection: antibiotic, antifungal, antiviral, antiparasitic drugs
Leukemia

Etiology:
Scientists don't understand the exact causes of leukemia. It seems to
develop from a combination of genetic and environmental factors.
Risk Factors:
Previous cancer treatment, Genetic Disorders, chemical exposure,
Smoking
Classifications:
Acute Leukemia
Chronic Leukemia

Treatment:
**Chemotherapy
Biological therapy
Targeted therapy
Radiation therapy
Stem cell transplant

Lymphoma
Non-Hodgkin's lymphoma occurs when your body produces too many
abnormal lymphocytes a type of white blood cell.
Occurrence: men more than woman/ Caucasians
Risk Factors:
Medications
Infectionsviruses/bacteria
Chemicals
Older Age

Treatment:
Chemotherapy
Radiation therapy

Bleeding Disorders: Platelets

Thrombocytopenia: a lowered # of platelets may be caused by decreased
production in the bone marrow
bone marrow depression due to an invasive disease or deficiencies
Example: leukemia, folate or vitamin B12 anemias
Platelet Dysfunction: interference with the blood clotting mechanism leads
to prolonged bleeding time
Results of certain hereditary states
Example: uremia, bon Willebrands disease, autoimmune
disease, NSAIDs/aspirins
Bleeding Disorders: Hemophilias
Hemophilia A (Classic Hemophilia):
Caused by a reduced amount or reduced activity of factor VIII
85%
Hemophilia B (Christmas Disease):

Caused by a deficiency of blood plasma protein called factor IX

affects the clotting properties of blood
Both:
X-linked recessive genetic diseasesmales
Severity is directly related clotting factor of circulating blood

Von Willebrands Disease

Prolonged bleeding time in the presence of normal platelet count

MOST common hereditary disorder of platelet function
Compound defect involving platelet function and the coagulation
pathway
Occurs in males and FEMALES
Extraoral signs: petechia of the skin

Dental Hygiene Care

Management of uncontrolled bleeding:
With uncontrolled bleeding, stop dental treatment
Apply digital pressure to area with sterile gauze
Local hemostatic agent may be applied, such as absorbable gelatin
sponge
Medical attention is required if unsuccessful in stopping bleeding
Implications: Bleeding Disorder:

Teach daily personal biofilm removal

Plan scaling in small segments
Avoid posterior superior alveolar nerve block
Never use NSAID
Frequent appointments
Take care in placement of radiographic barriers
Prevent hematoma
Prevention of stress

Questions:
1. Sickle Cell Anemia is of hereditary origin and occurs primarily
In:
a)
b)
c)
d)

Whites
Native Americans
Infants
African Americans

2. Leukopenia is an increase in total number of white blood cells,

Lymphocytopenia is an abnormally low number of lymphocytes
in the blood.
a) First statement is true, second statement is false
b) First statement is false, second statement is true
c) Both statements are true
d) Both statements are false
3. What blood disorder is considered a malignant neoplastic
disorder involving blood forming cells, originates in bone
marrow, and is considered an excessive proliferation of WBCs
in the immature state?
a)
b)
c)
d)

Lymphocytopenia
Hemophilia A
Sickle Cell Anemia
Leukopenia