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Cartever
Dimpal
Alexandria
Blood Composition
Normal blood composition
55%plasma fluid and 45%formed
element
45% formed element composed of
44% Erythrocyte(RBC)
1% leukocyte(WBC)
Origin of Blood
Origin of blood
Bone marrow, granulocyte and RBC
leave the bone marrow as mature
cell and enter circulating blood
Agranulocyte (lymphocyte and
monocyte) leave the bone marrow as
immature cells and go to lymphoid
tissue.
Immature cell predominate in
certain blood disease and cancer
Plasma Composition
Plasma composition
90% water and 10% of following
Albumin (maintain tissue fluid
balance), globulin (are circulating
antibodies essential in immune
system)
Fibrinogen and prothrombin
(essential for blood clotting)
Inorganic salt, gases- oxygen,
nitrogen, co2
Substance being transported:
Nutrients, hormones, waste product
and enzyme
Red Blood Cells
Red blood cells
Biconcave disc that contain
hemoglobin
RBC helps to transport hemoglobin
Carry oxygen to body cell
Co2 is transport from the cell
Normal hemoglobin 12-17.2g per ml
Anemic –when hemoglobin is low
Pathologic – when Hb increases over
normal
White Blood Cell
Granulocyte- neutrophils
(polymorph nuclear leukocytes
PMNs), eosinophils and basophils
Agranulocytes- lymphocyte and
monocyte
Function: phagocytosis, immunologic
and inflammatory process
Platelet- round or oval formed
element without nucleus
Active in the blood clotting
mechanism
Maintain the integrity of blood
capillaries by closing them at time of
injuries
Participate in clot dissolution after
healing
Disorders of Blood
Anemias
Reduction of the Hb concentration,
the hematocrit or number of red
blood cell to the level below normal.
Which result in low oxygen supply to
cell. This is essential for normal body
tissue maintenance
Clinical Characteristic of
Anemias
Pale thin skin
Weakness, malaise, easy fatigability
Dyspnea on slight exertion, faintness
Headache, vertigo, tinnitus
Dimness of vision
Brittle nail with loss of convexity
Different Type of Anemias
Iron deficiency anemia:
Hypochromic, microcytic anemia
(RBC are smaller than normal and
deficient in hemoglobin)
Megaloblastic anemia: large red
blood cell
• 2 types: pernicious anemiacause by vitamin B12 deficiency
• Folate deficiency anemia- cause
by deficiency of folate or folic
acid
Sickle cell disease (SCD)
name derived from sickle shape
erythrocyte
Appointment management with anemia
Physician consultation including complete blood count
Short appointment
Stress reduction protocol
Some patient might need prophylactic antibiotic
Use local anesthetic with low dose of vasoconstrictor
Use nitrous oxide-oxygen with greater than 50% oxygen
Maintain frequent appointment with dental hygienist
Supplemental oxygen is frequent recommended
Sickle Cell Disease
Life span of red blood cell is 90 to
120 days, in SCD it is 10 to 15days.
Sickle Cell Crisis
Sickle Cell Crisis-
Acute form of diseases is call
sickle cell crisis
Crisis can occur anytime with or
without stimuli.
Sickle Cell Anemia
Oral manifestation
Generalized pallor of tissue
SCD patients are not prone to an
increase in development of
periodontal disease; periodontal
involvement can lead to sickle cell
Delayed eruption , malocclusion and
dentin hypo mineralization
Prevention Of Sickle Cell
•
•
•
•
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
White Blood Cells
Disorder of white blood cells
Leukopenia
A decrease in total number of white
blood cells
Leukocytosis
Increase in number of circulating
white blood cell
l
Lymphocytopenia
Abnormally low number of
lymphocyte in the blood
Bleeding Disorders
Pathology of blood vessel wall
Vascular fragility is increased
Thrombocytopenia
A lowered number of platelet
Platelet dysfunction
Interference with the blood clotting
mechanism
Disorder of coagulation
Acquired disorder
Liver disease: nearly all the clotting
factors are produced in the liver.
Anticoagulation drugs: heparin,
coumarin, aspirin and NSAID
Bleeding Disorders
Hereditary disorder: there are 30
hereditary coagulation disorder
Hemophilia A(classic hemophilia):
cause by a reduce amount or reduce
activity of factor VIII
Hemophilia B( Christmas disease):
cause by deficiency of blood plasma
protein called factor IX
Von Willebrand’s Disease:
characterized by prolonged bleeding
time in presence of normal platelet
count
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
Clinical implication:
Teach daily personal biofilm removal
Plan scaling in small segments
Avoid posterior superior alveolar nerve block as it is at higher risk for bleeding
Postoperative: never use NSAID
Frequent appointment can aid in keeping tissue in optimum oral health
Take care in placement of film/sensor , it can cut and press on mucous membrane
Prevent hematoma by pulling sublingual tissue in suction tip
Prevention of stress
Question:
1.
The two type of megaloblastic
anemia are pernicious anemia and folate
deficiency anemia. Deficiency of folate during
pregnancy can cause spina bifida.
A.
Both statement are true
B.
Both statement are false
C.
First statement is false and second
statement is true
D.
First statement is true and second
statement is false
2.
Iron deficiency anemia is
characterized by
A.
Hyperchromic , macrocytic anemia
B.
Hypochromic, macrocytic anemia
C.
Hyperchromic , microcytic anemia
D.
None of the above
3.
Life span of red blood cell in sickle
cell diseases is
A.
11 to 12 days
B.
90 to 120 days
C.
10 to 15 days
D.
None of the above
4.
Leukopenia is a decrease in total
number of white blood cells, leukocytosis is
decrease number of circulating white blood
cell.
A.
First statement is true, second
statement is falseB.First statement is false,
second statement is true
C.
Both statement are true
D.
Both statement are false
5.
The most common inherited blood
disorder is
A.
Hemophilia
B.
Von willebrand disease
C.
Factor IX deficiency
D.
Thrombocytopenia
6. The decision to proceed with oral healthcare
procedure in a client with anemia involves:
a. Determining whether the disease is
controlled
b. Prescribing prophylactic antibiotics
c. Providing education about plaque control to
prevent oral infection.
d. using stress reduction protocol
Answer:
1-A,
2-D,
3- C,
4-A,
5- A,
6-A
Refrences:
1.Wilkins, E. M. (2013). Clinical Practice of the
Dental Hygienist (11th edition). Lippincott Williams
and wilkins, 1025-1040
2.Preventing medical emergencies: use of medical
history / frieda Atherton Pickett, JoAnn R.
Gurenlian.- Third edition 2015 Wolters Kluwer
Health, 100-119
3.Picket FA, Terezhalmy G. Dental drug refrences.
2nd edition. Baltimore: Lippincott Williams and
wilkins; 2010. 34p
4.
https://www.washingtonpost.com/national/health
-science/sickle-cell-disease-once-meant-a-shortand-painful-life-but-now-theres-growinghope/2014/03/03/d964d318-6275-11e3-91b3f2bb96304e34_story.html
5. http://wepsicklecell.org/about
6.ScottE.Kasner,Brettl.Cucchiara..2016. Treatment
of “other” Stroke Etiologies. Stroke, 937-952.e9.
7. Roberto F.Machado, Mark T. Gladwin. . 2016.
Pulmonary Complications of Hematologic diseases.
Murray and Nadel’s Textbook of Respiratory
Medicine, 1653-1670.e11