3BDS: Haematology

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what are the functions of blood?
• Transport: Oxygen, Nutrients, Hormones, Waste
• Supports Immune system- WBC etc
• Coagulation: helps to stop us from bleeding to death
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blood is made of plasma and cells. what is plasma contain
Proteins (Roles include clotting, transport, immunity), Lipids, Nutrients, Hormones, Electrolytes, Water
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what are the cells of the blood
• Red blood cells [Oxygen and CO2 transport (via Haemoglobin)]
• White blood cells (Immune system)
• Platelets (Clotting)
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what is the protein responsible for carrying o2 in RBC.
what does this reflect about RBC
Haemoglobin
It reflects on the quantity and quality
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what does lack of haemoglobin mean
Anaemia
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what does mean cell volume mean ? what are the two examples of this
MCV: size of red blood cells.
Too big = MACROCYTIC
Too small = MICROCYTIC
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what is the name given to too many and too little WBC
TOO MANY = LEUKOCYTOSIS
TOO LITTLE = LEUKOPAENIA
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What types of WBC can be counted in a WBC count
• Neutrophils
• Lymphocytes
• Lots of others
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what is the name given to too little and too many platelets
TOO LITTLE = THROMBOCYTOPAENIA
TOO MANY = THROMBOCYTHAEMIA
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what would you see in a blood test if you have acute infections
high number of neutrophils= neutrophilia
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what is malaria caused by
Plasmodium parasites
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when is a bone marrow test done
If platelet levels, RBS or WBS are too high or too low
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why is an activated partial thromboplastin time test done
intrinsic pathway of coagulation
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why is a prothrombin time/ INR test done
to see functioning of extrinsic pathway to see how certain factors in our blood are working to clot properly. Compared to INR. Ratio rather than actual time just in case the pt takes meds like warfarin hence not actual time
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what is a normal time for PT
12-13 seconds
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what is anaemia
Haemoglobin deficiency/
Not enough haemoglobin
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why can be there a lack of haemoglobin
Lack of cells
Lack of haemoglobin itself
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what causes anaemia
o Lack of RAW MATERIALS – iron deficiency, hookworm
o PRODUCTION problem
o LONGEVITY problem – e.g. if spleen is overactive, the turnover time will drop and hence you lose more of this. Normal red cell life in circulation c. 120 days
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what are some examples of raw materials
iron and folic acid, vitamin B12
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How do the blood cells look like in a blood test if someone has iron deficiency anaemia
Hypochromic – paler than they should be AND microcytic – smaller than they should be
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what is Erythropoietin
– hormone produced by kidney to stimulate production and maintenance of rbc
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what causes lack of erythropoietin
caused by renal failure
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what could cause bone marrow failure
• Aplastic anaemia – complete failure of BM to produce rbcs
• Chemotherapy / Immunosuppressants drugs
• Haematological Malignancy
• Anaemia of chronic disease- Any chronic inflammatory process (chronic infections, CT disease- Rheumatoid arthritis)
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what are two examples of ways to have losses from circulation
Blood loss – commonest cause of anaemia
Haemolysis – destruction of cells in circulation
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what causes haemolysis
• Autoimmunity (Antibodies against red blood cells and destroy them)
• Abnormal red cells
• Sickle cell anaemia
• Thalassaemia
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how does type of anaemia influence the size of MCV
Microcytic (small cells)= iron deficiency
Macrocytic (large cells)= B12/folate deficiency, autoimmune
Normocytic= Marrow, renal failure
26 of 60
What are the symptoms of anaemia
tired and weak
breathless
dizzy
palpitations
specific to cause (blood loss)
more severe if faster rate of blood loss
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what are the signs of anaemia
pale
rapid pulse
may be oral features (dependant on type)
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what is the management of anaemia
• History and examination
• Establish type of anaemia
Simple blood tests – FBC, blood film, Haematinics: Iron, B12, Folate levels
• Establish cause
May require more complex tests i.e. identify bleeding source, cause of haemolysis
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what is the treatment of anaemia
• Replace what’s missing
Iron Sulphate, Folic acid, Vitamin B12 (suffer from reduced haematinix)
Erythropoietin
If severe and symptomatic blood transfusion
• Address underlying cause after replacing what’s missing
30 of 60
what are the dental aspects in regards to someone who has anaemia
Characteristic oral abnormalities may present to dentists (see Oral Medicine Lectures)
 Iron deficiency
 B12 / Folate deficiency
General Anaesthesia
 O2 capacity affected in anaemia
 Need to verify Sickle status in all patients of Black African or Car
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what are the two disorders of white blood cells
1. Neutropenia
2. Haematological malignancies
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what is neutropenia caused by
Bone marrow failure
Or
Auto-immune related i.e. viral infection
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what are the clinical features of neutropenia
infections particularly mouth and throat - Candida, viral, commensal bacteria
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what are haematological malignancies caused by
Majority due to uncontrolled proliferation white cells
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what are the two types of haematological malignancies
• Leukaemia: Proliferation of immature cells in blood and bone marrow
• Lymphoma: Proliferation of cells within lymphoreticular system – nodes, liver, spleen, bone marrow
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what are the two forms of leukaemia
• Acute
Commonest malignancy overall in children
Takes weeks/days to present
• Chronic
Could take months before it presents
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what is the presentation of acute leukaemia
marrow failure (anaemia, infection, bleeding), lymphadenopathy, soft tissue infiltration, chance finding
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what is the presentation of chronic leukaemia
anaemia + lymphadenopathy
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how does acute and chronic leukaemia show on blood tests
acute:Immature white blood cell, low RBC
chronic:Lymphocytes in blood which shouldn’t be there
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what are the two types of lymphoma
• Hodgkin’s lymphoma
• Non-Hodgkin’s lymphoma Lymphoma
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what is the presentation of Hodgkin's lymphoma
Lymphadenopathy (Cervical)
Systemic (Fever, weight loss, night sweats, Itch, Anaemia)
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what is the presentation of non-hodgkin's lymphoma
Lymphadenopathy
Systemic (Fever, weight loss)
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what is the treatment of haematological malignancies
• Supportive: Transfusions, infection management
• Chemotherapy – to kill of abnormal cell line developing. Difficult to do because wbcs are circulating around your body. use drugs that target high turnover. Therefore affects mucosal linings
• Radiotherap
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what are the dental aspects of haematological malignancies
Atypical infections
Bleeding
Lymphadenopathy
Gum infiltration
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what does coagulation depend on
 Platelets (number and function)
 Coagulation cascade
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what happens at the site of bleeding
vasoconstriction, platelet aggregation and coagulation cascade (the last two lead to clot formation)
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what causes platelet problems
• Deficiency of:
Raw materials (B12, Folate)
• Production problems
Bone marrow failure
• Destruction
Immune mediated [Autoimmune thrombocytopaenic purpura (ITP)]
Portal hypertension happens when you have cirrhosis of the liver (Spleen sequestration of pl
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what causes platelet aggregation problems
Function impaired due to medical therapy
• Aspirin / Clopidogrel – more modern to aspirin;/ Dipyridamole
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what is the management of platelet aggregation problems
• Treat underlying cause
• Platelet transfusions may be necessary
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what causes generalised deficiency (which in turn leads to coagulation cascade problems )
- Protein deficiency (most clotting factors) due to:
Liver disease (GI lecture)
Severe malnutrition
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what causes specific deficiency (which in turn leads to coagulation cascade problems )
• Congenital
Haemophilia
Von Willebrand’s disease
• Drugs
Warfarin and heparin
New agents replacing warfarin (See BNF)
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what could coagulation cascade problems cause
haemophilia A+B, von willebrand's disease
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what is the treatment for haemophilia/ von willebrand's disease
• Factor replacement: Early, Prophylactic
• Also
DDAVP (Haemophilia A and Von Willebrands): Increases factor VIII levels
Tranexamic acid (Inhibits clot breakdown)- IV, oral, mouthwas

* DDAVP = desmopressin i.e. Synthetic vasopressin
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what is the risk management for haemophilia/ von will brand's disease
Trauma avoidance
Preparation for expected bleeding i.e. Operations
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what are the associated conditions with haemophilia and von will brand's disease
HIV
Hepatitis
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give examples of coagulation drugs
warfarin , herapin
57 of 60
when is warfarin prescribed
Atrial fibrillation, prosthetic heart valves, DVT and pulmonary embolus
58 of 60
how can bleeding problems manifest
Cutaneous bleeding:
Petechiae – tiny capillary bleeds into surface
purpura- bigger bleeds
ecchymoses- very large bruised area

mucosal bleeding (oral, GI tract, excess menstrual cycle, UT bleeding)
traumatic bleeding (post op, after minor trauma, haemoph
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what are the dental aspects of coagulation problems- bleeding problems
Identify in history – specific diseases, drugs, symptoms (post-op bleeding, mucosal bleeds)
o Suspected undiagnosed bleeding disorder
Do not proceed!
Refer to GP / hospital
o Known bleeding disorder / medication
May need to liase with GP/Haematologist
Spe
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Other cards in this set

Card 2

Front

blood is made of plasma and cells. what is plasma contain

Back

Proteins (Roles include clotting, transport, immunity), Lipids, Nutrients, Hormones, Electrolytes, Water

Card 3

Front

what are the cells of the blood

Back

Preview of the front of card 3

Card 4

Front

what is the protein responsible for carrying o2 in RBC.
what does this reflect about RBC

Back

Preview of the front of card 4

Card 5

Front

what does lack of haemoglobin mean

Back

Preview of the front of card 5
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