Key Terms. Key Terms. Key Terms.. 7/27/2016

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1 Key Terms Acute And Chronic Leukemia Agranulocytosis Aminocaproic Acid Anemia Aplasia Aplastic Anemia ASA, Acetylsalicylic Acid Asymptomatic Basophil Bleeding Time Chelation Therapy Christmas Disease Clotting Time Coagulation Factor Cooley Anemia Differential Cell Count Key Terms. Key Terms.. Dysphagia Ecchymosis Eosinophil Epistaxis Erythrocyte Fibrin Fibrinogen Folate Deficiency Gamma Globulin Glossodynia Granulocyte Hemarthrosis Hematocrit Hematopoiesis Hemoglobin Hemolysis Hemophilia (A & B) Hemostasis Hematologist Hypoxia Idiopathic Iron Deficiency Anemia Leukocyte Leukocytosis Leukopenia Lysis Macrophage Megaloblast Key Terms Key Terms. Megaloblastic Anemia Monocyte Myelocyte Neoplastic Disease Neutrophil Oxyhemoglobin Paresthesia Partial Thromboplastin Time Pernicious Anemia Petechiae Plasma Platelet Count Platelets Plummer Vinson Syndrome Polycythemia Prothrombin Prothrombin Time Purpura Reduced Hemoglobin Sickle Cell Anemia Thalassemia Thrombocytes Thromboplastin Thrombosis Tranexamic Acid Vertigo von Willebrand s Disease 1

2 Learning Objectives Define and correctly spell each of the key terms. Describe the major types of blood disorders. Explain the general and oral signs and symptoms of the major types of blood disorders. Describe the four oral manifestations of anemia Compare and contrast the cause and oral manifestations of each of the following: iron deficiency anemia, pernicious anemia, folic acid deficiency and vitamin B12 deficiency, aplastic anemia, and sickle cell anemia. Learning Objectives. Compare and contrast the etiology, pathogenesis and treatment of those systemic diseases that exacerbate gingivitis including leukemia, diabetes, vitamin deficiency, and hormonal imbalances Compare and contrast the oral manifestations of thalassemia and sickle cell anemia Compare and contrast the etiologies and oral manifestations of thrombocytopenia and nonthrombocytopenic purpura Learning Objectives.. Identify clinical implications of selected blood values including the PT, PTT, INR, platelet count, hemoglobin, hematocrit, and neutrophil count. Provide examples of dental hygiene treatment modifications necessary for the patient with a blood disorder. REVIEW ANATOMY AND PHYSIOLOGY BLOOD & BLOOD COMPONENTS BLOOD: THE FLUID OF LIFE FUNCTIONS OF BLOOD Transports oxygen and nutrients to the lungs and tissues. Forms blood clots to prevent excess blood loss Carries cells and antibodies that fight infection Brings waste products to the kidneys and liver which filter and clean blood Regulates body temperature 2

3 Whole Blood Blood that runs thru the veins, arteries and capillaries is known as whole blood 55% plasma 45% blood cells Blood makes of 7-8% of body weight. An average adult male has approximately 12 pints of blood An average adult female has approximately 9 pints of blood. Four Blood Components 1. PLASMA 2. RED BLOOD CELLS 3. WHITE BLOOD CELLS 4. PLATELETS Components Of Plasma PLASMA IS THE LIQUID COMPONENT OF BLOOD AND IS A MIXTURE OF: WATER = 90 % SUGAR FAT PLASMA PROTEINS: ALBUMIN, IMMUNOGLOBULINS, FIBRINOGEN (FACTOR 1) AND PROTHROMBIN (FACTOR 2) SALTS: NA, K, CA, BICARB, CL IF PLASMA IS ALLOWED TO CLOT, THE REMAINING FLUID ID CALLED SERUM Functions Of Plasma THE PRIMARY JOB OF PLASMA IS TO TRANSPORT BLOOD CELLS THROUGHOUT THE BODY. IT ALSO TRANSPORTS: NUTRIENTS WASTE PRODUCTS ANTIBODIES CLOTTING PROTEINS CHEMICAL MESSENGERS SUCH AS HORMONES, ENZYMES AND PROTEINS THAT HELP MAINTAIN THE BODY S FLUID BALANCE. RED BLOOD CELLS (ERYTHROCYTES) PLATELETS (THROMBOCYTES) WHITE BLOOD CELLS (LEUKOCYTES) AGRANULOCYTES LYMPHOCYTES MONOCYTES GRANULOCYTES NEUTROPHILS BASOPHILS EOSINOPHILS Blood Cells Where Are Blood Cells Conceived or Formed? DO TWO BLOOD CELLS GET TOGETHER AND UMMMM NOOOOO! 3

4 Blood Cells Are Born Or Formed In The Bone Marrow Two Types Of Bone Marrow RED BONE MARROW/HEMATOPOIETIC PRODUCES RBC S, WBC S AND PLATELETS GETS IT RED COLOR FROM THE HEMOGLOBIN IN THE ERYTHROID CELLS HEMATOPOIETC CELLS MATURE AND MIGRATE INTO SINUSOIDS TO ENTER THE CIRCULATION WHEN THEY ARE FORMED HIGHLY VASCULAR YELLOW BONE MARROW/STROMAL PRODUCES FAT, CARTILAGE AND BONE GETS IT YELLOW COLOR FROM THE CAROTENOIDS IN THE FAT DROPLETS IN THE HIGH NUMBER OF FAT CELLS NOT AS VASCULAR Hematopoietic Cells STEM HEMATOPOIESIS IS THE FORMATION OF BLOOD CELLS BY STEM CELLS FOUND IN THE BONE MARROW. HEMATOPOIETIC CELLS ARE THE STEM CELLS THAT PERFORM THIS FUNCTION, SPECIFIC TO EACH TYPE OF BLOOD CELL. Red Blood Cells (RBC s) Erythrocytes or Corpuscles ABOUT 45% BLOOD VOLUME BICONCAVE DISCS WITH NO NUCLEUS OR ORGANELLES MICROMETERS IN DIAMETER ERYTHROPOIETIN (HORMONE FROM THE KIDNEY) STIMULATES STEM CELLS IN BONE MARROW TO PRODUCE NEW RBC S THAT MATURE IN ABOUT 7 DAYS RBC S SURVIVE ABOUT 120 DAYS 4

5 Hgb molecule with Oxygen.. Hemoglobin/RBC Hemoglobin is a special pigmented protein that carries gases. RBC s Functions Review Of Circulation HEMOGLOBIN REQUIRES IRON (FE) TO CARRY OXYGEN. OXYGEN RICH HEMOGLOBIN IS CALLED OXYHEMOGLOBIN THE % OF WHOLE BLOOD THAT IS MADE UP OF RBC S IS CALLED THE HEMATOCRIT. NORMAL HEMATOCRIT RANGE IS 34% - 50% GASSES Exchange Of Gases 5

6 Oxygen depleted hemoglobin is called reduced hemoglobin Reduced hemoglobin is converted back to oxyhemoglobin in the lungs Anemia = reduced RBC and hemoglobin Hemoglobin White Blood Cells (WBC s) Leukocytes 1% OF THE BLOOD VOLUME THERE ARE TWO TYPES OF LEUKOCYTES: AGRANULOCYTES NO GRANULES IN CYTOPLASM LYMPHOCYTE MONOCYTE GRANULOCYTES GRANULES IN CYTOPLASM BASOPHIL NEUTROPHIL EOSINOPHIL Agranulocyte Vs Granulocyte WBC s Formation And Function Of Blood Cells 6

7 Leukocytes Cells Of The Immune System That Aid In The Body s Defense Against Foreign Materials And Infectious Disease Granulocytes Neutrophils target Bacteria And Fungi Eosinophils target Parasites And Present During Allergic Reactions Basophils present In Allergic Reactions Agranulocytes Lymphocytes target Tumor Cells, Virus-infected Cells And Other Pathogens Monocytes mostly Become Macrophages And Engulf Cellular Debris And Large Pathogens, Platelets (Thrombocytes) Blood Types SMALL ROUND OR OVAL FORMED ELEMENT WITHOUT A NUCLEUS ARE NOT CELLS, BUT ARE FRAGMENTS LESS THAN 1% OF BLOOD VOLUME HELP THE BLOOD CLOTTING PROCESS GATHER AT THE SITE OF INJURY STICK TO THE LINING OF THE INJURED BLOOD VESSEL FORM A PLATFORM ON WHICH BLOOD COAGULATION CAN OCCUR PARTICIPATE IN CLOT DISSOLUTION AFTER HEALING HIGHER THAN NORMAL NUMBER OF PLATELETS CAN CAUSE TOO MUCH CLOTTING AND RESULT IN STROKES & HEART ATTACKS. BLOOD TYPES ARE INHERITED SEE THE ADJACENT CHART TYPE AB=UNIVERSAL RECIPIENT TYPE O=UNIVERSAL DONOR Rh Factor Rh Factor. Rh factor (+ or -) if rh +, an additional antigen is present on rbc s Hemolytic disease incompatibility in blood types between mother and fetus. The mother s antibodies essentially attack the fetus s rbc s Mother rh- and baby rh+, if any exchange of blood during delivery, mother s body will produce antibodies to rh+ blood. This is of concern in future pregnancies. Antibodies can cross the placenta and damage rbc s of future babies. This is life-threatening. An injection of rh immunoglobulin is given to prevent the formation of antibodies. Rhogam shot. RR=RH+ RR=RH+ RR=RH- 7

8 Laboratory Blood Tests CBC, Complete Blood Count MEASURES SEVERAL COMPONENTS AND FEATURES OF YOUR BLOOD INCLUDING RBC S WBC S HEMOGLOBIN HEMATOCRIT PLATELETS Hematocrit Hematocrit Lab Procedure HEMATOCRIT MEASURES THE % OF RBC S IN BLOOD 45% FOR MEN 40% FOR WOMEN INCREASED IN POLYCYTHEMIA DEHYDRATION DECREASED IN ANEMIAS HEMORRHAGE LEUKEMIAS Hemoglobin z Platelet Count MEASURES THE AMOUNT OF HEMOGLOBIN IN THE BLOOD HEMOGLOBIN IS A PROTEIN IN YOUR RBC S THAT CARRIES OXYGEN AND CARBON DIOXIDE NORMAL VALUES: MEN: G/DL WOMEN: G/DL INCREASED IN POLYCYTHEMIA DEHYDRATION DECREASED IN ANEMIAS HEMORRHAGE LEUKEMIAS MEASURES THE NUMBER OF PLATELETS IN THE BLOOD PLATELETS HELP BLOOD CLOT NORMAL=200, ,000/MM³ THROMBOCYTOPENIA (LOW PLATELET COUNT) = 200,000/MM³ SPONTANEOUS GINGIVAL BLEEDING AT <20,000/MM³ 8

9 Bleeding Time BLEEDING TIME ASSESSES PLATELET FUNCTION NOT NUMBER HOW LONG IT TAKES AN INCISION TO STOP BLEEDING WITH FORMATION OF CLOT NORMAL=1-6 MINS >5-10 IS PROLONGED ASA CAN CAUSE INCREASE IN BLEEDING TIME Prothrombin Time or Clotting Time, PROTHROMBIN TIME MEASURES PTS. ABILITY TO CLOT MEASURES THE EXTRINSIC CLOTTING SYSTEM NORMAL=11-15 SECS PROLONGED-PT IS NOT ASSOC. WITH BLEEDING UNLESS LONGER THAN 1.5 TIMES A CONTROL TEST USED TO MONITOR ANTICOAGULANT THERAPY PROLONGED IN PROTHROMBIN DEFICIENCY ANTICOAGULANT THERAPY VITAMIN K DEFICIENCY NEEDED FOR MAKING PROTHROMBIN AND OTHER CLOTTING FACTORS LIVER DISEASES ASPIRIN USE INR International Normalized Ratio INR (INTERNATIONAL NORMALIZED RATIO) AN EXPRESSION OF THE RATIO OF PT TO THROMBOPLASTIN ACTIVITY INR STANDARDIZED FROM LAB TO LAB INR LESS THAN 2.5 IS NORMAL ANTICOAGULANT PTS MAY HAVE INR OF 4-5 PROLONGED IN POLYCYTHEMIA VERA PROTHROMBIN DEFICIENCY ANTICOAGULANT THERAPY VIT K DEFICIENCY LIVER DISEASES ASPIRIN USE ROUTINE CARE MAY BE PERFORMED IN THE DENTAL OFFICE WHEN INR=2-3 MD CONSULT WITH INR LESS THAN 3.0 Partial Prothromboplastin Time- PTT MEASURES TIME IT TAKES BLOOD TO CLOT NORMAL = SECS PROLONGED IN HEMOPHILIA VON WILLEBRAND S DISEASE LIVER/KIDNEY DISEASE ANTICOAGULANT THERAPY AUTOIMMUNE CONDITIONS ANTIBODIES ATTACK BLOOD Activated Partial Prothromboplastin Time/aPTT MEASURES INTRINSIC CLOTTING PATHWAYS PLATELET POOR PLASMA IS INCUBATED AT 37 DEGREES C SURFACE ACTIVATOR, PHOSPHOLIPID, AND CALCIUM ARE ADDED APTT IS THE TIME IT TAKES FOR THE FIBRIN CLOT TO FORM aptt Results NORMAL VALUE= SECS ROUTINE CARE WHEN APTT=LESS THAN 1.5 TIMES NORMAL MD CONSULT WHEN APTT= GREATER THAN 57 SEC PROLONGED IN HEMOPHILIA VON WILLEBRAND S DISEASE ANTICOAGULANT THERAPY 9

10 Intrinsic Vs Extrinsic Pathways and aptt and PT Absolute Neutrophil Count-ANC WE WILL DISCUSS THIS MORE LATER MEASURES THE NUMBER OF INFECTION FIGHTING WBC S IN BLOOD NORMAL=2,000-6,000/mm³ Less than 500/mm³ is life threatening DECREASED IN ANEMIAS CHEMOTHERAPY 10