HEMATOLOGIC

(BLOOD) DISEASES
Text Reading Assignment:
Chapter 7 - Bleeding Disorders
Chapter 8 - Blood Dyscrasias

HEMATOLOGIC (BLOOD)
DISEASES
Bleeding Disorders

Clotting Factor Disorders

Platelet Function Disorders

Blood Dyscrasias (Formed Elements)

Red Blood Cell (RBC) Disorders

White Blood Cell (WBC) Disorders
Platelet Deficiencies

HEMATOLOGIC (BLOOD)
DISEASES

Bleeding Disorders

Platelet Function - Associated

Coagulation Factor - Associated

Platelet Deficiency

Thrombocytopenia / Thrombocytopathia

Red Blood Cell (RBC) Disorders

Anemia

White Blood Cell (WBC) Disorders

Leukopenia
Leukemia
(Lymphoma)

CLINICAL FEATURES OF BLOOD

DISORDERS
Oral Bleeding - See Bleeding Protocol

Petechiae / Easily Bruised (Ecchymoses)

Bleeding After Brushing
Spontaneous Gingival Bleeding
Prolonged After Extractions
Excessive From Minor Trauma

Other Bleeding: Epistaxis, Hematemesis, Hemoptysis, Hematuria, Melena

Possible Associated Increased Susceptibility to Infection - See
Immunosuppression Protocol

Leukemia

HIV
Immunosuppression from Chemtherapy for Organ Transplant or Cancer TX

Oral Swelling &/or Ulceration

Long Term Immunosuppression carries increased Risk for

Malignancy (Especially lymphoma and leukemia)

Go To
Basic
Disease

Clinical Bleeding
Petechiae

Petechiae and Ecchymoses

Ecchymoses

Clinical Photos

Bleeding(and sometimes Swollen) Gums

Leukemia

Hemophilia

Leukemia
Leukemia

Other Clinical Features of

Blood Disorders
Ulceration

Ulceration

Atrophy and
Pallor

HEMATOLOGIC (BLOOD) DISEASES

Health History Correlation
HEALTH HISTORY
University of the Pacific School of Dentistry
Patient Name:

Soc. Sec. No.:

Birth Date:
I. CIRCLE APPROPRIATE ANSWER (leave Blank if you do not understand question):
1. Yes
No
Is your general health good?
2. Yes
No
Has there been a change in your health within the last year?
3. Yes
No
Have you been hospitalized or had a serious illness in the last three years?
If YES, why?
4. Yes
No
Are you being treated by a physician now? For what?
Date of last medical exam?
Date of last Dental exam
5. Yes
No
Have you had problems with prior dental treatment?
6. Yes
No
Are you in pain now?
II. HAVE YOU EXPERIENCED:
7. Yes
No
Chest pain (angina)?
8. Yes
No
Swollen ankles?
9. Yes
No
Shortness of breath?
10. Yes
No
Recent weight loss, fever, night sweats?
11. Yes
No
Persistent cough, coughing up blood?
12. Yes
No
Bleeding problems, bruising easily?
13. Yes
No
Sinus problems?
14. Yes
No
Difficulty swallowing?
15. Yes
No
Diarrhea, constipation, blood in stools?
16. Yes
No
Frequent vomiting, nausea?
17. Yes
No
Difficulty urinating, blood in urine?

18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

No
No
No
No
No
No
No
No
No
No
No

Dizziness?
Ringing in ears?
Headaches?
Fainting spells?
Blurred vision?
Seizures?
Excessive thirst?
Frequent urination?
Dry mouth?
Jaundice?
Joint pain, stiffness?

III. DO YOU HAVE OR HAVE YOU HAD:

29. Yes
No
Heart disease?
30. Yes
No
Heart attack, heart defects?
31. Yes
No
Heart murmurs?
32. Yes
No
Rheumatic fever?
33. Yes
No
Stroke, hardening of arteries?
34. Yes
No
High blood pressure?
35. Yes
No
Asthma, TB, emphysema, other lung diseases?
36. Yes
No
Hepatitis, other liver disease?
37. Yes
No
Stomach problems, ulcers?
38. Yes
No
Allergies to: drugs, foods, medications, latex?
39. Yes
No
Family history of diabetes, heart problems, tumors?

40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

No
No
No
No
No
No
No
No
No
No
No

AIDS
Tumors, cancer?
Arthritis, rheumatism?
Eye diseases?
Skin diseases?
Anemia?
VD (syphilis or gonorrhea)?
Herpes?
Kidney, bladder disease?
Thyroid, adrenal disease?
Diabetes?

IV. DO YOU HAVE OR HAVE YOU HAD:

51. Yes
No
Psychiatric care?
52. Yes
No
Radiation treatments?
53. Yes
No
Chemotherapy?
54. Yes
No
Prosthetic heart valve?
55. Yes
No
Artificial joint?

56.
57.
58.
59.
60.

Yes
Yes
Yes
Yes
Yes

No
No
No
No
No

Hospitalization?
Blood transfusions?
Surgeries?
Pacemaker?
Contact lenses?

V. ARE YOU TAKING:

61. Yes
No
62. Yes
No

Recreational drugs?
Drugs, medications, over-the-counter medicines
(including Aspirin), natural remedies?

63.
64.

Yes
Yes

No
No

Tobacco in any form?

Alcohol?

Are you or could you be pregnant or nursing?

66.

Yes

No

Taking birth control pills?

Please list:
VI. WOMEN ONLY:
65. Yes
No
VII. ALL PATIENTS:
67. Yes
No
If so, please explain:

Do you have or have you had any other diseases or medical problems NOT listed on this form?

To the best of my knowledge, I have answered every question completely and accurately. I will inform my dentist of any change in my health
and/or medication.
Patients signature:

Date:

RECALL REVIEW:
1. Patients signature

Date:

2. Patients signature

Date:

3. Patients signature

Date:

Go To
Health
History

TESTING FOR BLEEDING

DISORDERS

Prothrombin Time (PT) (Extrinsic Pathway)

DBL
N ~ > 25 sec. (N=12-14 sec.)
(Activated)Partial Thromboplastin Time (APTT) (Intrinsic
Pathway) DBL N ~ > 50 sec. (N=25-35 sec.)
International Normalized Ratio (INR) > 3.0 (N=1.0-2.0)
Bleeding Time > 10 min. (N~5 min.)
Clotting Time > 10 min. (N = < 5 Minutes)
Platelet Count as Part of CBC with Differential WBC - <
20 - 40K (N=150-500K/mm3)

INR = PTR ISI = (ProThrombinRatio) ISI = (Patients PT/ControlPT)ISI

Normal INR = 1.0-2.0
ISI = International Sensitivity Index (for Lab Thromboplastin)

Bleeding Time

N ~ 5 min.

Clotting Time

N = < 5 Minutes

PLATELET-ASSOCIATED
BLEEDING DISORDERS

Thrombocytopenia
Thrombocytopathia (Thrombasthenia)
Primary or Secondary Deficiency of Platelets
10 / Idiopathic (Probably Autoimmune)
Thrombocytopenic Purpura
20 / i.e. Leukemia, HIV, Aplastic Anemia

Altered Platelet Function as in ASPIRIN (and

other NSAIDs)
von Willebrands disease
Petechiae are Common Finding

Platelet Adhesion, Aggregation

and Blood Clotting

COAGULATION FACTORASSOCIATED BLEEDING

DISORDERS
Hereditary Defects

Hemophilia A (VII), B (IX), or C (XI)

Other: Parahemophilia (V) and Afibrinogenemia (I)

Liver Disease

Cirrhosis, Hepatitis (I and II) + (VII, IX, and X)

Anti-Coagulant Medication

Coumarin (Warfarin) - Vitamin K Antagonist (II, VII, IX, and X)

Heparin - Anti-Thrombin / Plasma Thromboplastin

GI Malabsorption Problems

Fat Soluble Vitamin K Deficiency (Sprue or Biliary Disease)

Blood Dyscrasias

Diseases of the Formed Elements

Anemia
Leukopenia
Leukemia
(Thrombocytopenia)

Test with Complete Blood Count (CBC) with Differential White Cell Count
(WBC):
RBC Count - Normal = 4.5-5.0 Million RBCs / 100 mL
WBC Count - Normal = 4 - 6 Thousand WBCs / 100 mL
Neutrophils ~ 60 - 65 %
Lymphocytes ~ 30 - 35 %
Monocytes
~ 4-6 %
Eosinophils ~ 1 - 2 %
Basophils
~ 0-1 %
Platelets = 150 - 600 Thousand / 100 mL

 Clinical: Weakness, Fatigue, Pallor

Decreased Oxygen Carrying Capacity
of Blood
Result of: Decreased Number, Size, or
HgB Content of RBCs or of Defective
HgB
Secondary to:
Nutritional / Iron Defeciency
RBC loss or destruction (Chronic
Bleeding)
Failure of RBC formation (Leukemia)
Hereditary HgB malformation

Oral Features:
Pallor
Bald Tongue

Possible Association with other

Disease: Leukemia, Kidney Disease,
etc.

ANEMIA

Anemia Classification
Size of RBCs
Microcytic (Small)
Macrocytic (Large)
Normocytic (Normal Size)

Concentration of Hgb
Hypochromic (Less)
Hyperchromic (More)
Normochromic (Normal)

Microcytic / Hypochromic
Chronic Blood Loss, Iron Deficiency, Thalassemia

Macrocytic (Megaloblastic) / Hyperchromic

Vit B12 (Pernicious) or Folic Acid Deficiency

Normocytic / Normochromic
Hemolytic, Aplastic, Myelophthisic, Acute Blood Loss, Chronic Renal Failure

Determination of RBC
Indices

RBC count (RBC) - # RBCs / 100 mL of Blood

(NORMAL = 4.5-5.0 Million / 100 mL)

Hematocrit (Hct) - % of (RB) Cells By Volume

(NORMAL = 36-45%)

Hemoglobin (Hgb) - mg / 100 ml of Blood

(NORMAL = 13-15 mg/dL)

Mean Corpuscular Volume (MCV)

Hct/RBC - Normal = 90 (+or- 10) cubic microliter

Mean Corpuscular Hemoglobin (MCH)

Hgb/RBC - Normal = 30 (+or- 3) picograms

Mean Corpuscular Hgb Concentration (MCHC)

Hgb/Hct - Normal = 33 (+or- 2) %

LEUKOPENIA
(Decreased Number of WBCS)
Increased Susceptibility to
Infection
Aplastic Anemia

Failure of Formation of All Blood Cells: RBCs, WBCs and

Platelets

Agranulocytosis

Failure of Formation of Neutrophils

Cyclic Neutropenia

Periodic Suppression of Neutrophil Formation

Associated Oral Ulceration and Infection:

Candidiasis
HSV

Oral Ulceration and Infection

Secondary to Leukopenia or
Leukemia

LEUKEMIA

Leukemia - Blood Smear

Leukemia - Definition

Malignancies of WBCs Originating in BONE

MARROW
Expression in PERIPHERAL BLOOD

Leukemia - Classification

Acute Lymphocytic Leukemia (ALL)

Chronic Lymphocytic Leukemia (CLL)
Acute Myelogenous Leukemia (AML)
Chronic Myelogenous Leukemia (CML)

Children
Elderly
All Ages
Adults

Clinical Significance

Disease and Treatment Make Patients Anemic and

More Susceptible to Infection and Bleeding
Decreased RBC Formation, Ineffective Leukocytes
(&/or Leukopenia) and Thrombocytopenia

Diagnosis by: CBC with Differential and Bone

Marrow Biopsy

Leukemia

LYMPHOMA
Cancer of Lymphocytes
Lymph Nodes or Extranodal
Soft Tissue (including mouth)
- NOT Blood or Bone Marrow
Classified by:

Hodgkins Disease (with REEDSTERNBERG CELLS) VS. NonHodgkin Lymphoma

Type of Lymphocyte: B-cell; Tcell; etc.
Maturity of Malignant Cells

Non-Hodgkin Lymphoma

THE END

Test with Complete Blood Count (CBC) with Differential White

Cell Count (WBC) + Hgb, Hct, and Red Cell Indices:
RBC Count - Normal = 4.5-5.0 Million RBCs / 100 mL
WBC Count - Normal = 4 - 6 Thousand WBCs / 100 mL
Neutrophils ~ 60 - 65 %
Lymphocytes ~ 30 - 35 %
Monocytes
~ 4-6 %
Eosinophils ~ 1 - 2 %
Basophils
~ 0-1 %
Platelets = 150 - 600 Thousand / 100 mL