Acquired hemolytic disorder: drugs, infections, and certain physical and chemical agents can cause RBC destruction. or erythroblastosis fetalis occurs when a mother is Rh positive
Plasma is made up of _______% water and ________% of additional substances
90%
10%
Plasma has 90% water, the other 10% is made up of what 4 substances?
plasma proteins: albumin (tissue fluid pressure); gamma globulins (curculating antibodies); beta globulins (transport stuff); fibrinogen and prothrombin (clotting)
substances being transported: hormones, nutrients, waste products, enzymes
Which plasma protein functions to maintain tissue fluid pressure?
albumin
Which plasma protein functions in circulating antibodies essential in the immune system?
gamma globulins
Which plasma protein functions in the transport of hormones, metallic ions, and lipids?
beta globulins
Which plasma proteins function in blood clotting?
fibrinogen
prothrombin
What component of blood functions to transport oxygen, carry oxyten to the body cells in the form of oxyhemoglobin, and carbon dioxide is transferred from cells?
Red blood cells (erythrocytes)
What are 2 possible causes of diminished productino of red blood cells?
nutritional deficiency
bone marrow failure
The following is what cause for diminished production of red blood cells?
inadequate dietary choices or intake, defective absorption from the GI pernicious anemia is an example from a B12 vitamin absorption deficiency or iron deficiency may occur diring pregnancy or growth spurt
nutritional deficiency
The following is what cause for diminished production of red blood cells? aplastic anemia is an example can be inherited; can occur without apparent cuase or when bone marrow is injured by meds, radiation, chemotherapy, or infection; in aplastic anemia a combination of anemia, neutropenia, and thrombocytopenia occurs, which leads to a quantitative decrease in all cells formed in the bone marrow
bone marrow failure
What is a genetic blood disorder that is characterized by absent or decreased production of normal hemoglobin?
thalassemia
What are 5 groups of people that the inherited blood disease thalassemia typically effects?
mediterranean
african
middle eastern
southeast asia
middle eastern
What is the most severe form of the inherited blood disorder thalassemia?
Cooley's anemia
What is the only available curative approach for the inherited blood disorder thalassemia?
increased hemolysis: destruction of red blood cells
diminished production of RBC's: nutritional deficiency; bone marrow failure
anemia of chronic diseases: second most prevalent after anemia caused by iron deficiency
genetic blood disorders: thalassemia
What is the oral effect of liquid ferrous that is sometimes used for children to treat iron deficiency anemia?
may stain teeth
What type of anemia is characterized by abnormally large red blood cells; many which are oval shaped? And what are 2 principle types of this type of anemia?
megaloblastic anemia
types: pernicious; folate deficiency
Which type of megaloblastic anemia is cuase by a deficiency of vitamin B12, is rare, and is not usually developed until late adulthood?
pernicious anemia
Which type of megaloblastic anemia is most often seen in 40-70 yr old european women with fair skin, or african american women?
pernicious anemia
true or false. vitamin B12 and folate are essential in red blood cell production in the bone marrow.
true
What are 3 factors that can cuase a deficiency in vitamin B12 (pernicious anemia)?
decreased intake: inadequate diet or impaired absorption
increased requirement: pregnancy, hyperparathyroidism, disseminated cancer
impaired absorption of B12: failure of production of intrinsic factor; or lack of production of intrinsic factor (chronic atrophic gastritis, or surgical removal of partial or all of stomach)
List 8 good dietary sources of vitamin B12.
meat
kidney
fish
oyster
clams
mild
cheese
eggs
liver: rich source originally used for therapy until development of synthetic vitamin
Which vitamin deficiency can cause neural tube defects and can cause spina bifida: a severe condition affecting the formation fo the nerves of the spinal cord, and resulting in infant paralysis?
folate deficiency anemia
What blood disorder is a hereditary form of hemolytic anemia, resulting from a defective hemoglobin molecule. the name is derived from the crescent shape the erythrocytes assume when they become deoxygented?
sickle cell disease
What happens to the red blood cells when blood experiences lowered oxygen tension, or decreased pH, or the body is dehydrated?
The RBCs become sickle shaped (sickle cell anemia)
What are 7 effects of changes from sickle cell anemia blood disease?
erythrostasis
increased blood viscosity
decreased blood flow
hypoxia
increased adhesion of RBCs
vascular occlusion
further sickling
Is the pt with sickle cell trait at risk during the dental appointment?
no - unless severe hypoxia, severe infection, or dehydration occurs
What 2 ethnic groups are at the most risk for sickle cell anemia?
African american population
white mediterranean origin
It is more commonly found in regions that have malaria and populations who have migrated from these areas, because of the mutated gene from malaria
The following bone changes can be identified by the hygienist in pts with what type of blood disorder?
changes in bone; including the mandible results from thrombosis with infarction and from infection
trabecular pattern of the bone and x-rays may be affected due to hyperplasia of marrow elements in response to increased destruction of RBC's
enlarged bone marrow spaces
bone marrow hyperplasia
decreased number of trabeculations
osteoporosis
trabeculae between teeth appear as horizontal rows or step ladder
sickle cell anemia
In severe hemolytic anemia; it affects adults, and is _________ hemolytic sickle cell disease; the hematocrit may range between _ and __%
chronic
18-30%
The life span of red blood cells normally is from _______ to _________ days, whereas in hemolytic anemia, such as sickle cell anemia, the RBC survival rate is about _______ to _______ days
90-120
10-15
What is the acute form of sickle cell anemia called?
sickle cell crisis
What are 5 precipitating factors of sickle cell crisis?
may appera at any time or w/out stimuli
viral or bacterial infections
hypoxia, dehydration, sudden changes in temp
physical activity, extreme fatigue, acidosis
stress/anxiety, additional burden, trauma
What are 3 signs and symptoms of sickle cell crisis (acute)?
self-limited, or reversible pain episodes involving extremities, head, back, chest, and abdomen
infactions occur in various tissues and organs
symptoms of seizure or stroke, or coma
What are 3 steps in an acute sickle cell anemia (sickle cell crisis) emergency?
stop procedure
activate medical emergency system
administer oxygen
What is an increase in the number and concentration of red blood cells above the normal level? Hemoglobin and hematocrit values are raised. The three general categories are relative, primary, and secondary?
polychythemias
Which category of polycythemia is described?
loss of plasma occurs w/out loss of RBCs
concentration of cells increases and relative polycythemica results
cause of fluid loss may be dehydration, diarrhea, repeated vomiting, sweating or burn
factors such as smoking, hypertention, overweight, stress can add
relative
Which type of polycythemia results from actual increased red blood cell count and hemoglobin value? White cell and platelet counts are elevated, and blood viscosity increased affecting oxygen transport?
primary polycythemia
Which type of polycythemia is a neoplastic condition resulting from a bone disorder in which the primitive red cells or stem cells proliferate?
polycythemia primary type
Which type of polycythemia is the only form with oral signs? Identify them. (3)
primary polythemia
tongue, mucous membrane, and gingiva: deep purplish red
gingiva enlarged: bld on slt provocation
petechiae, ecchymosis, and hemotoma
What are 3 factors that can contribute to secondary polycythemia?
hypoxia from:
high altitudes
pulmonary disease
heart disease
tobacco smoking
What are the 2 main types of WBCs?
granulocytes: neutrophils, eosinophils, basophils
agranulocytes: lymphocytes, monocytes
Whicy type of WBC Has three types of T cells that are involved with the delayed or cellular immune reaction?
lymphocytes (an agranulocyte)
What is the normal value of lymphocytes in blood? What will an increase of this result in? decrease?
normal: 20-35%
increase: lymphocytic leukemia, chronic infections, and viral disease
Which type of WBC functions in phagocytosis, intracellular killing (especially mycobacteria, protozoa, and fungi), and mediating of immune inflammatory response? They serve as antigen presenting cells, and migrate into tissues.
monocytes (an agranulocyte)
What is the normal value of monocytes in blood? What will an increase result in? decrease?
Which type of WBC functions to increase vascular permeability during inflammation, so phagocytosis cells can pass into the area?
basophils (granulocyte)
What is the normal value of basophils in blood? What will an increase result in? decrease?
normal: 1%
increase: certain chronic infections
decrease: aplastic anemia
What is a reduction in total number of leukocytes in the blood; count under 500 per ml?
leukopenia
What are 2 specific causes of leukopenia?
specific infections: HIV/AIDS, typhoid fever, influenza, malaria, measles
disease or intoxification of the bone marrow: chronic drug poisoning, radiation, autoimmune or drug induced immune reaction
What is a rare, serious disease involving the destruction of bone marrow? Its causes relate to toxicity from drugs and chemicals, antipsychotic drugs, and autoimmune reactions?
agranulocytosis (malignant neutropenia)
What is an oral manifestation of agranulocytosis?
ulceration and necrosis of tissue
What the general types of bleeding disorders caused by? (3)
pathology of the blood vessel walls: fragile vessels; petechial and hemorrhage appear in mucous membrane and skin
Platelet deficiency or dysfunction: thrombocytopenia or plateley dysfunction
Disorders of coagulation: acquired disorders or hereditary disorders
What type of platelet deficiency or dysfunction is a lowered number of platelets that may be caused by decreased production in the bone marrow?
thrombocytopenia
What will platelet dysfunction result in?
prolonged bleeding time
List 3 acquired disorders of coagulation.
Vitamin K defiency
liver disease
anticoagulant drug therapy
How many hereditary coagulation disorders exist? List 3 examples.
at least 30: deficiency or abnormality of a plasma protein
hemophilia A: factor VIII abnormality
hemophilia B: factor IX abnormality
von Wellebrand's disease
What is the normal level of blood clotting factor in circulating blood?
platelet count: 140,000-400,000/mm3
At what blood clotting factor level can spontaneous bleeding occur?
less than 50,000/mm3
Which hemophilia type is associaged with reduced amt of factor VIII?
hemophilia A
Which hemophilia type is associated with factor IX?
hemophilia B
Which type of hemophilia is characterized by prolonged bleeding time in the presence of a normal platelet count?
von Willebrand's disease
What is the most common hereditary disorder of platelet dysfunction?
von Willebrand's disease
Hemophilia A and B most often affect boys or girls? what about von Willebrand's?
A and B: boys
von Willebrand's: both
What are effects of minor trauma from hemophilia?
bld and bruising from minor trauma
What is bleeding into the soft tissue of joints begins in the very young who have severe hemophilia, much swelling, pain, and incapacitation are created?
hemarthroses
true or false. an effect and long-term complication of hemophilia is that permanent joint damage can result and the pt may need splints, braces, or orthopedic surgery
true
true or false. Pts with hemophilia may avoid brushing and flossing for fear of bld. inform pt to brush well
true
What are 3 different screening tests to determine pts status with hemophilia?
PT: prothrombin time
aPTT: activated PTT
platelet count
which hemophilia test is described?
measures the status of extrinsic and common pathways of coagulation, it reflects the ability of blood lost from vessels in the area of injury to coagulate
PT: prothrombin time
Which hemophilia test is described?
measures the status if the intrinsic and common pathways of coagulation; it reflects the ability of the blood still within the vessels in the area of injury
activated PTT
Which hemophilia test is described?
screens for possible bleeding problems because of thrmobocytopenia; an examination of a blood smear may be requested by a physician inresponse to abnormality in blood counts
