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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”)

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hematologic blood diseases

HEMATOLOGIC (BLOOD) DISEASES

Text Reading Assignment:

Chapter 7 - Bleeding Disorders

Chapter 8 - Blood Dyscrasias

hematologic blood diseases1
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 diseases2
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)

HEMATOLOGIC (BLOOD) DISEASES
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 - SeeImmunosuppression 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)

CLINICAL FEATURES OF BLOOD DISORDERS

Go To Basic Disease

clinical bleeding
Clinical Bleeding

Petechiae

Petechiae and Ecchymoses

Ecchymoses

clinical photos bleeding and sometimes swollen gums
Clinical PhotosBleeding(and sometimes Swollen) Gums

Leukemia

Hemophilia

Leukemia

Leukemia

other clinical features of blood disorders
Other Clinical Features of Blood Disorders

Ulceration

Atrophy and

Pallor

Ulceration

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)

TESTING FOR BLEEDING DISORDERS

INR = PTR ISI = (ProThrombinRatio) ISI = (Patient’s PT/ControlPT)ISI

Normal INR = 1.0-2.0

ISI = International Sensitivity Index (for Lab Thromboplastin)

bleeding time
Bleeding Time

N ~ 5 min.

clotting time
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 NSAID’s)

von Willebrands disease

Petechiae are Common Finding

PLATELET-ASSOCIATED BLEEDING DISORDERSThrombocytopeniaThrombocytopathia (Thrombasthenia)
coagulation factor associated 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)

COAGULATION FACTOR-ASSOCIATED BLEEDING DISORDERS
blood dyscrasias diseases of the formed elements
Blood DyscrasiasDiseases 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 RBC’s / 100 mL

WBC Count - Normal = 4 - 6 Thousand WBC’s / 100 mL

Neutrophils ~ 60 - 65 %

Lymphocytes ~ 30 - 35 %

Monocytes ~ 4 - 6 %

Eosinophils ~ 1 - 2 %

Basophils ~ 0 - 1 %

Platelets = 150 - 600 Thousand / 100 mL

anemia
Clinical: Weakness, Fatigue, Pallor

Decreased Oxygen Carrying Capacity of Blood

Result of: Decreased Number, Size, or HgB Content of RBC’s 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
Anemia Classification
  • Size of RBC’s
    • 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
Determination of RBC Indices
  • RBC count (RBC) - # RBC’s / 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 wbc s increased susceptibility to infection
Aplastic Anemia

Failure of Formation of All Blood Cells: RBC’s, WBC’s and Platelets

Agranulocytosis

Failure of Formation of Neutrophils

Cyclic Neutropenia

Periodic Suppression of Neutrophil Formation

Associated Oral Ulceration and Infection:

Candidiasis

HSV

LEUKOPENIA (Decreased Number of WBC’S)Increased Susceptibility to Infection
leukemia
Leukemia - Definition

Malignancies of WBC’s Originating in BONE MARROW

Expression in PERIPHERAL BLOOD

Leukemia - Classification

Acute Lymphocytic Leukemia (ALL) - Children

Chronic Lymphocytic Leukemia (CLL) - Elderly

Acute Myelogenous Leukemia (AML) - All Ages

Chronic Myelogenous Leukemia (CML) - Adults

Clinical Significance

Disease and Treatment Make Patients Anemic and More Susceptible to Infection and Bleeding

Decreased RBC Formation, IneffectiveLeukocytes (&/orLeukopenia) and Thrombocytopenia

Diagnosis by: CBC with Differential and Bone Marrow Biopsy

Leukemia - Blood Smear

LEUKEMIA

Leukemia

lymphoma
Cancer of Lymphocytes

Lymph Nodes or Extranodal Soft Tissue (including mouth) - NOT Blood or Bone Marrow

Classified by:

Hodgkin’s Disease(with REED-STERNBERG CELLS) VS. Non-Hodgkin Lymphoma

Type of Lymphocyte: B-cell; T-cell; etc.

Maturity of Malignant Cells

LYMPHOMA

Non-Hodgkin Lymphoma

the end
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 RBC’s / 100 mL

WBC Count - Normal = 4 - 6 Thousand WBC’s / 100 mL

Neutrophils ~ 60 - 65 %

Lymphocytes ~ 30 - 35 %

Monocytes ~ 4 - 6 %

Eosinophils ~ 1 - 2 %

Basophils ~ 0 - 1 %

Platelets = 150 - 600 Thousand / 100 mL