Rbc Disturbances

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What is polycythemia?

Back 1

an increase in the concentration of hemoglobin which is ALWAYS accompanied by an increase in number of RBC

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what is anemia?

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a decrease in circulating hemoglobin leading to decreased oxygen in the tissues

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hematocrit

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the packed volume of erythrocytes expressed as a percentage of the volume f whole blood in a sample.

normal values:
men- 39-49%
women: 33-43%

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MCV

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mean corpuscular volume. the average volume of the individual red cell in cubic microns

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MCH

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mean corpuscular hemoglobin. the content of hemoglobin of the average red cell.

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Relative polycythemia

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caused by a decreased plasma volume relative to the red cell mass.

causes:
prolonged vomiting or dirrhea, diabetic ketoacidosis or postsurgical dehydration.

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secondary polycythemia

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primarily mediated by erythropoietin either due to hypoxia-drivin or hypoxia-dependant processes.
-high altitudes
-CHF
-pulmonary diseases
-some tumors due to erythropoietin-like substances

** also can have secondary thrombocytopenia with an increased bleeding potential

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primary polycythemia

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characterized by a neoplastic, erythropoietn-independent increase in the circulating red blood cell mass.
-higher incidence in people of jewish ancestry

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polycythemia management

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-treat
-smoking cessation
-phlebotomy
-chlorambucil (used to reduce blood cell mass)

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polycythemia lab findings

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RBC count- > 7 x 10^6
hemoglobin- 18 gm/dL
platelet- elevated
WBC- elevated

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polycythemia oral manifestations

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ruddy complexion in the face, purplish discoloration of the oral mucosa, tongue and gingiva. gingiva may be swollen and bleed. petechia is common

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anemia symptoms

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severity depends upon the degree of anemia. many patients with mild anemias are asymptomatic.
-weakness, dyspnea, dizziness, palpitations, tingling, gastric ulcer

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Anemia Oral manifestations

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-atrophic glossitis
-angular chelitis
-pallor
-aphthae
-burning mouth
-jaundice (hemolytic anemias)

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Blood loss anemias (Iron-defiency anemia)

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Iron-defiency anemia is the most common of all anemias and usually results from blood loss.
-10-20% of women in reproductive years has this anemia

Management: identifying the source of iron loss and treating it appropriatly. Iron supplements

** if in dental office NEVER perform elective surgeries on these patients due to an increased risk of bleeding and faulty wound healing

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Iron-defiency anemis lab findings

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hemoglobin- decreased
MCH- decreased
MCV- decreased
MCHC- decreased

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Plummer-vinson syndrome

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found in women in the 4th and 5th decades of life. characterized by dysphagia and micocytic hypochomic anemia.
-smooth tongue, sore mouth, dry mouth, angular chelitis, spoon shaped nails.
-often complain of a spasm of sticking the back of the throat

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Megaloblastic Anemia from vitamin B12 defiency

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-occurs late in adult life.
-most common form is pernicious anemia is caused by the defiency of the intrinsic factor form the stomach.
-pernicious anemia is assoicated with gastrointestinal signs and symptoms, oral manifestations and neurologic changes.

treatment: parenteral injections of cobalamin.

oral manifestations:
-burning tongue, papillary atrophy, red color, loss of taste, oral ulcers

lab findings:
Peripheral smear macrocytic, normochromic
Hemoglobin decreased
MCV increased
MCH increased
MCHC normal
Serum B12 decreased (N = 200 - 900 pg/mL)
Neutrophil hypersegmented

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folic acid defiency

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-needed for the synthesis of DNA, RNA and proteins.
-usually caused by dietary defiencies
-causes predisposition to increased levels of homocysteine and results in ischemic heart disease.

management: oral replacement therapy but before treatment can be done a throurough check of the vitamin B12 must be preformed.

lab findings:
smear: macrocytic, normochromic
hemoglobin: decreased
MCV: increased
MCH: increased
MCHC: normal

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Aplastic anemia

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normocytic normchromic anemia resultant from bone marrow failure.
causes: inherited abnormalities, drug exposure, radiation and chemicals.

lab findings:
hemoglobin: decreased
WBC: decreased
platelet: decreased
bleeding time: prolonged

Oral manifestations: gingival bleeding, and severe infection of the peridontal tissue. petichiae, purpura, ecchymosis

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Hemolytic anemias

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results from excessive destruction of erythrocytes that may be caused by intrinsic defects in the erythrocytes that are often heriditary or by extrinsic factors.
-shortened red cell life span
-elevated erythropoietin levels
-accumulation of products of hemoglobin catabolism (jaundice)

oral manifestations: common ones to all anemias, pallor, soft palate, tongue, and sublingual tissues. jaundice, phyerplasia of eryryoid elements

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sickle- cell anemia

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-common form of hemolytic anemia
-intrinsically derived that is characterized by the number of globin genes affected by the mutant sickle cell hemoglobin.
-8-10% of african americans carry the trait
-painful attacks of hemplytic anemia which arise when the patent has lowered oxygen tension, decreased pH, or dehydration.
-can cause osteomylitis of the jaw

managent: hydroxyurea and bone marrow transplant