Oral manifestations of blood disorders

1. ORAL MANIFESTATIONS
OF BLOOD DISORDERS
Arsalan Wahid Malik
‫يم‬ ِ‫ح‬َّ‫ر‬‫ال‬ ِ‫من‬ْ‫ح‬َّ‫ر‬‫ال‬ ِ‫هللا‬ ِ‫م‬ْ‫س‬ِ‫ب‬

2. DISORDERS OF RBC
Iron-deficiency Anemia
Megaloblastic Anemia
Pernicious Anemia
Aplastic Anemia
Haemolytic Anemia
Sickle-cell Anemia

3. DISORDERS OF WBC
Leukaemia
Leukopenia

4. ANEMIA
 Level of Hb in blood is low
 Decreased number of red cells
1.Due to blood loss
 Acute
 Chronic
2.Due to inadequate production of cells
 Iron deficiency anemia
 Megaloblastic anemia
 Pernicious anemia
 Aplastic anemia
3.Due to excessive red cells destruction
 Hemolytic anemia
 Sickle cell anemia

5. Microcytosis:
 Average size of red cell is reduced
 e.g. Iron-deficiency anemia
Hypochromia:
 When there is less than the normal amount of Hb in cells
 e.g. iron deficiency anemia
Macrocytosis:
 Average size of cell is greater than normal
 e.g. megaloblastic anemia
Anisocytosis:
 Inequality in size of cells
 e.g. megaloblastic anemia

6. IRON-DEFICIENCY ANEMIA:
Inadequate intake of iron
Excessive blood loss
Diagnosis:
 Hb level is low
 Microcytic erythrocytes
 Hypochromic erythrocytes
 The number of red cells per unit volume does not
vary

7. MEGALOBLASTIC ANEMIA:
Vitamin B12 deficiency
Folic acid deficiency
Macrocytosis
Anisocytosis

8. PERNICIOUS ANEMIA:
 Autoimmune condition causing atrophy of gastric
mucosa with failure to secrete intrinsic factor due to
anti-intrinsic factor antibody
Diagnosis:
 Antibodies to intrinsic factor can be detected in
blood

9. APLASTIC ANEMIA:
 Disease of stem cell producing hypoplasia of bone
marrow elements
 Failure of production of all bone marrow cells
(pancytopenia)
 Suppression of bone marrow
Etiology:
 Autoimmune disease
 Cytotoxic drugs/chemotherapeutic agents
 Chloramphenicol/sulphonamides
 Benzene/toluene
 Radiation

10. HAEMOLYTIC ANEMIA:
 Excessive destruction of RBC
 Shortened life span and require more rapid
replacement
 Increase in unconjucated bilirubin in blood with mild
jaundice
Cause:
Autoimmune
Infections
Abnormal Hb and erythrocytes

11. SICKLE-CELL ANEMIA:
 Red cell contain abnormal HbS
 When HbS is deoxygenated it causes distortion and
produces a sickle shaped cells
Clinical Features:
 Jaundice
 Growth retardation
 Skeletal abnormalities
 Bone pain
Oral Manifestations:
 Delayed eruption
 Hypoplasia of teeth
 Radiolucencies in jaw
 Osteomyelitis

12. CLINICAL FEATURES OF ANEMIA
Pallor
Fatigue/weakness
Breathlessness
Tachycardia
Palpitations
Jaundice
Increased susceptibility to infections
Purpura
Constipation/diarrhea

13. ORAL MANIFESTATION OF ANEMIA:
 Generalized stomatitis
 Mucosal pallor
 Atrophy of filiform papillae of tongue
 Glossitis
 Disturbed taste sensations
 Angular cheilitis
 Gingivitis
 RAS
 Susceptibility to infections
 Candidial infections
 Plummer-Vinson syndrome

14. Plummer-Vinson syndrome
Iron-deficiency anemia
Glossitis and stomatitis
Angular cheilitis
 Pharyngo-esophageal ulcers
 Dysphagia
 Cracking/splitting of nails

15. Tongue is red, smooth, depapillated with angular cheilitis due to Candida
infections
Iron-deficiency Anemia

16. Bilateral angular cheilitis with stomatitis

17. LEUKAEMIA
 Overproduction of white cells which suppresses
other cells of marrow
Acute leukemia
 Immature cells
 Sudden onset
 Affects children
3-5 yrs of age
Chronic leukemia
 Abnormal cells
 Slow progressing
disease of adults
 Asymptomatic

18. ETIOLOGY OF LEUKEMIA:
 Radiation
 Viruses
 Chemical agents
 Drugs
 Phenylbutazone
 Chloramphenicol
 Cotrimoxazole
 Carbamazepine
 Thiouracil
 Cytotoxic drugs

19. SIGNS/SYMPTOMS
 Splenomegaly
 Hepatomegaly
 Lymphadenopathy
 Anemia
 Infections
 Purpura
 Fever
 Weight loss
 Bone pains
 Weakness
 Fever
 Weight loss
 Anorexia
 Bleeding
 Infections
 Anemia
 Thrombocytopenia
 Splenomegaly
 Hepatomegaly
 Lymphadenopathy
Acute Leukemia Chronic Leukemia

20. ORAL MANIFESTATIONS:
 Gingival swelling
 Gingival bleeding
 Mucosal swelling with loosening and exfoliation of
teeth
 Mucosal ulcerations
 Oral infections-candidal
 Leukemia deposits
 Purpura and petechiae
 Anemia
 Cervical lymph node enlargement
 Leukemic infiltration of salivary and lacrimal glands

21. leukemia
Ulcerated tumor mass formed by emigration
of leukaemic cells

22. Leukemia-gingiva are swollen and purplish with ulceration along the
palatal aspect of anterior teeth due to increased susceptibility to
infections

23. LEUKOPENIA:
Deficiency of white cells <than 5000/L
Cause:
 Leukemia
 Aplastic anemia
 Autoimmune disorders
 HIV and EBV infections
 Drugs
 Carbamazepine
 Phenylbutazone
 Chloramphenicol
 Sulphonamides
 Cotrimoxazole
 Thiouracil
 Cytotoxic drugs

24. CLINICAL FEATURES:
 Fever
 Weakness
 Sore throat
 Increased susceptibility to infections of oral cavity
 Ulcerations of gingiva, mucosa and pharynx
Management:
 Stop the drug
 Antibiotics
 Blood transfusion if necessary
 Improve oral hygiene
 Avoid extractions