Pathology: Diseases of the Blood

Erythrocytes are increased in number

-deficiency in the erythrocytes abaility to transport oxygeb to and CO2 away from the tissues
¡Excessive blood loss from trauma, internal hemorrhage, or spontaneous hemolysis ¡Genetic diseases ¡Nutritional deficiencies

-Lack of red blood cells and hemoglobin because of indeaquate dietary intake of iron

- Tiredness, weakness, and malaise

-Pale tissue pallor, glossitis, angular chelitis, apthous ulcerations

-Impaired red blood cell maturation secondary to B12 deficiency as a result of a defective intrinsic factor required for its absorption through the intestinal wall
-Folic acid and B12 are needed for erythocytematuration
-Deficiency caused by defective absorption factor (intrinsic factor)
-Gasticmucosa is atrophic and fails to secrete hydrochloric acid —
-Folateand B12 deficiency also cause megaloblasticanemia in which there is larger-than-normal red blood cells —Clincially- ¡Hunter’s glossitis- red tongue with atrophic filliformpapilla ¡Oral mucosa is atrophic and exhibit pallor, angular cheilitis

-Inherited defect in the structure of the hemoglobin molecule causing erythrocyte to assume a crescent “sickle” shape and undergo lysis
-Primarily occurs in African and Mediterranean descent. It is also seen in people from South and Central America, the Caribbean, and the Middle East
-Symptoms- malaise, weakness, yellowed sclera, muscle ridgidityand unconsciousness in sickle cell crisis. Wide spread ischemia may develop leading to death
-Radiographically- numerous small icicle-like spiculesin the skull-cap (hair-on-end effect), stepladder trabeculaeare often seen between posterior teeth

-Inherited defect in either the alpha or beta chain of the hemoglobin molecule resulting in hemolysis
-Most common in people of Meditteraneandescent
-Hair-on-end in the skull cap bone, unusual “honeycomb” trabeculationin jaw

-Decrease ability to generate neutrophilsor reduction in neutrophils
-Causes ¡Arrest in maturation of the cells of the bone marrow ¡Hematopoietic elements have been replaced ¡Pharmaceuticagents have inhibited cell cycling

-A marked decrease in circulating granulocytes, particularylyneutrophils, attributable to a variety of causes
-Neutrophilsare the first line in defense against bacterial infections
-Can result in death because of secondary bacterial infection (pneumonia)
-Clincally- oral ulcerations with chemotherapy at toxic levels causing white blood cell levels to drop. The lesions quickly progress to the bone with resultant osteomyleitisand sequestration

-Idiopathic disease in which episodic fluctuation in the number of circulating neutrophilsand is due to a bone marrow maturation arrest -Children suffer from frequent recurrent respiratory infections
-Apthous-like ulcers can occur within a few day of neutropenicphase
-Premature periodontal disease is often encountered and children and teens may experience alveolar bonelossand periodontal pockets

-Neoplastic process of leukocytes result in elevation of white blood cell count. These leukocytes are referred to as leukemias.

Circulating malignant leukoctes of bone marrow or lymph node orgin

-Leukemias are categorized according to the stem cell of orgin
¡Myelogenous or granulocytic- bone marrow ¡Lymphocytic
-Acute- rapidly progressing, usually fatal and tend to occur in children -Chronic- More often encountered in adults, potentially fatal, but may will undergo prolonged periods of remission with chemotherapy -Clinical features
¡Chronic fatigue and malaise
¡Petechiaesecondary to thrombocytopenia ¡Anemia ¡Fevers of unkownorigin or other infections of the UR or genitourinary tract ¡Orally- petechialhemorrhage and gingival enlargement in 10%

-A disseminated (widely dispersed) neoplasm of differnetiatedB lymphocytes -Lymphoma
-Arises in the 4th, 5thand 6thdecades
-Usually goes unnoticed because it is asymptomatic until it is wide spread
-Symptoms- deep bone pain due to osteolyticbone lesion
-Radiographically- coin-shaped, punched-out lesions radiolucenciesand are prominent in the skull. Dental radiographs may also have punched-out lesions, but may have widespread osseous destruction with radiographic margins appear “moth-eaten” and teeth may be loose
-Poor prognosis

-Platelet disorder
-Decrease in number of circulating blood platelets that can be caused by a variety of factors
-Caused by chemotherapeutics, leukemia and idiopathic thrombocytopenic purpurain HIV patients

-Hereditary coagulation disorders

-Purpurais purple-colored spots and patches that occur on the skin, organs, and in mucus membranes, including the lining of the mouth. (bruises, ecchymosis)
-Acquired coagulopathy- associated with liver cirrhosis
-Oral surgical procedures can be life threatening if appropriate precautions are not observed.
-Hospitalization and coagulation factor supplement