Diseases Of Blood And Blood Forming Organs Oral Pathology Essay Question And Answers

Diseases Of Blood And Blood Forming Organs Important Notes

1. Plummer-Vinson syndrome

• Iron deficiency anemia
• Carcinoma of hypopharynx
• Koilonychias

2. Types of anaemia

3. Hair on-end appearance is seen in

• Thalassemia
• Sickle cell anemia

4. Anitschow cells

• They are modified epithelial cells with
  • Elongated nuclei
  • Linear bar of chromatin
  • Seen in
• Sickle cell anemia
  • Iron deficiency anemia
  • Aphthous ulcer
  • Rheumatic heart disease

5. Clotting factors

6. Types of leukemia

7. Agranulocytosis

• Mostly occurs due to the ingestion of drugs like
  • Amidopyrine
  • Barbiturates
  • Chloramphenicol
  • Quinine
    • Sulfonamides
• Features
  • Presence of infection in the oral cavity, GIT, genitourinary tract, respiratory tract, and skin
  • Oral manifestation
    • Necrotizing ulcerations of oral mucosa, pharynx, tonsils
    • Rapid destruction of supporting tissues of the teeth

8. Cyclic neutropenia

• It is characterized by periodic cyclic diminution of leukocytes
• Cycle commonly occurs every 3 weeks
• Loss of alveolar bone around the teeth is an important oral manifestation

Diseases Of Blood And Blood Forming Organs Short Question And Answers

Question 1. Describe leukemia
Answer:

Leukemia

Leukemia: Leukemia is a disease characterized by the progressive overproduction of white blood cells which usually appears in the circulating blood in an immature form

Leukemia Etiology:

• Chromosomal abnormality-presence of Philadelphia chromosome
• Exposure to high doses of radiation therapy
• Exposure to certain chemicals- benzene, phenyl butanone
• Following chemotherapy treatment
• Myeloproliferative disorders like polycythemia vera
• Congenital or genetic abnormalities- Down’s syndrome
• The presence of primary immune deficiency
• Infection with human leukocyte virus
• Hereditary

Leukemia Classification:

1. Acute leukemia
   • Acute lymphocytic leukemia
   • Acute myeloblastic leukemia
2. Chronic leukemia
   • Chronic myelogenous leukemia
   • Chronic lymphocytic leukemia

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Clinical Features:

• Acute type is more common in children and young adults while chronic is more common in adults of middle age
• Males are more affected than females
• Fatigue
• Generalised weakness, malaise
• Easy bruising
• Epitaxis
• Headache
• Vomiting
• Generalised pain
• Hepatosplenomegaly
• Anaemia
• Persistent fever
• Weight loss
• Heat intolerance
• Scattered petechiae, ecchymosis
• Generalised lymphadenopathy
• Shortness of breath
• Tachycardia
• Hyperuricaemia
• Cerebral hemorrhage
• Increased intracranial pressure
• Cranial nerve palsies

Leukemia Oral Manifestations:

1. Gingiva
   • Gingivitis
   • Gingival hyperplasia
   • Enlargement of interdental papillae
   • Gingival tissues become swollen
   • Cyanotic bluish discoloration of gingiva
   • Thrombosis of gingival vessels
2. Teeth
   • Rapid loosening of teeth
   • Alterations in developing tooth crypts
   • Destruction of lamina dura
   • Displacement of teeth
3. Oral mucosa
   • Thinning of oral mucosa
   • Petechiae and ecchymosis develop over oral mucosa
   • Multiple large irregular necrotic ulcers develop
4. Other
   • Large hematomas over the lower lip
   • Oral infections
   • Palatal ulcerations
   • Mental nerve neuropathy
   • Prolonged post-extraction bleeding
   • Osteomyelitis of jaw

Leukemia Diagnosis:

1. Blood
   • WBC count- reduced
   • Presence of abnormal leukocytes
   • Platelet count- low
   • Hemoglobin levels- reduced
2. Bone marrow aspiration
   • Detects increase in the number of bone marrow cells
3. Lumbar puncture
   • Determines the presence of blast cells in CNS
4. Radiographic appearance
   • Chest X-ray- detects mediastinal involvement
   • Skeletal X-ray- Detects skeletal lesions
   • MRI and CT scan- detects lesions and site of infection
5. Lymphangiogram
   • Locates malignant lesions

Leukemia Treatment:

• Chemotherapeutic drugs
• Radiation therapy
• Corticosteroids

Question 2. What is anemia? Classify anemia. Write about clinical features and treatment of pernicious anemia.
Answer:

Anaemia: It is defined as an abnormal reduction in the number of circulating red blood cells, the quantity of hemoglobin, and the volume of packed red cells in a given unit of blood

Anaemia Classification: Etiological classification

1. Loss of blood
   • Acute posthemorrhagic anaemia
   • Chronic posthemorrhagic anaemia
2. Excessive destruction of red cells
   • Extracorpuscular causes
     • Antibodies
     • Infections
     • Drugs
     • Chemicals
     • Trauma to RBC
   • Intracorpuscular causes
     • Hereditary
       • Disorders of glycolysis
       • Abnormalities of RBC membrane
     • Acquired
       • Lead poisoning
     • Impaired blood production
       • Iron deficiency anemia
       • Pernicious anemia
       • Megaloblastic anemia
       • Protein deficiency
       • Ascorbic acid deficiency
3. Inadequate production of mature erythrocytes
   • Deficiency of erythroblasts
   • Infiltration of bone marrow
   • Endocrine abnormality
   • Chronic renal disease
   • Chronic inflammatory diseases
   • Cirrhosis of liver

Pernicious Anaemia: Pernicious anemia is a relatively chronic hematological disease

Pernicious Anaemia Clinical Features:

• Occurs after the age of 30
• Males are commonly affected
• Triad of symptoms: generalized weakness, sore and painful tongue, and numbness or tingling of the extremities
• Easy fatigability
• Headache, dizziness
• Nausea, vomiting, diarrhea, loss of appetite
• Shortness of breath
• Loss of weight
• Pallor
• Abdominal pain

Pernicious Anaemia Oral Manifestations:

• Glossitis
• Painful ami burning lingual sensation
• Inflamed and beefy red tongue
• Hunter’s glossitis
• Presence of small and shallow ulcers
• Atrophy of papillae- bald tongue
• Dysphagia
• Pallor of oral mucosa
• Hyperpigmentation of oral mucosa
• Increased susceptibility to oral infections

Pernicious Anaemia Treatment: Administration of Vitamin B12 and folio acid

Question 3. Hemophilia
Answer:

Hemophilia

Hemophilia is a potentially fatal inherited bleeding disorder characterized by profound hemorrhage due to genetic deficiency of clotting factors

Hemophilia Etiology:

• Hereditary
• Se-linked recessive trait
• Spontaneous mutations

Hemophilia Types

Hemophilia Clinical features

• Persistent bleeding following mild injury or spontaneously
• Easy bruising
• Bleeding into muscles and joints causing pain
• Spontaneous bleeding into subcutaneous tissues or internal organs resulting in hematoma formation
• Epitaxis
• Haemarthrosis
• Gastric hemorrhage
• Spontaneous hematuria
• Intracranial hemorrhage

Hemophilia Oral Manifestations:

• Massive and prolonged gingival hemorrhage
• Internal blooding Into the glottis
• Recurrent subperiosteal hematoma
• Deep tissue blooding In the oropharyngeal region
• Severe periodontal disease

Laboratory Findings

Hemophilia Treatment:

• Immediate transfusion of factor 8 or 9
• Transfusion of packed red blood cells or white blood cells to replace blood volume
• Prophylactic transfusion of factor 8 to a level of 50% above normal
• Use of local hemostatic agents to control topical bleeding
• Analgesics and corticosteroids to reduce joint pain and swelling
• Joint immobilization
• Use of intravenous desmopressin

Question 4. Cyclic neutropenia
Answer:

Cyclic neutropenia

Cyclic neutropenia is a rare form of agranulocytosis characterized by periodic decrease in circulating neutrophils due to bone marrow maturation arrest

Cyclic neutropenia Clinical Features:

• Can affect any age group
• Fever, malaise
• Sore throat
• Stoamtitis
• Regional lymphadenopathy
• Headache
• Arthritis
• Cutaneous infection
• Conjunctivitis

Cyclic neutropenia Oral Manifestations:

• Severe gingivitis
• Stomatitis
• Aphthous tike ulceration
• Serve gingival recession
• Rapid alveolar bone loss
• Tooth mobility
• Cyclic neutropenia

Cyclic neutropenia Diagnosis

Question 5. Agranulocytosis
Answer:

Agranulocytosis

Agranulocytosis is a serious acute leukopenia characterized by a significant decrease in neutrophil count

Agranulocytosis Etiology:

• Toxic effects of drugs
• Ionizing radiation
• Tuberculosis
• Typhoid fever
• Malaria

Agranulocytosis Clinical Features:

• Occurs at any age- common in adult women
• High fever with chills and sore throat
• Malaise, weakness
• Pallor skin
• Regional lymphadenopathy
• Severe dysphagia
• Urinary tract infections
• Weak and rapid pulse

Agranulocytosis Oral Manifestation:

• Necrotizing ulcerations Involving gingiva, soft palate, tonsils, lips, pharynx, and check.
• Gingival Weeding
• Excessive salivation
• Dysphagia
• The halitosis-Excessive tendency for secondary Infections
• Acute necrotizing ulcerative gingivitis
• Opportunistic fungal infections

Agranulocytosis Treatment:

• Elimination of causative factors
• Antibiotics
• Vitamin
• Antipyretics
• High-caloric soft diet

Question 6. Iron deficiency anemia
Answer:

Iron deficiency anemia

Iron deficiency anemia is a chronic, microcytic, hypochromic anemia

Iron deficiency anemia Etiology:

• Chronic blood loss
• Inadequate dietary intake
• Faulty iron absorption
• Increased demand for iron

Iron deficiency anemia Clinical Features:

• Fatigue
• Palpitations
• Dizziness
• Sensitivity to cold
• Generalized weakness
• Lemon-tinted pallor skin
• Koilonychia- spoon-shaped nails

Iron deficiency anemia Oral Manifestations:

• Pallor of oral mucosa
• Loss of keratinization of gingiva
• Atrophic mucositis
• Atrophic glossitis
• The tongue appears smooth, bald, and red with a burning sensation
• Abnormal bleeding from ulcers
• Angular cheilitis
• Delayed wound healing

Iron deficiency anemia Diagnosis:

• Peripheral blood smear- shows microcytic, and pale RBCs
• Hemoglobin level- reduced
• RBC count- reduced
• Serum iron- reduced
• Total iron binding capacity- elevated
• MCV, MCH, and MCHC- reduced
• Hemosiderin- absent

Iron deficiency anemia Treatment:

• High protein diet
• Replacement of iron by 300 mg ferrous sulfate tablet, 3-4 tablets per day for 6 months

Question 7. Plummer-Vinson syndrome
Answer:

Plummer-Vinson syndrome

• It is a feature of iron deficiency anemia
• It mainly occurs in women in the 4th-5th decade of life
• It consists of a triad of symptoms
  • Angular cheilitis
    • Cracks or fissures at the corners of the mouth
  • Glossitis
    • Smooth, red, and painful tongue
    • Atrophy of filiform and fungiform papillae
  • Dysphagia
    • This leads to the limitation of diet to a soft diet
    • Such patients are susceptible to oral cancers and pre-cancers

Question 8. Sickle cell anemia
Answer:

Sickle cell anemia

Sickle cell anemia is a hereditary type of chronic hemolytic disease

Sickle cell anemia Clinical Features:

• More common in females younger than 30 years
• Fever
• Weakness, fatigue
• Shortness of breath
• Joint pain
• Abdominal pain
• Nausea, vomiting, loss of appetite
• Systolic murmur
• Cardiomegaly
• Jaundice
• Loss of consciousness-sickle cell crisis
• Increased susceptibility to infection
• Renal failure
• Hypoxia, hypothermia

Sickle cell anemia Diagnosis:

• Total RBC count-reduced
• Hemoglobin level-reduced
• Serum unconjugated bilirubin-raised
• Presence of Hb-S in blood

Question 9. Rh pump
Answer:

Rh pump

• Rh pump is the term by Waston
• It is seen in erythroblastosis fetalis
• Enamel hypoplasia involves the p[ortion of the deciduous cuspid and first molar crown
• This results in a characteristic ring-like defect
• This is called the Rh pump

Question 10. Eosinophilic granuloma

Answer:

Eosinophilic granuloma

• Eosinophilic granuloma was introduced by Lichtenstein
• It describes a lesion of bone which is primarily a histiocytic proliferation with an abundance of eosinophilic leukocytes

Eosinophilic granuloma Clinical Features:

• Initially asymptomatic
• Later causes local pain, swelling, and tenderness of the involved bone
• General malaise, weakness
• Fever
• Sites Involved are:
• Skull
• Mandible
• Femur
• Humerus
• Ribs

Eosinophilic granuloma Treatment:

• Surgical currettage
• Radiotherapy

Question 11. Polycythaemia
Answer:

Polycythaemia

It is a chronic stem cell disorder with an insidious onset

Polycythaemia Clinical Features:

• Headache
• Dizziness
• Weakness, lassitude
• Tinnitus
• Visual disturbances
• Mental confusion
• Slurring of speech
• Inability to concentrate
• Flushing or diffuse reddening of skin

Polycythaemia Oral Manifestations:

• Oral mucosa appears deep purplish red
• Cyanosis
• Gingiva are often engorged and swollen and bleed easily
• Submucosal petechiae
• Hematoma formation
• Increased susceptibility to infections

Question 12. Purpura
Answer:

Purpura

Purpura is defined as purplish discoloration of the skin and mucous membrane due to spontaneous extravasation of blood

Purpura Types:

• Non-thrombocytopenic purpura
• Thrombocytopenic purpura
• Primary purpura
• Secondary purpura

Purpura Clinical Features:

• Commonly occurs in females below 40 years of age
• Petechiae, ecchymosis
• Hematoma formation
• Purpuric spots
• Excessive gingival bleeding
• Blister formation over oral mucosa
• Excessive bruising
• Epitaxis
• Hematuria
• Melena and hematemesis
• Spontaneous bleeding
• Prolonged bleeding per surgery or injury
• lnlmerenlel bleeding

Question 13. Strawberry tongue
Answer:

Strawberry tongue

• It Is the oral manifestation of scarlet fever
• The tongue exhibits a white coating
• Fungiform papillae are edematous and by pernnomlc
• The project above the surface of the tongue as small red knobs
• So-called strawberry tongue

Question 14. Thalassaemia
Answer:

Thalassaemia

Thalassaemia is a genetically determined disorder of hemoglobin synthesis with decreased production of either alpha or beta polypeptide chain of the hemoglobin molecule

Thalassaemia Clinical Features:

• Jaundice
• Fever with chills
• Anaemia
• Malaise with generalized weakness
• Hepatosplenomegaly
• Bone marrow hyperplasia
• Leg Ulcers
• Severe infections in tissues
• Mongloid prominent forehead, depressed time bridge, prominent cheekbones, protrusion of maxillary anterior teeth, and slanting eyes
• High cardiac failure
• Xerostomia
• Severe malocclusion
• Retracted upper lip
• Discoloration of teeth

Question 15. Hair on-end appearance
Answer:

Hair on-end appearance

• It is a radiographical feature of the skull bone
• Appears as a thin, poorly defined inner and outer cortex of the bone
• Trabeculae between them are coarse, elongated and bristle-like
• This produces hair with an end appearance
• Seen in
  • Thalassemia
  • Sickle cell anemia

Question 16. Chloroma
Answer:

Chloroma

• It is a solid collection of leukemic cells occurring outside of bone marrow
• Seen in
  • Acute myeloid leukemia
  • Myeloproliferative
  • syndrome
  • Eosinophilic leukemia

Chloroma Clinical features

• Skin lesions appear as raised, nontender plaques or nodules
• Oral lesions appear as swollen and painful gingiva that bleeds profusely

 

Diseases Of Blood And Blood Forming Organs Viva Voce

1. Rh hump is seen in erythroblastosis fetalis
2. The bald tongue of the sandwich is a feature of pernicious anemia
3. Howell Jolly bodies are seen in pernicious anemia
4. Safety pin cells are seen in thalassemia
5. Sickle cell anemia occurs due to the substitution of valine for glutamic acid of the sixth position of the beta globulin chain
6. Philadelphia chromosome is seen in chronic myeloid leukemia
7. Most common form of leukemia in children is acute lymphocytic leukemia
8. Splenomegaly of moderate grade is seen in acute leukemia
9. Massive splenomegaly is seen in chronic leukemia
10. Purplish discoloration of skin occurs in purpura
11. The presence of Hb-S is seen in sickle cell anemia
12. Hunter’s glossitis is seen in pernicious anemia