Some common hematological medical diseases encountered in dental clinics

• Hematological disorders-

1. Anaemia
2. Thalassaemia
3. Polycythemia Vera or Primary Polycythemia
4. Disseminated intravascular coagulation
5. Leukemia
6. Thrombocytopenia (quantitative disorder of platelets)
7. Thromboasthenia (qualitative disorder of platelets)
8. Haemophillia A/B
9. VWD
10. Liver disorders
11. Vitamin k deficiency 

• Anaemia-Hemoglobin level is below the normal range in a given individual on the basis of age and sex.
• Thalassaemia-Thalassemia  is an inherited blood disorder that causes your body to make less hemoglobin.There are two types of thalassaemia-Alpha(major/minor) ; Beta (major/minor).
• Polycythemia Vera-Increased production of all type of blood cells-R.B.C,W.B.C and platelets.This makes blood thick.
• DIC- In DIC, the body's natural ability to regulate blood clotting does not function properly. This causes the blood's clotting cells (platelets) to clump together and clog small blood vessels throughout the body. This excessive clotting damages organs, destroys blood cells, and depletes the supply of platelets and other clotting factors so that the blood is no longer able to clot normally. This often causes widespread bleeding, both internally and externally.
• Leukemia-When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. They don't do the work of normal white blood cells, they grow faster than normal cells, and they don't stop growing when they should.Over time, leukemia cells can crowd out the normal blood cells. This can lead to serious problems such as anemia, bleeding, and infections. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain.
• Thrombocytopenia-Decreased platelets count.
• Thromboasthenia-Normal platelet count but still there is defective haemostasis as in case of drugs intake like aspirin;VWF;splenomegaly.
• Haemophillia-Deficiency of clotting factors.(VIII in haemophillia A & IX in haemophillia B)
• VWD-There is decrease in von willibrand factor in blood.This factor is must for the maintenance of factor VIII & also for platelet aggregation.
• Liver disorders-Liver is must for the production of clotting factors.so any insufficiency can affect the normal clotting process.Thrombocytopenia can be seen in cirrhosis.
• Some common blood test-

1. Bleeding time (B.T) - Normal B.T=2 to 6 minute Increased in DIC,Leukemia,Thrombocytopenia,Thromboasthenia,VWF
2. Clotting Time (C.T)- Normal C.T=5 to 15 minute Increased in Haemophillia,VWF,DIC
3. PT-monitors extrinsic pathway (amount of factor III,VII,V) Normal value 10-12 sec.
4. PTT-monitors intrinsic pathway(VIII,IX,XI,XII) normal values 25-38 sec.
5. C.B.C- Normal R.B.C- 4-6 million/mm cube of blood                                                                          Normal W.B.C- 4000-11000/mm cube of blood                                                                         Normal Platelet count- 150000-400000/mm cube of blood                                                                Normal Hb- Female 14gm/dl  male 16 gm/dl                                                                           Haematocrit-The hematocrit measures how much space in the blood is occupied by red blood cells. It is useful when evaluating a person for anemia. Males-40%-54% Females-37%-47%                                                     WBC differential- Neutrophil- 40-75%  Lymphocyte- 15-45%  Monocytes- 1-10%  Eosinophils- 1-6% Basophils-0 - 2%

• Neutrophil- Normal value 1500-7000 cells/mm cube.Increases in bacterial infections.Decreases in Viral infection.                                                                                                                                           1000-1500cells/mm cube = Mild chances of infection chances

          500-1000 cells/mm cube=Moderate chances of infection

          Less than 500 cells/mm cube=severe chances of infection.                                                                                                In case of mild or moderate neutropenia before every dental procedure make patient use non alcoholic mouthwash gargle.Administer systemic antibiotics even after the treatment.In case of severe neutropenia neutrophils can be administered.

• Lymphocyte count increases in viral infections.
• Eosinophils increase in allergies,parasitic infections
• Normal platelet count-150000-400000/mm cu

When platelet count goes below 150000 than its called as throbocytopenia.For major surgeries count should be 100000/mm cube.For oral and periodontical surgeries normally platelet should be 75000/mm cube.For minor dental procedures paltelet count should be about 50000/mm cube.Spontaneous bleeding occurs when count is below 20000/mm cube.Such cases need platelet rich plasma.

Idiopathic thrombocytopenia-auto antibodies against platelets cells

• Anemia- 

Iron deficiency anemia,Thalesemia: MCV;MCH;Hematocrit;Hb all decreases.

Folic acid deficiency/vit.B12 anemia:MCV;MCH increases but Hb;Haematocrit decreases.

Aplastic anemia:MCV and MCH all are normal.Hb & hameatocrit decreases.

Differ routine dental t/m in case of severe anemia(Hb less than 50%)

• Drugs which affect platelets-

Quality-Aspirin,indomethcin,phenylbutazone,sulphinpyrazone (NSAIDS COX inhibitors)

Quantity-Quinine,sulfonamide drugs(Thiazide diuretics,sulfonylurease),rifampicin,cytotoxic drugs(chemotherapy)

• Immediate bleeding-Beyond 24 hours of operation or surgery.Defect in platelets.

          Delayed bleeding-after 4 or 10 days of operation.Defect in clotting factors.

• Thalassaemia-If there are repeated blood transfusions, it’s possible for body to get too much iron. This can damage organs, especially the liver. Make sure to avoid vitamins that contain iron, and don't take extra vitamin C, which can increase how much iron absorbed from food. If there is too much iron, you can give chelation therapy.