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Some Important Concepts
Some Important Concepts
Some Important Concepts
Folate deficiency
Anemia
Blood loss Usually chronic blood loss
M
F
41-50 36-45
Normal Values:
Men 41.5-50.4%
Women 35.9-44.6%
Classification of anemia by pathogenesis
Blood Loss Anemias
Hemolytic anemias
Bone Marrow
Hypoproliferative anemias
Celiac disease
Helicobacter Pylori
Blood loss anemias
Food
Liver, meat, green vegetables, legumes,
nuts, egg yolk whole grain or enriched
breads, cereals
Supplements
Vitamins
▪ Elemental iron in iron supplements
Ferrous fumarate 33%
Ferrous gluconate 11.6%
Ferrous
Ferrous SO4 20%
Ferrous sulfate, dessicated 30%
Iron interferes with absorption of: tetracyclines, quinolones, levothyroxine, pencillamine, levodopa. Wait 2 hrs
between drugs.
Hemolytic anemias
G6 PD deficiency anemia
Due to a deficiency of an enzyme in the hexose
monophosphate shunt pathway
Found in 400 M persons worldwide
11% of African Americans (has an association with SCA)
Very prominent in persons of Mediterranean origin
Blockage of this pathway allows accumulation of
oxidants in the RBCs with altered cell
membranes and resulting hemolysis
Hemolytic episodes can be triggered by infection,
drugs and foods (fava beans)
Aspirin, dapsone, ascorbic acid, vitamin K
Disorders of the hemoglobin
•When the red blood cell is subjected to a low oxygen tension the hemoglobin will
form a sickle-shaped crystal within the erythrocyte
In patients with SCA the normal molecule is substituted for 75-100% hemoglobin S
(substitution of the a.a.)
In patients with the sickle cell trait 20-35% of the hemoglobin is S, the rest
is normal hemoglobin A
Patients with the “trait: usually have a normal life with mild symptoms,
except under ABNORMAL low oxygen conditions
Disorders of hemoglobin
Thalassemias
Due to a genetic defect in either the α- or
β-globin chain of hemoglobin resulting in
diminished survival of RBCs
Common in persons of Mediterranean,
African and Southeast Asian ancestry
β-thalassemia treated with blood
transfusion, folic acid supplement and
ascorbic acid, and possibly splenectomy
Hypoproliferative anemias
•Vitamin B12 deficiency along with folic acid deficiency falls under the
group: MEGALOBLASTIC ANEMIAS
•Foods of animal origin are the primary dietary sources of Vitamin B12
Pernicious Anemia
Pernicious Anemia
-In 85% of the patients serum antibodies to the gastric parietal cells are
noted
•Pallor
•Atrophic tongue
•Glossodynia
Plummer-Vinson Syndrome
•Xerostomia
•Angular stomatitis
•Koilonychia
•Atrophic changes are not limited to the oral cavity pharynx, upper GI
•Marked underdevelopment
•Delayed eruption
Thalassemia
•Bimaxillary protrusion
-Pharyngitis
-Ulcerative Stomatitis
-Angular cheilitis
•In children Vitamin B12 deficiency often presents with non-specific symptoms
•Systolic murmurs
•Glossodynia
•Atrophic tongue
Anemia
Dental Management of Patients with Anemia
General issues:
Patients with severe anemia may not tolerate blood loss or hypoxia
Patients with anemia may not tolerate certain drugs
Patients with anemia may not handle infection well
1. CBC with differential in who patient presents with sign and symptoms
of anemia
Cautious use of nitrous oxide analgesia in patient with sickle cell anemia;
ensure good oxygenation at all times
G-6-PD Deficiency
Avoid the use of aspirin
The end