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Blood disorders & nutritional deficiency.docx

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‫الرحيم الرحمن هللا بسم‬ Blood disorders & nutritional deficiency In this lecture we'll Talk about Blood disorders & nutrition deficiency and their oral manifestations :…. Introduction: Blood disorders and nutritional deficiencies do have oral manifestations , and sometimes the manifestations are solely oral before other symptoms appear… Blood disorders and nutritional deficiencies might be manifested in the oral cavity very early in the disease process before any symptoms or signs appear o
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  مس ا   نحرل ميحرل Blood disorders & nutritional deficiency In this lecture we'll Talk about Blood disorders & nutrition deficiency and their oral manifestations :….   Introduction:  Blood disorders and nutritional deficiencies do have oral manifestations , and sometimes the manifestations are solely oral before other symptoms appear…    Blood disorders and nutritional deficiencies might be manifested in the oral cavity very early in the disease process before any symptoms or signs appear on t he pt.. that’s why you should understand this topic well. Anemias :  Definition of anemia: reduction in the concentration of hemoglobin (Hb) below normal for age and gender..   You know that the normal value of (hb) conc. differs among different age groups (between newborns and adults) for many reasons , and for different gender( males and females) for other reasons . **Anemia is different from iron deficiency Anemia related to hemoglobin and iron deficiency related to level of ferritin    You know that hemoglobin (hb) is carried on the RBCs , so all factors which affect RBCs would indirectly affect hemoglobin as well :-  –  Reduction in concentration of Hb..( NO or retarded Hb formation) .  –  Reduction in the number of RBCs. .( thus reduced amount of Hb).  –  Reduction in the function of RBCs..  –  Alterations in the shape of RBCs.. (the altered RBCs would not last for long in the circulation and would be destroyed easily thus we'll end up in reduction of both RBCs and (Hb) conc.)   So all these factors would lessen Hb) concentration leading to anemia. TYPES of Anemia :  FIRSTLY :M EGALOBLASTIC MACROCYTIC ) ANAEMIAS :  resulting from deficiency in :  –     Vitamin B12…    –    Folic acid…    Usually pts who have B12 deficiency there's high possibility to have folic acid deficiency as well if its due to dietary reasons… they are exclusively exist in animal products   WHY pts with B12(/folic acid) deficiencies would have low (Hb) levels (anemia)??? B12/folic acid are essentials for the production of RBCs , so less B12/folic acid means low RBCs production  low Hb conc…   Megaloblastic anemia can be caused by either 2 mechanisms :  low B12 intake: 1. Obligatory   pts who don’t take enough animal products in their diet because of famines or poverty…  2. Voluntary   people who are strict vegetarians must be B12 deficient..  absorption : - Pts with problems in the absorption of B12 although they take good or enough dietary amounts of it.. - you all know that vit B12 to be absorbed needs intrinsic factor  which's produced by parietal cells present in the stomach and the upper part of the small intestine ,so if these parietal cells are destroyed due to either autoimmune disease or surgery there will be no intrinsic factor ,so the intake of B12 wont be absorbed …  in this case we cannot treat the pt by giving oral vit B12 supplements because the intrinsic factor that's responsible in the absorption of vit B12 is already not there( we usually give it by injections).. - in the case above where the anemia is caused by vitamin B12 deficiency due to lack of intrinsic factor this type of anemia is called Pernicious anemia, so pernicious anemia is a type of macrocytic anemia .  - patients with Crhon’s disease or Cealiac disease , those pts usually have defection in the absorption of all nutrients (multiple deficiencies syndrome) including B12 due to abnormality in the  whole intestine.. -  To diagnose a case of macrocytic anemia you need 1. CBC (complete blood count /or what's called FBC full blood count ), 2. Blood film …  - what we see in the blood film is Macrocytic (cells with big sizes) normochromic cells (normally- stained RBCs)…why these cells appear macrocytic???  because B12 is essential in the maturation of the RBCs and all these cells are premature that’s why they appear  big.. - long-standing B12 deficiency anemia may eventually ends up with iron deficiency anemia ( where the cells appear microcytic) because of decrease in RBCs production , in this case when you do blood film you'll be confused because you may see some macrocytic cells (due to b12 def.) and other microcytic cells (due to iron def) & the MCV will be normal Treatment of vitamin B12 deficiency:  If it's due to low B12 intake  Oral  vitamin B12 therapy & improve diet…    if it's pernicious anemia oral supplements won't be effective so : - injections of 1000 mg of hydroxocobalamin or cyanocobalamin and after achieving the normal level of B12 we put the pt on life-long  maintenance therapy (  1000 u g hydroxocobalamine injection every 2 months(bi-monthly) for the rest of the life ? How to recognize whether this B12 deficiency is due to low dietary intake or absence of intrinsic factor …? Using schilling test..    SECONDLY : I RON DEFICIENCY ANAEMIAS : - It’s the most common type among anemias…  - It has many mechanisms, and a single pt may present with more than one mechanism…   Mechanisms of iron deficiency anemia are :  ã Excessive loss of RBC:   The most common mechanism in iron deficiency anemia..  post-hemorrhagic anemia  - It could happen in acute Haemorrhage  where there's excessive blood loss over short period of time (like in case of accidents or deep cut injuries) …  - or in chronic blood loss in which there is small amount of blood loss but for along period ending eventually with anemia (it could happen in case of Hemorrhoids or in females with heavy period for longtime )  ã Excessive destruction of RBCs :  (hemolytic anaemia)  normally RBCs are renewed every (100-120)days / but in pts with abnormal RBC shape (like in thalassemia or sickle cell anemia) there's rapid or early destruction of the RBCs (hemolysis) resulting in anemia..  ã Failure of production of RBCs:   You know that RBCs are formed in the bone marrow , so  Failure in RBCs production could be due to :  –    marrow aplasia  failure of RBCs production because of marrow aplasia (suppression)  (aplastic anaemia).  –    marrow hyperplasia   when there's dietary deficiency in iron ,bone marrow tries to compensate this deficiency by producing more RBCs ,this over-function of the marrow leads to marrow hyperplasia….but the marrow still couldn’t  
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