Anemia 1 decreased production of RBCs iron deficiency

Anemia (1) decreased production of RBCs (iron deficiency, folate deficiency, pernicious anemia) (2) blood loss (3) increased rate of destruction of circulating RBCs (hypersplenism, autoimmune destruction).

Iron Deficiency Anemia Microcytic anemia Causes: excessive blood loss poor iron intake poor iron absorption increased demand for iron

Sickle Cell Anemia sickle cell trait: heterozygous state, affected person carries one gene for sickle cell hemoglobin (Hb. S) sickle cell (disease) anemia: more than 80% of the Hb is Hb. S deoxygenation or decreased blood p. H: distortion od RBCs

Glucose-6 -Phosphate Dehydrogenase Deficiency enables the RBC to convert carbohydrates into energy via the hexose monophosphate shunt pathway G 6 PD: production of methemoglobin and denatured Hb, which leads to cell membrane alterations and hemolysis of the cell (hemolytic anemia)

Aplastic Anemia inability of the hematopoietic stem cells to proliferate, differentiate, or give rise to mature blood cells oral findings : petechiae, ecchymoses, mucosal pallor, ulceration (infection), gingival bleeding, and gingival hyperplasia

Folate Deficiency and Pernicious Anemia B 12 (cobalamin) and folic acid are needed for RBC formation Folate is needed for enzymatic reactions required for the synthesis of purines and pyrimidines of (DNA) and (RNA) and thus for the synthesis of proteins Pernicious anemia is caused by a deficiency of intrinsic factor, a substance secreted by the gastric parietal cells that is necessary for absorption of vitamin B 12 Autoimmune origin

Symptoms of Anemia fatigue tinnitus lethargy irritability palpitations dizziness shortness tingling of breath abdominal bone pain of fingers and toes muscular weakness

Signs of anemia jaundice pallor cracking, splitting, and spooning of the fingernails increased size of the liver and spleen lymphadenopathy blood in the stool

LABORATORY AND DIAGNOSTIC FINDINGS Hb level less than 12 g/d. L for women and less than 13 g/d. L for men microcytic (MCV <80 f. L [or μm 3]) macrocytic (MCV>100 f. L) normocytic (MCV of 80– 100 f. L) absolute reticulocyte count: below 75, 000/μL: hypoproliferative anemias greater 100, 000/μL indicates hemolysis or an appropriate erythropoietic response

MEDICAL MANAGEMENT In children, iron supplements (ferrous sulfate, 2– 6 mg/kg/day) gastrectomy, iron supplements (ferrous sulfate, ferrous fumarate, or ferrous gluconate) are provided on a longterm basis Folate deficiency : administering folic acid supplements and by increasing the intake of green, leafy vegetables and citrus fruits

sickle cell anemia: vaccination ( Streptococcus pneumoniae, Haemophilus influenzae, hepatitis B, and influenza) Penicillin prophylaxis is used for at least the first 5 years of life Treatment: Hydroxyurea (with or without erythropoietin), which induces production of Hb. F and thus prevents formation of Hb. S polymers Stem cell transplantation

DENTAL MANAGEMENT Hb levels should be above 11 g/d. L oxygen saturation more than 91% Contraindication in G 6 DH: sulphonamide (sulfamethoxazole), aspirin, chloramphenicol. Penicillin, streptomycin, and isoniazid Dental infection may accelerate the rate of hemolysis in G 6 DH oral infection can precipitate a crisis in sickle cell anemia

If infection occurs: it must be treated rapidly using local and systemic measures, such as incision and drainage, heat, therapeutic doses of appropriate antibiotics, pulpectomy, or extraction In sickle cell anemia: Barbiturates and narcotics should be avoided because suppression of the respiratory center by these agents leads to hypoxia and acidosis, which may precipitate an acute crisis In sickle cell anemia: Light sedation can be provided with midazolam (Versed) or nalbuphine hydrochloride

SCD General anesthesiais not recommended when the Hb level falls below 10 g/d. L High doses of salicylates should be avoided because the “acid” effect can precipitate a crisis Pain control: acetaminophen and small doses of codeine. prophylactic antibiotics : major surgical procedures to prevent wound infection or osteomyelitis Penicillin, amoxicillin and clindamycin delayed eruption of teeth, dental hypoplasia