Anaemia part 1 /orthodontic courses by Indian dental academy

ANAEMIA
PART -I
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.iniandentalacademy.com

LEARNING OBJECTIVES
 At the end of the lecture, the learner should be able to
understand –
 Definition of anaemia
 Classification
 Pernicious anaemia
 Aplastic anaemia

CONTENTS
 Definition of anaemia
 Classification
 Clinical features, oral manifestations and lab
investigations of –
Pernicious anaemia
Aplastic anaemia

ANAEMIA
 Defined as the reduction in the concentration of
circulating haemoglobin or oxygen carrying capacity
of blood below the level that is expected for healthy
persons of same age and sex in the same environment.

RED CELL COUNT

INTRODUCTION
 Erythrocytes or red blood cells are the non nucleated
formed elements in the blood.
 The red color of these cells is due to the presence of
the coloring matter – hemoglobin in these cells .

MORPHOLOGY
NORMAL SIZE
 DIAMETER : 7.2 µ ( 6.9 – 7.4 µ)
 THICKNESS : At the periphery it is
thicker with 2.2µ and at the center it
is thinner with 1µ. The difference in
thickness is because of the biconcave
shape.
 SURFACE AREA : 120 square µ
 VOLUME : 85 – 90 cubic µ

NORMAL SHAPE
 Normally, the red blood
cells are disc shaped
and biconcave.

CLASSIFICATION
PATHOPHYSIOLOGIC
1) Anaemia due to increased blood loss-
a) Acute post haemorrhagic anaemia
b) Chronic blood loss
2) Anaemia due to impaired red cell production
a) Cytoplasmic maturation defects
- Fe deficiency anaemia
- Thalaesemia
b) Nuclear maturation defects
- Megaloblastic anaemiawww.iniandentalacademy.com

c) Defect in stem cell proliferation and differentiation
- Aplastic anaemia
d) Anaemia of chronic disorders
e) Bone marrow infilteration
f) Congenital anaemia
- Sideroblastic anaemia
3) Anaemia due to increased red cell destruction
a) Extracorpuscular causes
- infections (malaria)
b) Intracorpuscular causes
- Lead posisoning
eg. Hemolytic anaemia

MORPHOLOGIC
1) MICROCYTIC, HYPOCHROMIC
- Red cells smaller than normal
- Fe deficiency anaemia
- Thalassemia
2) NORMOCYTIC, NORMOCHROMIC
- Red cells with normal size and colour
- After acute blood loss
- Hemolytic anaemia
3) MACROCYTIC, NORMOCHROMIC
- Red cells larger in size than normal
- Megaloblastic anaemiawww.iniandentalacademy.com

PERNICIOUS ANAEMIA
 First described by Addison in 1855.
 Also called as Addisonian Megaloblastic anaemia.
 Associated with gastric atrophy and loss of
intrinsic factor.
 Lack of absorption of vit B12
 Rare before the age of 30 years
 Females are commonly affected

Clinical Features
 Characteristic Feature
– Generalized weakness
– Sore and painful tongue
– Numbness or tingling of the extremities
– Patients with severe anemia shows yellowish tinge
of skin or/and sclera.

Other clinical features
1. Fatigability 6. Diarrhoea
2. Loss of appetite 7. Headache
3. Dizziness 8. Loss of weight
4. Nausea 9. Pallor
5. Vomiting 10.Abdominal pain
• Nervous system involvement- 75% cases
• Consists of weakness, stiffness, difficulty in walking,
general irritability, depression or drowsiness.

Oral Manifestations
– Glossitis
– Inflamed tongue
– Beefy red in color, either entirely or in patches
over dorsum and lateral border of tongue.
– Small ulcers resembling aphthous ulcers on tongue
– Gradual atrophy of papillae-Blad or smooth
tongue-Hunter’s glossitis or Moeller’s glossitis

Beefy red tongueAphthous like ulcers
Hunter glossitis

 Investigations:
– RBC- decreased
– Macrocytosis
– Poikilocytosis
– Serum vit B12 < 50ng/l
– Serum folate level
normal or high
– RBC folate level reduced

APLASTIC ANAEMIA
 It is a bone marrow failure syndrome characterized by
peripheral pancytopenia and general lack of bone
marrow activity.
 Two types:
1. Primary -unknown etiology, mostly in young adults,
develops rapidly and fatal.
2. Secondary - Known etiology, occurs at any age, good
prognosis, if cause is removed.

1) Drugs – methotrexate
2) Toxic substances – Benzene derivatives
3) Infections – EBV, AIDS, Infectious hepatitis
4) Miscellaneous – ( associated with SLE &
therapeutic X rays)
Causes of Sec.Aplastic anemia

 Onset usually gradual
 Some times sudden & of great severity
 Anemia – weakness, pallor, dyspnea
 Thrombocytopenia – pethicae & echymoses of skin
and mucous membrane
 Granulocytopenia – persistent minor infection or
chills and fever
Aplastic anemia – C/F

 Petechiae
 Purpuric spots or frank hematomas
 Bleeding gums
 Ulcerative lesions of oral mucosa or pharynx .(lack of
resistance to infection)
 Ulcerative lesions may
resemble gangrene
Aplastic anemia – oral manifestations

• RBC count low
• Reduced Hb
• Paucity of granulocytes, monocytes and reticulocytes.
• Pancytopenia
• Bleeding Time prolonged
• Clotting Time normal
• Marrow normal or hypocellular
Aplastic anemia – Investigations

CONCLUSION
ANAEMIA CLINICAL FEATURES LAB
INVESTIGATIONS
PERNICIOUS
ANAEMIA
• Weakness
• Sore and Painful tongue
• Beefy red tongue
• Hunters glossitis
• Ulcers
• Nervous system involvement
• RBC decreased
• Macrocytosis
• Poikilocytosis
• Serum folate level
normal or high
• RBC folate level
reduced.
APLASTIC
ANAEMIA
• Weakness
• Pallor
• Dyspnoea
• Petechiae
• Purpuric spots
• Ulcerative lesions
• Bleeding gums
• RBC count low
• Hb reduced
• Pancytopenia
• BT prolonged
• CT normal

REFERENCES
 Basic Pathology. Kumar, Cortan, Robbin. sixth
edition.
 Shafers Oral Pathology.
 Basics of hematology. Kwathilkar.3rd
edition.
 Neville Oral Pathology

Thank
You…..

Anaemia part 1 /orthodontic courses by Indian dental academy

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