Anemia and Hematologic Disorders: Clinical Manifestations

Microcytic Hypochromic Anemia

1. Iron Deficiency Anemia

Causes

• Physiological: Nutritional deficiency, menstrual iron loss, pregnancy, blood donation, gastrointestinal bleeding.
• Pathological: Excessive blood loss (peptic ulcers, carcinoma), excessive uterine bleeding.

Clinical Features

• Fatigue, pale oral mucosa/lips/eyes, koilonychia, sparse hair.

Oral Manifestations

• Glossitis, stomatitis, angular cheilitis, oral candidiasis, aphthous ulcers.
• Treatment: Ferrous sulfate, eliminate underlying cause.

2. Thalassemia

Also known as Cooley's anemia. Features include kyphosis, dark urine, and jaundice.

Oral Manifestations

• Spiky short roots, taurodontism, enlarged bone marrow, parotid gland swelling (iron deposition), caries.
• Treatment: Deferoxamine mesylate, RBC transfusion.

Macrocytic Hyperchromic Anemia

1. Pernicious Anemia

Vitamin B12 deficiency leading to megaloblastic anemia.

Clinical Features

• Spinal cord degeneration, numbness of extremities, impaired sense of smell, depression, psychosis.

Oral Manifestations

• Burning sensation, smooth tongue, altered taste, aphthous ulcers, dysphagia.
• Treatment: IM hydroxocobalamin.

2. Folate Deficiency

Vitamin B9 deficiency affecting DNA synthesis.

Clinical Features

• Pallor, sore tongue, aphthous ulcers, loss of appetite, weakness, headache.

Normocytic Anemia

1. Sickle Cell Anemia

Clinical Features

• Infection, pain, acute chest syndrome, strokes, retinitis/blindness.

Oral Manifestations

• Stepladder trabeculae pattern, radiopaque lesions, increased overbite/overjet, pale mucosa, inferior alveolar nerve anesthesia.
• Treatment: Antibiotics, NSAIDs, avoid general anesthesia.

2. Aplastic Anemia

Absence of blood production.

Clinical Features

• Anemia, thrombocytopenia, leukopenia.

Oral Manifestations

• Oral hemorrhage, petechiae, candidiasis.
• Treatment: RBC transfusion, bone marrow transplant.
• Dental Management: Antifibrinolytic drugs, avoid nerve blocks, use antibiotics.

White Blood Cell Disorders

1. Agranulocytosis

Clinical Features

• Malaise, fever, pharyngitis, difficulty swallowing.

Oral Manifestations

• Deep ulcers without erythema, periodontal disease (ANUG), increased salivary flow, halitosis, osteoporosis.
• Treatment: Antibiotics, oral hygiene.

2. Cyclic Neutropenia

Oral: Recurrent oral ulcers, major aphthous ulcers. Treatment: Repeated CBC, oral hygiene.

3. Leukemia

General Features

• Anemia, infection, bleeding, suppressed platelet production, DIC.

Acute Oral Manifestations

• Gingival swelling, mucosal ulcers, leukemia deposits, purpura, delayed healing, mucosal pallor, cervical lymphadenopathy, osteolytic lesions.
• Treatment: Oral hygiene, chlorhexidine, antibiotics, folic acid, avoid extractions.

Chronic Oral Manifestations

• Mucosal pallor, gingival swelling, purpura, ulcers.

4. Multiple Myeloma

General Manifestations

• Osteolytic lesions, bacterial infection, pancytopenia, systemic amyloidosis, hypercalcemia, hyperviscosity, renal failure.

Oral Manifestations

• Jaw lesions, soft tissue lesions, hemorrhage, bacterial infection.