Hematological System. Acute
and chronic leukemia.
Implications on Dental Practice.
Classification of acute leukemias
Pathogenesis acute leukemias
• Cells lose ability to
differentiate – blast
stage, don’t function
effectively
• Cells divide
uncontrollably – other
cells “crowded out”
what leads to
cytopenias
Pathogenesis chronic leukemias
• Cells mature only
partially
• Cells don’t work
effectively
• Other cells “crowded
out” what leads to
cytopenias
Clinical Features
• Fatigue (anemia)
• Easy bleeding (thrombocytopenia)
• More infections (leukopenia)
• Hepatosplenomegaly
• Lympadenopathy
• Other manifestations are stomatitis, sternal
tenderness, testicular enlargement and
infiltration of skin and meninges
Gum hyperplasia in AML
monocytic subtype (M4, M5) of AML
Investigations
• Blood examination
• A bone marrow examination
(more than 20% of the cells in
ALL, AML or blast phase of
CML)
• immunophenotyping and
chromosome and molecular
analysis (prognosis)
IMPLICATIONS ON DENTAL PRACTICE
• Oral bleeding, oral ulcers, gingival infiltrates, oral infections and
cervical lymphadenopathy may be the presenting features of
leukemias. Hence, the dentist may be the first clinician to suspect
the disease
• The transfusion of blood and blood components should be done if
absolutely necessary to avoid the risk of transfusion-associated
infections such as HIV, hepatitis B, hepatitis C, syphilis, malaria,
cytomegalovirus and parvovirus