Wbc disordes 2 /orthodontic courses by Indian dental academy

White Blood Cell Disorders
INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education
www.indiandentalacademy.com

OBJECTIVES
At the end of the lecture student should be able to
Describe etiology, clinical features, histopathological
features of cyclic neutropenia
features of infectious mononucleosis
features of leukemia

Cyclic neutropenia
Unusual form of agranulocytosis characterized by a
periodic or cyclic diminution in circulating
neutrophils as a result of bone marrow maturation
arrest
Mild clinical manifestations
Spontaneous regression
Rhythmic recurrences
Two hereditary form of disease :
• cyclic
• non cyclic

Clinical features
• Most commonly occurs in infants or young children, may
occur at any age
• Features are due to infection occurring during
neutropenic episode
• Fever, malaise, headache, sore throat, stomatitis,
regional lymphadenopathy, arthritis, cutaneous
infections, conjunctivitis
• Recurrent oral ulcers persisting for 10-14 days, heal with
scarring
• The episodes vary from 2-4 weeks weth 21 days most
common, the neutropenic period lasts for 3-5 days.

Oral & Dental Considerations
• Ulceration of oral mucosa – most common with ragged
necrotic ulcers covered by gray or black membrane,
commonly occur on the gingiva and hard palate
• Lack surrounding inflammation & are characterized by
necrosis
• Oral ulcers, advanced periodontal disease with rapid bone
loss, pericoronitis & pulpal infection – potentially life
threatening – can lead to bacteremia & septicemia

Palatal Ulcers In Neutropenia Thrush In Neutropenic Patient

Lymphopenia
• Lymphocytes <1500/cmm
• Causes:
1. Irradiation
2. Steroids and Immunosuppressive drugs
3. Hodgkin’s disease
4. Chronic uremia
5. Blood diseases: e.g. myelocytic leukemia

Infectious Mononucleosis ( kissing disease
)
• Caused by EPV
• Clinical picture: sore
throat, fever,
Lymphadenopathy ±
splenomegaly.
• Laboratory findings:
1. Absolute lymphocytosis
with atypical
lymphocytes
2. Monospot test: positive

Oral Manifestation
• Gingivitis & stomatitis.
• Edema of soft palate & uvula.
• Early manifestation : Petechial hemorrhages of soft
palate near the junction with hard palate.
• Bleeding from the gingiva.

leukemias
• The leukemia are a group of disorders characterized
by the accumulation of malignant white cells in the
bone marrow and blood.

Classified as :
• Lymphoid ( lymphoblastic, lymphocytic )
Leukemia : involving lymphocytic series.
• Myeloid ( myelogenous ) leukemia: involving
progenitor cell.
• it can be modified as

leukemias
• Classification of leukaemias:
• Acute:
- Acute myeloid leukaemia : M0-M7
- Acute lymphoblastic leukaemia: L1-L3
• Chronic:
- Chronic myeloid leukaemia
- Chronic lymphoid leukaemia

Leukemia
Acute Chronic
Lymphoid ALL CLL
Myeloid AML CML

leukemias
• Acute leukaemia is defined as the presence of over
20% of blast cells in the blood or bone marrow at
clinical presentation.
• It can be diagnosed with even less than 20% blasts if
specific leukaemia-associated cytogenetic or
molecular genetic abnormalities are present.

French-American-British (FAB)
classification of AML
Code Name % cases of all leukemias
M0 Minimally differentiated AML 2
M1 AML without maturation 20
M2 AML with maturation 30
M3 Acute Promyelocytic leukemia 5
M4 Acute Myelomonocytic leukemia 30
M5 Acute monocytic leukemia 30
M6 Acute erythroleukemia <5
M7 Acute megakaryocytic leukemia <5

French-American-British (FAB)
classification of ALL
Code Name Frequency
L1 Childhood ALL More common in children
L2 Adult ALL More frequent in adults
L3 Burkitt type ALL Uncommon

Clinical features
• Sex – male > female
Chronic leukemia
• more common in
middle aged &
elders
• Insidious onset
• protracted course
Acute leukemia
• more common in
children &
young adults
• Sudden onset
• Fatal in short
course

• Generalized constitutional symptom
• Signs of anemia
• Infections
• Subcutaneous & submucosal hemorrhages
• Generalized lymphadenopathy
• Hepatosplenomegaly, renal infiltration
• Bone pains, destructive lesions of bone including
Osteomyelitis & pathological fractures
• Frequent involvement of skin
• Chloromas
• Meningeal involvement, testicular swelling, mediastinal
compression

Oral manifestations
 Gingival hyperplasia in 80% of cases
 Ulcerations
 Sub mucosal hemorrhages
 Necrotizing infections

Gingival hyperplasia
• Boggy, edematous &
deep red gingivae
• Spontaneous bleeding or
bleeding on slightest
provocation

Palatal ulcer

Radiographic features of Leukemia
• There are multiple, round, well-defined and non-
corticated, and extended radiolucencies seen throughout
the body and ascending ramus of the mandible
bilaterally.
• The lesions themselves varied from 1–2 cm in diameter
may have a monolocular ‘‘punched-out’’ appearance.
• In certain areas, they appeared to have eroded the bony
cortex.

• Further radiological investigations were requested
and a lateral skull radiograph was taken
• The radiological signs of Leukemia include
disappearance of the inferior dental canal (IDC), an
increased periodontal ligament space, loss of lamina
dura and destruction of alveolar crestal bone

Dental panoramic radiograph of the patient. Arrows indicate
some of the punched-out radiolucent lesions in the mandible

Lateral skull radiograph of the patient. Arrows indicate
some of the punched-out radiolucent lesions

Summary
Student studied etiology, clinical features, histopathological
features of :
• cyclic neutropenia
• infectious mononucleosis
• leukemia

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

Wbc disordes 2 /orthodontic courses by Indian dental academy

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