Term
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Definition
- Follows allogenic bone marrow transplantation
- Caused by TH17 cells - a type of T lymphocyte
- Leukemia, aplastic anemia, agranulocytosis, genetic metabolic storage disease, hemolytic anemia
- Marrow destroyed w/ chemo and/or radiation
- transplant cells engraft and reject the host
- Some degree of GVHD expected w/ any allogenic transplant
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Term
| Mechanism of Graft vs. Host disease |
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Definition
- Often mediated by T cells & assoc w/ bone marrow transplantation
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Term
| Acute Graft vs. Host disease |
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Definition
| Occurs w/in 100 days, 50%; diarrhea, dermatitis, malabsorption, jaundice |
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Term
| Chronic graft vs. host disease |
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Definition
| occurs 3-15 mos after; 30-70%, produces changes similar to progression systemic sclerosis |
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Term
| Oral manifestations of graft vs. host disease |
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Definition
Oral mucosa: lichenoid mucositis, epi atrophy, erosions, ulcerations
Salivary glands: xerostomia/salivary gland hypofunction; multiple mucoceles |
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Term
| Histopathology of graft vs. host disease |
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Definition
| resembles lichen planus w/ epi atrophy, lymphocytic infiltrates, basal cell layer degeneration; salivary glands exhibit acinar atrophy & fibrosis |
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Term
| Treatment for graft vs. host disease |
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Definition
Prevention w/ cyclosporine, methotrexate, prednisone
Oral cavity: topical steroids, CHX, salivary stimulant for xerostomia |
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Term
| Prognosis for graft vs. host disease |
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Definition
Mild: 70% 6 yr survival rate
Severe: 15% 6 yr survival rate |
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Term
| Diseases of coagulation & platelets |
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Definition
- Defective production-marrow infiltration, megaloblastic anemia, marrow suppression
- Idiopathic thrombocytopenia-autoimmune
- Consumption of platelets - DIC
- Plately dysfunction uremia, chronic liver disease, myeloma, anti-platelet drugs
- Increase in platelet number: neoplasms=thrombocytopenia or reactive-thrombocytosis
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Term
| Definition of non-thrombocytopenia purpura |
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Definition
| Bleeding disorders due to mainly vascular abnormalities |
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Term
| Etiology of non-thrombocytopenic purpura |
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Definition
- Autoimmune (allergic, drug-induced, purpura fulminans)
- Infections: bacterial, viral, rickettsial, protozoal
- Structural malformations: HHT, Ehlers=Danlos, osteogenesis imperfecta, pseudoxanthoma elasticum
- Miscellaneous: autoerythrocyte sensitization, Waldenstrom's macroglobulinemia, snake venom, amyloidosis, Kaposi's sarcoma, etc.
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Term
| Thrombotic thrombocytopenic purpura pts have... |
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Definition
- Thrombocytopenia
- Hemolytic anemia
- Fever
- Transitory neurologic dysfunction
- Renal failure
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Term
| Diagnosis of thrombotic thrombocytopenic purpura |
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Definition
| Gingival biopsy (fibrin deposits in small capillaries in 30-40% of gingival biopsies) and/or lab coagulation studies |
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Term
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Definition
- Qualitative defect of platelets, usually w/ a normal platelet count
- Defective aggregation - increased bleeding time
- Rare
- Hereditary = familial thrombasthenia (Glanzmann's Disease)
- Acquired = uremia |
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Term
| Differential diagnosis of oral petechiae |
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Definition
| Trauma, platelet abnormalities quantitative, qualitative platelet abnormalities, clotting factor abnormalities, vascular integrity abnormalities |
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Term
| Thrombocytopenia definition |
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Definition
- Decreased #s of platelets
- Reduced production
- Increased destruction
- Sequestration in spleen
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Term
| Characteristics of thrombocytopenia |
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Definition
Etiology: unknown
Immune may follow viral infection esp in children
100,000 mm3 bleeding clinical features bleeding
Life-threatening when <10,000
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Term
| Treatment for thrombocytopenia |
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Definition
Discontinue offending medication
Platelet transfusion
Steroids
IV immunoglobulin |
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Term
| Prognosis of thrombocytopenia |
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Definition
Variable
ITP: may resolve spontaneously
TTP: plasmaphoresis, exchange transfusion 70% survive |
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Term
| Defects in vascular integrity |
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Definition
1. Scurvy (vitamin C deficiency)
2. Hereditary hemorrhagic telangiectasia
3. CREST
4. Schamberg's disease
5. DIC
6. Waterhouse-Frederichsen syndrome
7. Infectious endocarditis
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Term
| Clotting factor abnormalities |
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Definition
- Acquired: Vit K deficiency, anticoagulent therapy
- Hereditary: hemophilia, plasminogen deficiency |
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Term
| Oral manifestations of hemophilia |
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Definition
| TMJ hemarthosis, Oral hemorrhage, hematoma, pseudotumor |
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Term
| Pseudotumor of Hemophilia |
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Definition
Clinically and radiographically mimics neoplasia
Pressure necrosis secondary to intraosseous hemorrhage |
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Term
| Histology of pseudotumor of hemophilia |
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Definition
| Granulation tissue, hemorrhage, fibroblastic proliferation, osteoid formation, new bone formation |
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Term
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Definition
- Glycoprotein for platelet adherence
- Autosomal dominant or recessive, several subtypes, variable clinical expression |
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Term
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Definition
| Factor replacement therapy, avoid trauma, avoid aspirin, epsilon-aminocapoic acid antifibrinolytic agent to prevent clot degradation before & after surgery, Desmopression-VW type 1 |
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Term
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Definition
| Variable, hemorrhage, hepatitis, HIV, Antibody or inhibitor formation in 5-15%, genetic counseling |
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Term
| Complications to consider for dental treatment in hemophiliac patients |
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Definition
1. type and severity
2. Presence of inhibitor in factor concentrate
3. Pt's home therapy
4. Family history
5. Previous dental experience |
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Term
| Plasminogen deficiency/Ligneous disease synonyms |
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Definition
| Plasminogen deficiency, amyloidaceous ulcerated gingival hyperplasia, ligneous conjunctivitis, destructive membranous periodontal disease (ligneous periodontitis) |
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Term
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Definition
- Autosomal recessive, chronic membranous conjunctivitis
- Larynx, nose, cervix, hyperplastic gingivitis
- Negative for glycogen, lipid, amyloid
Positive for fibrin, immunoglobulin and albumin
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Term
| Destructive Membranous Perio disease (ligneous periodontitis) |
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Definition
- Defective fibrinolysis & abnormal wound healing; plasminogen deficiency
- Treatment: replacement fibrinogen, meticulous OH
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Term
| Diagnosis for destructive membranous periodontal disease |
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Definition
Blood tests for:
- Plasminogen antigenic
- Plasminogen activator inhibitor-1
- Plasminogen activity |
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Term
| Chronic fibrosing osteomyelitis/Neuralgia-inducing cavitational osteonecrosis (NICO) |
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Definition
| Degeneration and death of bone marrow from diminished blood flow --> ischemic osteonecrosis --> chronic pain |
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Term
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Definition
| Dental infections, vasoconstrictor in local anesthetics, hypercoagulation (81%) |
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Term
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Definition
Selective anesthesia, identification of coagulopathy, hyperlipidemia, osteoporosis
Biopsy: marrow fibrosis, edema, hemorrhage |
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Term
| Treatment and prognosis for NICO |
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Definition
| 72% respond to surgery (curettage), treatment of underlying problems, recalcitrant to treatment |
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Term
| Chronic fibrosing osteomyelitis conclusions |
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Definition
- Pathophysiology of jaw osteonecrosis is still unclear
- Prothrombotic conditions appear to contribute to its development
- Nitric oxide deficiency may play a role as well
- Anticoaguatlion has not been proven to improve outcomes
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