Anemia

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Anemia

Vol. 95 No. 2 February 2003

ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY MEDICAL MANAGEMENT UPDATE
Editor: Donald Falace

Scott S. DeRossi, DMD,a and Sree Raghavendra, DMD,b Philadelphia, Pa
UNIVERSITY OF PENNSYLVANIA SCHOOL OF DENTAL MEDICINE

(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:131-41)

Anemia is a disease resulting from a decrease in the normalamount of circulating hemoglobin. A variety of factors cause this decrease, including iron deficiency, hemolysis, a decrease in the production of red blood cells (RBCs), folic acid deficiency, or a combination of these entities. Many types of anemia have oral manifestations, and the disease itself or its medical management can affect the provision of dental care. This article will discuss some ofthe more common anemias, their systemic and oral manifestations, and suggested modifications for dental care. CLASSIFICATION/ETIOLOGY Anemia can be classified by pathogenesis into bloodloss anemias, hemolytic anemias, hemoglobinopathies, and hypoproliferative anemias. This classification of anemia is summarized in Table I. Anemia also can be classified by the appearance of the RBC on the peripheralblood smear by virtue of its size (microcytic, normocytic, or macrocytic) or by the concentration of hemoglobin (hypochromic, normochromic).1 This article will discuss some of more common anemias, including iron deficiency anemia, hemolytic anemias, glucose-6 phosphate dehydrogenase (G-6-P-D) deficiency, sickle cell anemia, thalassemia, anemias caused by vitamin Bl2 deficiency and folic acid deficiency,and aplastic anemia (Table II).
a

Table I. Classification of anemia by pathogenesis
Blood loss anemia Hemolytic anemias Iron deficiency anemia; PlummerVinson syndrome Glucose-6-phosphate dehydrogenase deficiency; druginduced; immune mediated Sickle cell anemia; thalassemia; Cooley’s anemia Vitamin B12 deficiency; pernicious anemia; folic acid deficiency; aplastic anemia

Hemoglobinopathies ordisorders of hemoglobin Hypoproliferative anemias

Assistant Professor, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine. b Oral Medicine Resident, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine. Received for publication Apr 8, 2002; returned for revision ????; accepted for publication Sept 5, 2002. © 2003, Mosby, Inc.1079-2104/2003/$30.00 0 doi:10.1067/moe.2003.13

Blood loss anemias Iron deficiency anemia. Iron deficiency anemia is the most common of all anemias, affecting approximately 30% of the world population and accounting for up to 500 million cases worldwide.2 In the United States, 5% to 11% of women and 1% to 4% of men are iron deficient, and 5% of women and 2% of men have iron deficiency anemia.3 Inindividuals of Southeast Asian background, there is an increased prevalence, suggesting a cultural component to this anemia. Specifically, a diet of milk, rice and soup, with a lack of meat, and prolonged bottle-feeding are suggested causes of iron deficiency anemia in this population.4 Other causes of iron deficiency anemia include chronic blood loss such as menstrual or menopausal bleeding, parturition,bleeding hemorrhoids, or a bleeding malignant ulcer in the gastrointestinal tract. Malabsorption of iron can also cause this anemia, such as is seen in subtotal or complete gastrectomy, a habit of eating clay (pica), or as part of a malabsorption syndrome. Pica, which is the craving of unusual foodstuffs, is associated with iron deficiency anemia, especially pagophagia or the craving for ice, whichis the most common kind of pica. Up to 58% of patients with iron 131

132 DeRossi and Raghavendra Table II. Manifestations and treatment of anemia
Kind of anemia Blood loss anemia Iron deficiency anemia

ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY February 2003

Manifestations Pica, especially pagophagia Impaired motor and mental development in children Pallor: Koilonychia Atrophic tongue...