13

Red Blood Cells Associated Disorder: Polycythemia: Assessment, Analysis, and Associated Dental Management Guidelines

Polycythemia is a disease in which too many red blood cells are made in the bone marrow. Polycythemia can present as primary or secondary polycythemia. Polycythemia vera is primary polycythemia. It is a myeloproliferative disorder associated with an increased number of circulating RBCs. The white blood cell (WBC) and platelet counts are also increased and the erythropoietin level is low. These extra blood cells may collect in the spleen and cause it to swell. The increased number of red blood cells or platelets in the blood can cause bleeding problems and make clots form in blood vessels. This can increase the risk of stroke or heart attack. The risk of stroke or heart attack is higher in patients who are older than 65, or who have a history of blood clots. Patients also have an increased risk of acute myeloid leukemia or primary myelofibrosis.

Chronic obstructive pulmonary disease (COPD), smoking, erythropoietin-producing tumors, and other long-standing heart or lung problems can cause chronic hypoxia (low oxygen level), and chronic hypoxia causes secondary polycythemia.

The leading physiological cause for erythrocytosis (increased RBC count) or secondary polycythemia is high altitude. The erythropoietin production is always incr- eased in secondary polycythemia.

Polycythemia is mainly a disease of the elderly. Males are affected more than females. An excessive number of RBCs in the circulation causes sluggishness in blood flow, and this increases the incidence of strokes, myocardial infarctions, and deep vein thrombosis (DVTs).

These patients also experience gout and excessive gastrointestinal bleeds. It is not uncommon for these patients to have gout due to the excessive breakdown of RBCs. Increased RBC breakdown increases the serum uric acid level and this, in turn, precipitates gout. Gout can compromise the kidney status. Always check the CBC and serum creatinine prior to dentistry.

POLYCYTHEMIA SYMPTOMS AND SIGNS

Th/>