Miscellaneous: Oral manifestations of anaemia presentation

Recognising the oral manifestations of systemic diseases is crucial for proper diagnosis and referral for treatment. Many of these diseases, including various types of anaemia, can be identified through oral lesions. Anaemia occurs when there is a decrease in the normal levels of circulating haemoglobin, with iron deficiency being the most prevalent cause worldwide.
In the case of iron deficiency anaemia, angular cheilitis and atrophic glossitis are commonly observed oral manifestations. Megaloblastic anaemia, on the other hand, presents with glossitis, recurrent oral ulcers, oral candidiasis, diffuse erythematous mucositis, and pale oral mucosa.
Iron deficiency anaemia tends to affect women more frequently than men. Patients with this type of anaemia may experience symptoms such as fatigue, weakness, light-headedness, shortness of breath, and palpitations. Oral symptoms can include tenderness or a burning sensation in the oral mucosa.
Additionally, Fanconi anaemia, a specific type of anaemia, can also contribute to oral complications.
Anaemia due to blood loss can be classified into two categories: a) Acute posthemorrhagic anaemia: anaemia resulting from sudden and severe blood loss. b) anaemia due to chronic blood loss: anaemia caused by ongoing and gradual blood loss over an extended period of time.
Anaemia due to impaired red cell formation can be further categorised as follows:
a) Cytoplasmic maturation defects:
Deficient heme synthesis: anaemia caused by a lack of iron, known as iron deficiency anaemia.
Deficient globin synthesis: anaemia caused by abnormalities in globin protein production, such as thalassemia.

b) Nuclear maturation defects:
Vitamin B12/Folic acid deficiency: anaemia resulting from deficiencies in vitamin B12 or folic acid, known as megaloblastic anaemia.

c) Defect in stem cell proliferation and differentiation:
Aplastic anaemia: anaemia characterised by a decrease in the production of red blood cells due to damage to stem cells in the bone marrow.
Pure red cell aplasia: anaemia caused by the failure of red blood cell production in the bone marrow.

d) Bone marrow failure due to systemic diseases:
anaemia of inflammation: anaemia associated with chronic inflammation or systemic diseases.
anaemia in renal disease: anaemia resulting from kidney dysfunction.
anaemia due to endocrine and nutritional deficiencies: anaemia caused by deficiencies in hormones or essential nutrients.
anaemia in liver disease: anaemia associated with liver dysfunction.

e) Bone marrow infiltration:
Leukemias: anaemia caused by the infiltration of abnormal white blood cells into the bone marrow.
Lymphomas: anaemia resulting from the infiltration of abnormal lymphocytes into the bone marrow.
Multiple myeloma: anaemia associated with the infiltration of abnormal plasma cells into the bone marrow.

f) Congenital anaemia:
Sideroblastic anaemia: anaemia characterised by abnormal iron metabolism in the bone marrow.
Congenital dyserythropoietic anaemia: An inherited disorder affecting the development of red blood cells.

Anaemia due to increased red cell destruction can be classified as follows:
Intracorpuscular defect: anaemia caused by defects within the red blood cells themselves.
Extracorpuscular defect: anaemia resulting from factors outside of the red blood cells that lead to their destruction.
In elderly individuals, general signs and symptoms of anaemia, such as pallor, fatigue, and dyspnea, are often overlooked or attributed to the effects of old age. However, there are other systemic indicators of anaemia that should not be disregarded. These include knuckle pigmentation, brittle nails, koilonychia (spoon-shaped nails), hair loss, and restless leg syndrome.
The formation of spoon-shaped nails, known as koilonychia, is primarily attributed to a decrease in subungual (under the nail) blood supply, resulting in a concave dip in the nail bed. On the other hand, the manifestation of brittle nails is hypothesised to be caused by the loss of cysteine disulfide bonds, which occurs due to a lack of oxygen. These disulfide bonds contribute to the hardness of the nail bed.
It is important to recognise these specific signs and symptoms in order to properly identify and address anaemia in elderly individuals.