MODULE 2

BLOOD & IMMUNOLOGY

1ST YEAR BDS

KMU (IHPER)- Dental Central Curriculum Committee 1

 Contents

Vision & Mission .......................................................................................................................................... 3

Teaching Hours Allocation .............................................................................................................................. 4
Themes for Blood Module............................................................................................................................... 5
Learning Outcomes ...................................................................................................................................... 6
Cognitive Domain ..................................................................................................................................... 6
Psychomotor Domain ................................................................................................................................ 6
Affective Domain ..................................................................................................................................... 7
Theme I: Pallor and Swelling .......................................................................................................................... 8
Lab Work .............................................................................................................................................. 10
Theme –II Fever (Infection and Immunology) ....................................................................................................... 11
Lab Work .............................................................................................................................................. 15
Theme –III Bleeding Gums ............................................................................................................................. 16
Lab Work .............................................................................................................................................. 17
Theme –IV Transfusion Reaction ...................................................................................................................... 18
Lab work ................................................................................................................................................. 19

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 Vision & Mission

Khyber Medical University (KMU) Vision:

Khyber Medical University will be the global leader in health sciences academics and research for efficient and
compassionate health care.

Khyber Medical University (KMU) Mission:

Khyber Medical University aims to promote professional competence through learning and innovation for providing
comprehensive quality health care to the nation.

Institute of Health Professions Education & Research (IHPER) Mission:

To produce leaders, innovators and researchers in health professions education who can apply global knowledge to
resolve local issues.

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 Teaching Hours Allocation

Table 2: Hours allocation for different subjects

S. No Subject Hours

1 Anatomy 14
2. Physiology 43
3. Biochemistry 07
4. Oral Biology 22
5. Pathology 06
6. Pharmacology 01
7. Oral Medicine 02
8. Periodontology 03
9. Community & Preventive dentistry 03
101
Total

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 Themes for Blood Module

SNO Theme Duration

1 Pallor and swelling 1 week

2 Fever (Infection and Immunity) 1.5 week

3 Excessive bleeding 1 week

4 Transfusion Reaction 0.5 week

Total 4 weeks

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 Learning Outcomes

Cognitive Domain

By the end of this module, first-year BDS students shall be able:

1. Describe the various cellular and non-cellular components of blood in relation to its Anatomy, Physiology &
Biochemistry.
2. Describe the structure, synthesis, and degradation of Hemoglobin.
3. Describe the regulatory mechanisms of normal hemostasis and coagulation.
4. Describe the conditions associated with the dysfunction of cellular and non-cellular components of blood.
5. Describe the basic characteristics of the immune system.
6. Discuss the structure, functions, and biochemical aspects of the Lymphoreticular system.
7. Explain the principles and clinical significance of the ABO/RH blood grouping system.
8. Explain the pathophysiology of various bleeding disorders.
9. Identify the role of pharmacology in anemia and bleeding disorders.

Psychomotor Domain

Description of the psychomotor skills to be developed and the level of performance required:
By the end of the Blood Module, the student should be able to:
1. Perform practical work as instructed in an organized and safe manner
2. Record observations accurately.
3. Identify slides of the Lymph node, thymus, tonsils, and spleen under the microscope.
4. Identify the slide of Gut-associated lymphoid tissue.
5. Determine the percentage of formed blood elements.

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 6. Identify RBC and should be able to do its counting-on-counting chamber and to know normal values. And also
classify Anemia morphologically.
7. Determine the Hemoglobin with the apparatus and have knowledge of normal and abnormal values.
8. Identify WBC morphology and its different types to count them on the counting chamber and know the normal
values. Diagnostic importance of each WBC.
9. Identify Platelets and should be able to do its counting on the counting chamber and to know normal values. Its
diagnostic importance in relation to bleeding disorders.
10. Perform bleeding time and clotting time, know normal values and their diagnostic importance in relation to
bleeding disorders.
11. Perform Blood group typing and Rh factor.
12. Perform ESR and to know its normal value and prognostic importance.
13. Detect blood, bile pigments & bile salts in the given sample of urine.

Affective Domain

By the end of the Blood Module, the student should be able to.
1. Demonstrate ability to give and receive feedback and respect for self and peers.
2. Demonstrate empathy and care to patients.
3. Develop respect for the individuality and values of others - (including having respect for oneself), patients,
colleagues, and other health professionals.
4. Organize and distribute tasks.
5. Exchange opinion & knowledge.
6. Develop communication skills and etiquette with a sense of responsibility.
7. Equip themselves with teamwork.
8. Regularly attend the classes.
9. Demonstrate good laboratory practices.

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 Theme I: Pallor and Swelling
Subject Topic Hours Learning objectives

Physiology Introduction to 1hr 1. Describe the composition and functions of blood.

2. Describe the various red cell indices.
Blood 3. Enlist the components of plasma.
4. Explain the difference between serum and plasma.
Red Blood 1hr 5. Describe the structure, function, life span and normal count of red
Cells blood cells.
Introduction to 2hr 6. Define Hematopoiesis.
hematopoietic 7. Classify hematopoietic stem cells.
system 8. Describe various components of hematopoietic. system including their
locations and their functions.
9. Describe the erythropoiesis sites during pre-natal and postnatal
periods.
Red Blood Cells 1hr 10. Discuss the stages of RBC development from pluripotent hematopoietic
Genesis stem cells to a mature RBC.
11. Describe the erythropoiesis and factors regulating erythropoiesis.
(Erythropoiesis ) 12. Describe the role of Vitamin B12 and Folic acid in RBC maturation.
13. Describe the effects of deficiency of Vita- min B12 and Folic acid on
RBC maturation.
Erythropoietin 1hr 14. Describe source, control / regulation, and functions of Erythropoietin
15. Explain the role of Erythropoietin in RBC production.
16. Describe the effects of high altitude and exercise on RBC production.
Anemia 1hr 17. Define and describe the different types of anemia
18. Define hemolysis.
19. Interpret the diagnosis of anemia by using red cell indices.

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 20. Describe the effects of anemia on functions of circulatory system / human
body.
Polycythemia 1hr 21. Define and classify polycythemia.
22. Differentiate between primary and secondary Polycythemia.
Biochemistry Introduction of 1hr 23. Define Porphyrins.
Porphyrins 24. Describe Chemistry of Porphyrins.
25. Enlist the types, metabolic causes, and clinical presentation of different
types of Porphyria’s.
Iron metabolism 1hr 26. Describe the iron metabolism.
Introduction to 1hr 27. Define heme and describe its structure and functions.
heme synthesis 28. Describe the biochemical features of the hemoglobin molecules.
and degradation 29. Describe Heme Synthesis on cellular and molecular level.
30. Describe Heme Degradation.
31. Describe the Regulation of Heme Synthesis.
32. Describe the concept of Oxygen binding with hemoglobin.
33. Describe the normal picture of blood chemistry.
Hemoglobinop 3hrs 34. Define Hemoglobinopathies and enlist the variants of hemoglobin.
athies 35. Describe causes of Hemoglobinopathies.
36. Describe two major categories of hemoglobinopathies.
37. Describe the amino acid substitution in sickle cell disease.
38. Define and Classify thalassemia’s.
39. Explain the genetic defects in α and β thalassemia’s.
40. Enlist the clinical features of α and β thalassemia’s.
41. Discuss the role of vit B12 and Folic acid in prevention of anemia.
42. Describe abnormalities of iron metabolism.
43. Discuss 2,3 BPG.

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Pathology Anemias of 2hr 44. Define anemia.
45. List the factors for regulation of erythropoiesis.
diminished
46. Enlist the types of anemia.
erythropoiesis
and 47. Define hemolytic anemia.
Hemolytic 48. Enlist types of hemolytic anemia.
anemia’s 49. Discuss pathophysiology of hemolytic anemias.
Pharmacology Drug 50. Enlist the drugs used in the treatment of iron deficiency &
treatment of 1hr Megaloblastic anemia.
anemia’s 51. Describe the pharmacological basis/ role of iron in iron deficiency
anemia (hypochromic normocytic anemia).
52. Describe the pharmacological basis/ role of vitamin B12 and folic acid
in megaloblastic anemia.
53. Describe the role of erythropoietin in the treatment of anemia
(normochromic normocytic anemia).
Oral 54. Enlist oral manifestations of anemia.
manifestation 1hr 55. Discuss various oral conditions associated with anemia.
Oral medicine
of anemia

Lab Work
Physiology Hemoglobin 2hrs 56. Assist the procedure of phlebotomy while practicing asepsis.
57. Determine the hemoglobin (Hb) concentration in the given sample by
Determination
Sahli's method.
58. Determine the ESR.
Blood cells 2hrs 59. Identify and describe various blood cells under microscope.
60. Determine the blood cell count and cell indices by hemocytometer.

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 Theme –II Fever (Infection and Immunology)
Subject Topic Hour Learning Objectives
Anatomy Gross anatomy 1hr 61. Classify the lymphoid organs and lymphoid tissues.
of hematopoietic 62. Describe the main gross external features of spleen, lymph node,
system thymus and oral mucosils.
63. Describe neurovascular supply of the mentioned structures
Histology of 64. Describe the overview of lymphatic tissue including MALT.
lymphoid tissues 65. Identify and describe the histological features and functions of lymph
4hrs node.
66. Identify and describe the histological features and functions of
thymus.
67. Describe the histological features and functions of tonsils
68. escribe the histological features and functions of spleen.
Physiology White Blood Cells 1hr 69. Classify white blood cells.
70. Describe the structure, function, life span and normal count of white
blood cells.
71. Describe the stages of differentiation of white blood cells
(leukopoiesis).
72. Describe the characteristics of WBCs (phagocytosis/chemotaxis,
diapedesis).
Reticuloendothelial 2hrs 73. Describe the components of reticulo-endothelial system (monocyte-
(Monocyte- macrophage system).
Macrophage) 74. Describe the role of monocyte macrophage system in immunity.
system

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 75. Explain the role of neutrophils, macrophages, basophils, eosinophils,
and monocytes in providing immunity against infections (immune
system).
Pathology Inflammation 76. Define inflammation.
77. Enlist the types of inflammation.
1hr 78. Describe characteristics of inflammation (hallmark of inflammation).
Abnormal 79. Define leukopenia and leukocytosis and Leukemia.
Leukocyte counts/
Leukemia
Physiology Introduction to 1hr 80. Define and classify immunity.
81. Define antigen.
immunity
82. Define pathogen.
83. Enlist the tissues that contribute to immunity and explain their
function.
84. Describe the functions of immune system.
85. Describe the structure and function of lymphatic system.
Physiology Immune system 1hr 86. Enlist the three lines of defenses.
87. Describe the properties of three lines of defenses.
88. Describe the characteristics, origin, and functions of cells of immune
system.
89. Describe the types of immunity.
90. Enlist the innate defenses.
91. List the substances and cells that participate in adaptive immunity.
92. Compare the characteristics innate and acquired immunity.
93. Compare the active and passive immunity mechanism.

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Physiology Humoral and cell 2hrs 94. Describe the role of T and B lymphocytes in immunity.
mediated 95. Describe cell mediated and humoral immunity.
immunity 96. Explain how helper T cells regulate the immune system.
97. Explain the function of cytotoxic T cells.
98. Describe the role of helper T cells.
99. Differentiate between humoral and cell mediated immunity.
Complement 2hrs 100. Describe the complement system.
system 101. Explain how the complement system elicits the inflammatory
response, lyses foreign cells, and increases phagocytosis.
102. Describe the two pathways that activate the complement system.
103. Compare Classic and alternate pathways of complement activation.
Immunity in 1hr 104.Compare the active and passive immunity.
extreme of ages 105.Explain transfer of passive immunity from mother to infant through
(Paediatrics to breast feeding.
Geriatics) 106.Describe changes in immune response that occur with aging.
1hr 107.Define allergy and allergen.
Allergy & 108.Describe the pathophysiology of allergy and hypersensitivity.
109.Define and classify the hypersensitivity reaction.
Hypersensitivity
110.Compare the immediate and delayed hypersensitivity reactions.
111.List the diseases associated with hypersensitivity reactions.
Biochemistry Immunoglobulin’s 1hr 112. Define Immunoglobulins.
/Antibodies 113. Describe the types of Immunoglobulins.
114. Describe Structure of Immunoglobulins.
115. Describe the mechanism of action of antibodies.
116. Explain biochemical role of each immunoglobulin in immunity.

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Oral Biology Dental pulp and 117. Discuss anatomy of pulp including coronal and radicular pulp.
PDL 4hrs 118. Describe the histology of pulp including cells, ground substance,
fibers, blood and nerve supply and lymphatic drainage.
119. Identify microscopic zones of pulp with detailed theoretical and
diagrammatic representation.
120. Describe functions of pulp.
121. Differentiation of pulp of primary and permanent dentition.
122. Discuss regressive changes of pulp (age changes).
123. Explain development of pulp.
124. Draw different microscopic zones of pulp with labelling.
125. Describe the overview of pulpitis and extravasation.
126. Differentiate types and properties of pulpal sensory nerve fibers.
127. Define pulpitis and its types, pulp polyps, pink tooth pulp necrosis.
128. Interpret the number of root canals its configuration and position of
apical foramen for endodontic procedures.
Periodontal 129. Define Periodontal Ligament (PDL).
Ligament (PDL) 130. Explain in detail the development of principle fibers and cells of
PDL.
6hrs 131. Explain PDL homeostasis which helps to maintain the width of PDL.
132. Describe cells of PDL under headings of synthetic, resorptive,
defense, progenitor cells and epithelial rest cells of Malassez.
133. Name markers of PDL and growth factors involved in normal biology.
134. Discuss the functions of PDL.
135. Discuss cell biology of PDL.
136. Enumerate the principal fibers of PDL with complete description of
course and functions.
137. Describe composition of ground substance of PDL and its functions.
138. Describe synthetic cells and their individual function in detail.
139. Discuss clinical correlation of PDL with operative, surgical, and
orthodontic procedures and conventional to latest treatment
modalities for periodontal inflammatory diseases.

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Community Prevention of 1hr 140. Epidemiology, etiology, and prevention of periodontal diseases
& Preventive periodontal
Dentistry diseases
Lab Work
Histology 2hrs 141. Identify and describe the microscopic anatomy of bone marrow and
spleen under microscope
Anatomy 4hrs 142. Identify histological features of lymph nodes, spleen, thymus and
tonsils.
TLC 2hrs 143. Determine the total leukocyte count (TLC) in the given sample
Determination
DLC 2hrs 144. Determine the differential leukocyte count (DLC) in the given sample
Determination

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 Theme –III Bleeding Gums
Physiology 1hr 145. Describe the structure, function, life span and normal count of
Introduction to Platelets.
hemostasis 146. Define hemostasis.
147. Describe the role of platelets in hemostasis.
148. Outline the sequence of processes involved in hemostasis.
149. Enlist the clotting factors.
150. Explain the role of calcium in coagulation.
3hrs 151. Explain how clotting is prevented in the normal vascular system.
152. Outline the sequence of processes during blood coagulation.
Blood 153. Describe with the help of a flow diagram (or draw) intrinsic
pathway of coagulation cascade.
Coagulation
154. Describe with the help of a flow diagram (or draw) extrinsic
pathway of coagulation cascade.
155. Explain how the mechanism of clot dissolution.
Pathology Bleeding disorders 1hr 156. Describe the role of Vitamin K in clotting.
157. Describe the following bleeding disorders: Vitamin K deficiency,
Thrombocytopenia, Hemophilia.
158. Define Von Willebrand disease.
Thrombotic 1hr 159. Describe the effects of low platelet count on Hemostasis.
disorders 160. Define thrombus/thrombi.
161. Define emboli/embolus.
162. Enlist the causes of thromboembolic conditions.
Oral Biology Oral mucosa 6hrs 163. Define oral mucosa and classify on basis of function and
histophysiology, into lining mucosa, masticatory mucosa, and
specialized mucosa.
164. Describe structure of Oral epithelium, Basement membrane,
Lamina Propria, Sub mucosa.
165. Describe functions of oral mucosa, compare with intestinal and
skin mucosa.

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 166. Enlist the histological differences between keratinized &non
keratinized oral epithelium.
167. Elaborate cells of OMM that is Keratinocytes and Non-
keratinocytes, Melanocytes Langerhans cells & Merkel cells.
(shift to bleeding gums theme in blood module).
168. Identify histological features, location, and function of tongue
papillae & taste buds,
169. Correlate Gingival sulcus, dento-gingival junction mucocutaneous
junction. (shift to bleeding gums theme in blood module).
170. Explain development of OMM, age changes, blood supply &nerve
supply of oral mucosa.
171. Discuss the clinical significance of oral mucosa.
Effects of hemo 172. Define Thrombocytopenia.
Periodontology diseases on 173. Classify Thrombocytopenia.
Periodontium 2hrs 174. Discuss periodontal manifestations of thrombocytopenic purpura.
(Thrombocytopenia, 175. Define scurvy.
Leukemia 176. Discuss clinical features of scurvy.
177. Discuss the association of gingivitis with Vit C deficiency.
& Scurvy)
178. Discuss the association of periodontitis with Vit C deficiency.
179. Describe periodontal manifestations of leukemia.
Community & Nutritional 1hr 180. Discuss the effects of nutritional deficiencies on oral health.
Preventive deficiencies
Dentistry
Oral Medicine Thrombocytopenia 1hr 181. Describe oral manifestations of Thrombocytopenia.
182. Idiopathic Thrombocytopenic purpura.
Lab Work
Physiology Blood Coagulation 2hrs 183. Perform BT and CT time.
2hrs 184. Perform PT and APTT.
Oral Biology (2+2+2) 185. Identify structures of PDL, pulp and oral mucosa in slides

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 Theme –IV Transfusion Reaction
Physiology Blood 2hrs 186. Describe different types of blood groups.
Grouping 187. Describe the genotype phenotype relationships in blood groups.
188. Interpret the plausible blood groups (A-B-O) in children of parents
with known blood groups.
189. Describe the role of agglutinogens and agglutinins in blood
grouping.
190. Describe the antigens and antibodies of the O-A-B blood types
191. Interpret the types of agglutinins present in individuals with a
specific blood group.
192. Describe the process of agglutination.
Transfusion 1hr 193. Describe the antigens and antibodies of the Rh system.
reactions 194. Describe the principles of blood typing.
195. Explain universal donor and universal recipient blood groups.
Erythroblastosis 1hr 196. Enlist the manifestations of transfusion reaction.
fetalis 197. Define Rhesus incompatibility.
198. Describe erythroblastosis fetalis.
199. Describe the transfusion reactions. resulting from mismatched O-A-
B and Rh blood types.
Pathology Transfusion 1hr 200. Discuss transfusion reaction and organ transplant.
reaction and 201. Explain the criteria for transplant, donor, recipient, role of immune
organ transplant system in transplant, different types of transplants.
Periodontology Relationship of 1hr 202. Discuss anemia & its oral presentation.
periodontal 203. Discuss leukemia & its oral presentation.
diseases with 204. Discuss thrombocytopenia & its oral presentation.
hematological 205. Discuss leukocytic disorders (neutropenia, agranulocytosis & certain
& Immune syndromes) & their oral presentation.
disorders

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 Community & Epidemiology of 1hr 206. Identify blood borne pathogens.
Preventive blood borne 207. Epidemiology of blood borne disease transmission.
Dentistry diseases 208. Routes of transmission \
209. Best practices to perform safe blood transfusion.
210. Identify potential risks of exposures.
211. Enlist important safeguards against blood borne pathogens.
Lab Work
Physiology Blood grouping 2hrs 212. Determine the O-A-B and Rh blood group in the given sample.
Blood smear 2hrs 213. Prepare blood smear needle by prick method.
preparation
Blood Bank 2hrs 214. Observe the process of blood donation, blood product separation,
screening and storage and observe the process of blood transfusion.

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