Aplastic anemia presenting as bleeding of gingiva: Case report and dental considerations

Rai, Arpita; V, Vaishali; Naikmasur, Venkatesh G; Kumar, Ansul; Sattur, Atul

doi:10.1016/j.sjdr.2015.04.004

Cited by 8 publications

(15 citation statements)

References 12 publications

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“…Most common oral symptoms include spontaneous gingival bleeding, oral ulceration, persistent infection, gingival enlargement or a combination of the above. Gingival bleeding can occur as a result of the thrombocytopaenia and is associated with the reduced level of platelets, affecting the blood coagulation. Opportunistic infections due to immunosuppression of the patient may appear as well.…”

Section: Discussionmentioning

confidence: 99%

Intra‐oral noma‐like lesion associated with acute myeloid leukaemia: a case report

Chatzipantelis

Atkin

2018

Oral Surgery

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Acute myeloid leukaemia is a malignancy of the white blood cells that can develop in both children and adults with rapid development and possible intra‐oral manifestations. This report describes a case involving a 50‐year‐old patient who was referred to the Emergency Department of a University Dental Hospital complaining of severe intra‐oral ulceration, spontaneous intra‐oral bleeding and generalised fatigue and malaise. Examination revealed the existence of an erythematous intra‐oral necrotising, noma‐like, ulceration in the posterior area of the right buccal mucosa. The patient was diagnosed with acute myeloid leukaemia. Acute myeloid leukaemia develops rapidly and the initial symptoms may be non‐specific. Patients may demonstrate intra‐oral manifestations; most common symptoms include spontaneous gingival bleeding, gingival enlargement and acute ulceration. Ulceration with necrotising (noma‐like) characteristics is a rare oral manifestation of acute myeloid leukaemia, the cause of which is yet unknown. Fewer than 10 cases have been reported in the international literature. Intra‐oral pathology can be an early indicator of significant medical pathology. A dental practitioner is likely to be the first point of contact for patients with acute myeloid leukaemia due to the unusual or painful nature of the intra‐oral pathology; identification of suspicious signs and symptoms can lead to early detection and treatment. Clinical relevance Leukaemia may present initially to dental practitioners because of a high incidence of early intra‐oral signs and symptoms. A high index of suspicion for underlying systemic disease will lead to prompt onward referral for specialist investigations. Oral presentations may include spontaneous gingival bleeding and gingival enlargement. A rare oral presentation of acute myeloid leukaemia is deep and severe oral ulceration presenting as a noma‐like lesion, which we present here.

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Section: Discussionmentioning

confidence: 99%

Intra‐oral noma‐like lesion associated with acute myeloid leukaemia: a case report

Chatzipantelis

Atkin

2018

Oral Surgery

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“…Anemia aplastik (AA) adalah gangguan perdarahan yang serius dan sering fatal, ditandai oleh kegagalan sel prekursor hematopoietik pada sumsum tulang untuk menghasilkan eritrosit, granulosit, dan trombosit yang mengakibatkan pansitopenia, 1,2,3 dengan kejadian tahunan sekitar 1-2 kasus baru per 1.000.000 individu per tahun. 1,3 Anemia aplastik ditandai dengan gejala kelelahan, pendarahan karena trombositopenia dan terjadinya infeksi berulang akibat neutropenia. 2 Neutropenia merupakan kondisi yang terjadi saat jumlah total neutrofil lebih rendah dari 2000 x 106 liter.…”

Section: Pendahuluanunclassified

Terapi Imunosupresan Pada Pasien Anemia Aplastik Dengan Perdarahan Gusi: Menyembuhkan Atau Memperparah?

Nelonda

Munthe

Setiadhi

2019

ODONTO : Dental Journal

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Background: Aplastic anemia (AA) is a hematologic disorder characterized by hypoplastic bone marrow and peripheral pancytopenia. The main symptoms are fatigue and bleeding. In the oral cavity, gingival bleeding is the common complaint.Case Management: A 18-year-old female patient referred from internal medicine department due to swelling of palate since 2 days before that interrupted eating activity. She routinely consumes Sandimun®100 mg tablets. A 2 x 1 cm black blood clot in anterior hard palate and ulcerative lesion at dorsal tongue regio 45 surrounded by necrotic area were found on intra oral examination. Patient was diagnosed with necrotizing ulcer-related neutropenia accompanied by AA-associated hemorrhagic bullae in the hard palate. Patient treated with mouthwash containing 0.1% hyaluronicacid and 1% feracrylum.Discussion: Immunosuppressant is the AA gold standard therapy. Cyclosporine (CsA) as imunosupressant is common drug to prevent T cells from attacking stem cells in bone marrow. The side effects of CsA is gingival hiperplasia.Conclusions: Gingival bleeding and gingival hiperplasia due to thrombocytopenia and the use of cyclosporine are vicious circles that need to be aware. With comprehensive management, good oral conditions will be obtained, therefore the quality of life can increase.

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“…These lesions are most likely due to a clotting disorder-induced thrombocytopenia, which causes bleeding after minor trauma such as friction with the tongue or teeth. 8 The World Health Organization (WHO) has declared the COVID-19 outbreak a global pandemic. Overall, this condition has resulted in crises in various fields, including public health.…”

Section: Introductionmentioning

confidence: 99%

Management of patients with aphthous-like ulcers related to aplastic anaemia in the COVID-19 pandemic era through teledentistry: A case report

et al. 2022

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Background: Aplastic anaemia is a disease that occurs when the body fails to produce enough blood cells. Oral lesions, such as canker sores, are often used as an early marker of this disease condition. In the COVID-19 pandemic era, a teledentistry method is expected to assist in the management of patients with various diseases including aplastic anaemia. Purpose: This case report discusses the management of patients with aphthous-like ulcers related to aplastic anaemia in a 34-year-old woman, based on history, clinical examination, and blood tests through teledentistry. Case: The patient complained of a bleeding wound on the inner left cheek and corner of the left lip that appeared one month ago. There was an ulcer lesion that was bleeding easily in the buccal mucosa sinistra and the angular sinistra, as well as macules lesion on her hand and foot. The complete blood count test exhibits a low platelet level. Case management: The diagnosis was an aphthous-like ulcer related to aplastic anaemia. Patient was treated with topical antiseptic and anti-inflammatory mouthwashes for the oral lesions, as well as collaboration with the medical team. The lesions improved after the patient received a blood transfusion and drug therapy from the internist while she was hospitalized, but the lesions reappeared in other locations in the oral cavity when the platelet level dropped. Conclusion: Management of oral manifestations in patients with aphthous-like ulcers related to aplastic anaemia in the COVID-19 pandemic era can be done through teledentistry. However, this requires sensitivity from the dentist, patient compliance in following instructions, and the involvement of a multidisciplinary approach, such as collaboration with internists to achieve recovery. Delay in detecting and treating aplastic anaemia will lead to death, as in this case.

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Aplastic anemia presenting as bleeding of gingiva: Case report and dental considerations

Cited by 8 publications

References 12 publications

Intra‐oral noma‐like lesion associated with acute myeloid leukaemia: a case report

Intra‐oral noma‐like lesion associated with acute myeloid leukaemia: a case report

Terapi Imunosupresan Pada Pasien Anemia Aplastik Dengan Perdarahan Gusi: Menyembuhkan Atau Memperparah?

Management of patients with aphthous-like ulcers related to aplastic anaemia in the COVID-19 pandemic era through teledentistry: A case report

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