blood disorder
Manifestations and Management of Immune Thrombocytopenic Purpura in Outpatient Dental Clinic Setting Case Report Feiyi Sun, D.D.S.; Harry Dym, D.D.S.
ABSTRACT There are a variety of contributing factors to spontaneous intraoral hemorrhage. It is important for dental health practitioners to correctly identify the underlying causes of uncontrolled bleeding for proper management of the diseased patient. We report a case of immune thrombocytopenic purpura (ITP) with oral manifestations of multiple hemorrhagic bullae. The patient was a 76-year-old female who complained of intraoral bleeding from multiple blood-filled bullae of various sizes, localized to lips, tongue and buccal mucosa starting two weeks before she presented to the Oral and Maxillofacial Surgery Clinic at the Brooklyn Hospital Center. Complete blood cell count revealed a significantly low platelet count of 8,000/ μL. A diagnosis of ITP was made. The patient was managed by the Department of Hematology for platelet transfusion, steroid therapy and intravenous immunoglobulin therapy. Her platelet level increased to 103,000/μL after a five-day hospital stay before she was discharged to home, and her hemorrhagic conditions were greatly improved and stabilized. 18 NOVEMBER 2020 The New York State Dental Journal ●
Immune thrombocytopenia (ITP) is a rare autoimmune disease where IgG autoantibodies are produced to attack the glycoproteins IIb/IIIa from platelet cell membranes, leading to a transient or persistently low platelet count that is below 10x103/μL. [1] The autoimmune response also causes insufficient megakaryopoiesis, further inhibiting platelet production by bone marrow.[1] The disease occurs in 2 to 4 per 100,000 adults each year and has a higher incident in adult women in comparison to adult men. The incidence increases with age, especially in women over 60 years old.[2-3] ITP is characterized by subcutaneous petechiae, conjunctivae hemorrhage, spontaneous skin purpura and hemorrhagic bullae in the oral mucosa.[4] In addition to possible organ hemorrhage, ITP predisposes patients to a higher risk of thromboembolism.[5] As a result, understanding how to identify and manage an ITP patient in a timely manner is imperative to prevent exacerbation of the hemorrhagic state. A platelet count persistently lower than 10x103/μL indicates platelet transfusion. Prophylactic transfusion of platelets is indicated when a patient who is planned for major surgery has a platelet count less than 50x103/μL.[6-7] Corticotherapy and intravenous immunoglobins are the standard first line interventions, with risks of relapse and complications.[8] We, therefore, report a case of an elderly patient who presented to the Oral and Maxillofacial Surgery Clinic with intraoral hemorrhaging and was rapidly managed by the Department of Hematology for platelet transfusion and immunosuppressive therapy.
