Idiopathic Thrombocytopenic Purpura Presenting as Post-extraction Hemorrhage

Abstract

Aim The aim of this article is to present a case of idiopathic thrombocytopenic purpura (ITP) in order to emphasize the importance of the clinical exam since the anamnesis leads to a diagnostic hypothesis of ITP. Background Acute ITP is considered an autoimmune disease characterized by the production of antibodies against platelets, antigens produced by a viral infection, or a platelet sparing drug combination. These antibodies adhere to platelets and are recognized and destroyed by the reticulo-endothelial system. Consequently, the platelet count gradually diminishes and is insufficient for the maintenance of primary hemostasis. Report A 77-year-old woman presented with post-extraction intermittent bleeding. The physical examination revealed discoloration of the skin, multiple petechiae, hematomas, ecchymosis of the upper lip, bruises all over the body, gingiva that bled spontaneously, and a malformed blood clot at the extraction site of tooth #44. The hematological exams confirmed the hypothesis of ITP. The patient was immediately hospitalized in the Hematology Department of a local hospital and received platelet replacement, hydration, medication, and general care. After the spontaneous bleeding stopped, the malformed clot was removed using alveolar curettage along with a thorough cleaning of the extraction site with a 0.9% saline solution before suturing the wound and prescribing medication. After the sixth day of hospitalization, the patient presented with the following results: Hb: 12.3 mg/dL, Ht: 36.1%, and PC: 87,000 mm3. The patient was then discharged and was placed under outpatient follow-up care. Summary The importance of the clinical exam must be emphasized since the anamnesis leads to a diagnostic hypothesis of ITP and provides the dental surgeon with an opportunity to make important systemic alterations to improve the prognosis of a patient with ITP. Citation Martini MZ, Lopez JS Jr., Gendler JLPL, da Fonseca EV, Soares HA, Franzi SA. Idiopathic Thrombocytopenic Purpura Presenting as Post-extraction Hemorrhage. J Contemp Dent Pract 2007 September; (8)6:043-049.

Adverse postoperative outcomes in surgical patients with immune thrombocytopenia

“…Haemorrhagic episodes, including intracranial haemorrhage, are long‐term complications of ITP, . In other studies, postoperative bleeding was noted as a major complication in patients with ITP after splenectomy and minor procedures, , but not cardiac operations. Studies in non‐surgical settings have associated ITP with risk of thromboembolism, , .…”

Immune Thrombocytopenic Purpura Presenting as Unprovoked Gingival Hemorrhage: a Case Report

“…Also, a case with steroid-induced damage to the condyles was caused by treatment for ITP [ 17 ]. A 77 year-old female patient with continuous intermittent post-extraction hemorrhage diagnosed with ITP was presented [ 18 ]. However, the present case with spontaneous gingival hemorrhage is the first reported case of the clinical diagnose of a patient with newly diagnosed ITP by a dentist and this patient was referred to the hematologist.…”

Management of the oral manifestations of senile purpura in an edentulous patient: a case report

“…Typically, there are no serious risks of bleeding when patients with senile purpura have prosthodontic treatment, however, local trauma should be minimized by careful postinsertion adjustments 13‐17 . Oral tissue should be handled delicately during the various clinical stages of prosthesis fabrication to reduce the risk of ecchymosis.…”

“…The erythrocyte and platelet counts were 4.84 million/mm 3 and 2,24,000/m 3 , respectively, ruling out a diagnosis of thrombocytopenia. The minimum blood platelet level acceptable before any dental surgical procedure is approximately 50,000/μL; extensive surgery may require >1,00,000/μL 14 . After 3 years of clinical follow‐up, with the patient returning every 6 months, the patient did not report any bleeding in the palate or the alveolar ridges of the maxillary mucosa.…”