Oral lesions in a patient with idiopathic thrombocytopenic purpura: A case report
DOI:
https://doi.org/10.33448/rsd-v13i10.47213Keywords:
Thrombocytopenia, Idiopathic Thrombocytopenic Purpura, Ecchymosis.Abstract
Idiopathic Thrombocytopenic Purpura (ITP) is a hematological disorder characterized by thrombocytopenia. The pathogenesis of this condition is mediated by autoantibodies directed at platelets and resulting in their elimination by the spleen. It can be asymptomatic and may present with mild, moderate or severe hematomas with a high risk of hemorrhage. Oral manifestations include bleeding, ecchymoses, petechiae, hemorrhages and mucocutaneous lesions. The aim of this study is to report a case of ITP with oral manifestations, provide a detailed description of the oral lesions, discuss diagnostic methods and therapeutic approaches. The presence of a dental surgeon in a hospital environment is of great importance for proper diagnosis and treatment, since oral manifestations are commonly observed as the first clinical signs of the disease. The dental surgeon can identify these symptoms early on and contribute to early diagnosis and the administration of appropriate care.
Downloads
References
Associação Médica Mundial. (1964). Declaração de Helsinque. Princípios éticos para a pesquisa em seres humanos. Helsinque.
Augusto, G., Silva, A. C. P., Vicari, P. & Figueiredo V. L. P. (2022). Trombocitopenia imune: Diagnóstico e evolução de pacientes acompanhados em serviço de referência do estado de São Paulo. Hematology, Transfusion and Cell Therapy, 44(2):S267-S268. https://doi.org/10.1016/j.htct.2022.09.452
Balitsky, A. K., Liu, Y., Meer, P. F., Heddle, N.M. & Arnold, D. M. (2021). Exploring the components of bleeding outcomes in transfusion trials for patients with hematologic malignancy. Transfusion, 61(1):286-293. doi: 10.1111/trf.16126.
Bussel, J., Cooper, N., Boccia, R., Zaja, F. & Newland, A. (2021). Immune thrombocytopenia. Expert Rev Hematol, 14(11):1013-1025. doi: 10.1080/17474086.2021.1995347.
Campos, L., Campanhã, D., Tateno, R. Y. & Palma, L. F. (2022). Photobiomodulation and Antimicrobial Photodynamic Therapy for Oral Ulcers in a Patient With Thrombocytopenia Following Bone Marrow Transplantation. J Lasers Med Sci, 13(17): 1-3. doi: 10.34172/jlms.2022.17.
Cines, D. B. & Bussel, J. B. (2005). How I treat idiopathic thrombocytopenic purpura (ITP). Blood Adv, 106(7):2244-2251. https://doi.org/10.1182/blood-2004-12-4598
Chi, A. C., Neville, B. W., Krayer, J. W. & Gonçalves, W. C. (2010). Oral Manifestations of Systemic Disease. Am Fam Physician, 82(11):1381-1388. PMID: 21121523.
Dompe, C.; Moncrieff, L.; Matys, J.; Grzech-Leśniak, K.; Kocherova, I.; Bryja, A.; Bruska, M.; Dominiak, M.; Mozdziak, P.; Skiba, T.H.I.; et al. (2020). Photobiomodulation-Underlying Mechanism and Clinical Applications. J. Clin. Med, 9(6):1-17. https://doi.org/10.3390/jcm9061724
Dong, Y., Xia, Z., Zhou, J., Hu, Y., Yue, M., Wang, Y & Hu, M. (2023). Risk of thrombotic events in immune thrombocytopenia patients treated with thrombopoietic agents: a systematic review and meta-analysis. Thromb J, 21(69):1-20. doi: 10.1186/s12959-023-00509-z.
Freitas, L.F. & Hamblin, M.R. (2016). Proposed Mechanisms of Photobiomodulation or Low-Level Light Therapy. IEEE J Sel Top Quantum Electron, 22(3):1-37. doi: 10.1109/JSTQE.2016.2561201.
Ker, K., Beecher, D. & Roberts, I. (2013). Topical application of tranexamic acid for the reduction of bleeding. Cochrane Database Syst Rev, 23(7):1-65. doi: 10.1002/14651858.CD010562
Lambert, M.P. & Gernsheimer, T.B. (2017). Clinical updates in adult immune thrombocytopenia. Blood, 129(21):2829-2835. https://doi.org/10.1182/blood-2017-03-754119
Lanza, A., Spirito, F. D., Petrosino, S. & Sbordone, L. (2021). Oral Healthcare and Idiopathic Thrombocytopenic Purpura: Early Recognition, Dental Management and Case Report. Dent J (Basel), 9(9):1-9. doi: 10.3390/dj9090108.
Lokesh, K., Kannabiran, J. & RAO, M.D. (2016). Salivary Lactate Dehydrogenase (LDH)- A Novel Technique in Oral Cancer Detection and Diagnosis. J Clin Diagn Res, 10(7):34-37.doi: 10.7860/JCD6/16243.7223.
Ministério da Saúde, (2018). Carta Circular nº166 – CONEP. Brasil.
Mithoowani, S., Cervi, A., Shah, N., Ejaz, R., Sirotich, E., Barty, R., Li, N., Nazy, I. & Arnold, D.M. (2020). Management of major bleeds in patients with immune thrombocytopenia. J Thromb Haemost, 18(7):1783-1790. doi: 10.1111/jth.14809.
Neunert, C., Lim, W., Crowther, M., Cohen, A., Solberg, L. & Crowther, M. A. (2011). The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood Adv, 117(16):4190-4207. https://doi.org/10.1182/blood-2010-08-302984
Neunert, C. (2017). Management of newly diagnosed immune thrombocytopenia: can we change outcomes?. Hematology Am Soc Hematol Educ Program. 1(24):400-405. https://doi.org/10.1182/asheducation-2017.1.400
Neunert, C., Terrell, D.R., Arnold, D.M., Buchanan, G., Cines, D.B., Cooper, N., Cuker, A., Despotovic, J.M., George, J.N., Grace, R.F., Kühne, T., Kuter, D.J., Lim, W., McCrae, K.R., Pruitt, B., Shimanek, H. & Vesely, S.K. (2020). American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv, 3(23):3829-3866. doi: 10.1182/bloodadvances.2019000966.
Pandeshwar, P., Roa, M.D., Das, R., Shastry, S.P., Kaul, R. & Srinivasreddy, M.B. (2016). Photobiomodulation in oral medicine: a review. J Investig Clin Dent, 7(2):114-126. doi: 10.1111/jicd.12148.
Pereira, A.S., Shitsuka, D.M., Parreira, F.J. & Shitsuka, R. (2018). Metodologia da Pesquisa Ciêntifica. [E-book gratuito].https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf. Santa Maria/RS. Ed.UAB/NTE/UFSM.
Pereira, N. M. S., & Torregrossa, V. R. (2023). Manejo odontológico de pacientes com púrpura trombocitopênica idiopática: relato de caso clínico. Revista Brasileira De Saúde Funcional, 11(1), 52-64. https://doi.org/10.25194/rebrasf.v11i1.1470
Provan, D. (2009). Characteristics of immune thrombocytopenic purpura: a guide for clinical practice. European Journal of Haematology, 82(71):8-12. https://doi.org/10.1111/j.1600-0609.2008.01207.x
Provan, D., Arnold, D. M., Bussel, J.B., Chong, B. H., Cooper, N., Gernsheimer, T., Ghanima, W., Godeau, B., González-López, T .J., Grainger, J., Hou, M., Kruse, C., McDonald, V., Michel, M., Newland, A. C., Pavord, S., Rodeghiero, F., Scully, M., Tomiyama, Y., Wong, R. S., Zaja, F & Kuter, D. J. (2019). Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv, 3(22):3780-3817. doi: 10.1182/bloodadvances.2019000812.
Queiroz, M .D., Souza, A. A. R., Rocha , A. C. A. A., Santos, M.D. dos. & Almeida, D. R. (2022). Idiopathic thrombocytopenic purpura in children: a narrative review. Research, Society and Development, 11(2): e35711225734. doi: 10.33448/rsd-v11i2.25734.
Rodeghiero, F., Stasi, R., Gernsheimer, T., Michel, M., Provan, D., Arnold, D. M., Bussel, J. B., Cines, D. B., Chong, B. H., Cooper, N., Godeau, B., Lechner, K., Mazzucconi, M. G., McMillan, R., Sanz, M. A., Imbach, P., Blanchette, V., Kühne, T., Ruggeri, M. & George, J. N. (2009). Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood, 113(11):2386-93. doi: 10.1182/blood-2008-07-162503.
Sangwan, A., Tewari, S., Narula, S. C., Sharma, R. K. & Sangwan, P. (2013). Significance of periodontal health in primary immune thrombocytopenia - a case report and review of literature. J Dent (Tehran), 10(2):197-202. PMID: 23724220; PMCID: PMC3666081.
Segal, J. B. & Powe, N. R. (2006). Prevalence of immune thrombocytopenia: analyses of administrative data. Journal of Thrombosis and Haemostasis, 4(11):2377-2383. https://doi.org/10.1111/j.1538-7836.2006.02147.x
Sugiura, T., Yamamoto, K., Murakami, K., Horita, S., Matsusue, Y., Nakashima, C. & Kirita, T. (2018). Immune Thrombocytopenic Purpura Detected with Oral Hemorrhage: a Case Report. J Dent (Shiraz), 19(2):159-163. PMID: 29854891; PMCID: PMC5960737.
Thackeray, R., Gharde, P. & Ranghuwanshi, M. (2023). Idiopathic Thrombocytopenic Purpura: Current Limitations and Management. Cureus, 15(11):1-10. doi: 10.7759/cureus.49313
Uda, C., Ohta, R., Koike, T. & Sano, C. (2024). Challenges in Managing External Dental Fistula in an Immunocompromised Elderly Patient: A Case Report. Cureus, 16(9):e69742. doi: 10.7759/cureus.69742.
Verde, C. F., Pinto, V. A. D. B. M., Dias, E. A. F., Azevedo, T. C. S., Gomes, A. A., Ribeiro, E. L. F., Rodrigues, J. M. P., & Lima Júnior, D. A. (2024). Manejo cirúrgico oral de pacientes com púrpura trombocitopênica idiopática: revisão de literatura. Brazilian Journal of Implantology and Health Sciences, 6(9), 1994–2010. https://doi.org/10.36557/2674-8169.2024v6n9p1994-2010
Zufferey, A., Kapur, R. & Semple, J.W. (2017). Pathogenesis and Therapeutic Mechanisms in Immune Thrombocytopenia (ITP). J Clin Med, 6(16):1-21. doi: 10.3390/jcm6020016.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Anna Isis Fornazari Rocha; Marceli Dias Ferreira; Fernanda Pereira da Silva; Valeska Caroline Walchaki; Maria Luiza Chemin; Manoela Wisniewski Bevervanso; Marcela Claudino

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.