Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
Home | About JISP | Search | Accepted articles | Online Early | Current Issue | Archives | Instructions | SubmissionSubscribeLogin 
Users Online: 105  Home Print this page Email this page Small font size Default font size Increase font sizeWide layoutNarrow layoutFull screen layout


 
CASE REPORT
Year : 2008  |  Volume : 12  |  Issue : 1  |  Page : 26-27 Table of Contents   

Periodontal considerations for Glanzmann's thrombasthenic patient


Department of Periodontics, M.S. Ramaiah Dental College and Hospital, MSRIT Post, Bangalore - 560 054, India

Date of Submission09-Oct-2008
Date of Acceptance04-Nov-2008

Correspondence Address:
Umesh Yadalam
Department of Periodontics, M.S. Ramaiah Dental College and Hospital, MSRIT Post, Bangalore-560 054
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-124X.44095

Rights and Permissions
   Abstract 

Glanzmann's thrombasthenia (GT) was reported and described as a bleeding diathesis seen in children and characterized by diminished clot retraction. The disorder is caused by a deficiency in the platelet membrane glycoprotein IIb-IIIa complex, with bleeding due to defective platelet hemostatic plug formation. The recurrent features of GT include purpura, epistaxis, gingival hemorrhage, and menorrhagia. GT being an autosomal recessive trait is reported to be especially prevalent in populations where intermarriage is common. Typically, the patients are diagnosed in infancy within the age of five. Though no differences appear to occur based on sex men more frequently present with gingival bleeding. We report the case of a female patient with GT who presented with the chief complaint of gingival bleeding. The patient was given periodontal treatment under platelet transfusion followed by proper oral hygiene instructions. The report discusses periodontal consideration for GT patients.

Keywords: Medically compromised, periodontal, thrombasthenia


How to cite this article:
Yadalam U, Kranti K, Seshan H. Periodontal considerations for Glanzmann's thrombasthenic patient. J Indian Soc Periodontol 2008;12:26-7

How to cite this URL:
Yadalam U, Kranti K, Seshan H. Periodontal considerations for Glanzmann's thrombasthenic patient. J Indian Soc Periodontol [serial online] 2008 [cited 2020 Aug 11];12:26-7. Available from: http://www.jisponline.com/text.asp?2008/12/1/26/44095


   Introduction Top


Glanzmann's thrombasthenia (GT) was first described in 1918 as a hemorrhagic diathesis characterized by decreased clot formation seen in children with normal platelet counts, normal prothrombin time (PT) and partial thromboplastin time (PTT), a prolonged bleeding time, abnormal clot retraction, and the absence of platelet aggregation in vitro in the presence of adenosine diphosphate (ADP), epinephrine, collagen, or thrombin. This rare autosomal recessively transmitted congenital disorder is characterized and considered among the most frequent inherited platelet diseases and reported to be especially prevalent in populations where intermarriage is common. [1] It is followed by characteristic pattern of mucocutaneous bleeding. The severity is variable, even within kindred. The recurrent features seen in GT include purpura, epistaxis, gingival hemorrhage, and menorrhagia. The disorder is caused by deficiency in the platelet membrane glycoprotein (GP) IIb-IIIa complex, [2] with bleeding due to defective platelet hemostatic plug formation.

GT is differentiated according to fibrinogen content of the platelets and clot retraction. Type I GT in which GP IIb-IIIa complex is <5%, clot retraction is absent, and fibrinogen binding is absent or severely deficient. Type II in which GP IIb-IIIa complex is 10-20%, clot retraction is normal or moderately deficient, and fibrinogen binding is present. Variant type in which GP IIb-IIIa complex is >50%, clot retraction is variable, and fibrinogen binding is variable. [1]


   Case Report Top


A 9-year-old girl, known GT patient, who presented with gum bleeding, was referred from the Pediatrics Department of M.S.R.M.C to the Department of Periodontics M.S.R.D.C. Her medical history revealed that she was born to consanguineous parents. At six months of age she had an episode of epistaxis following trauma and was given blood transfusion for the same. Since then she has had repeated episodes of epistaxis and episodes of bleeding from lips, gums, and tongue due to minor trauma. She had been hospitalized more than 18 times for repeated transfusions to control bleeding. Other clinical manifestations of GT like spontaneous bleeding, menorrhagia, bleeding of purpuric type were absent. On oral examination, her gingival status showed generalized pink colored gingiva. However, it was red, soft, and edematous with stippling and knife-edge lost in mandibular anterior region. Papillary gingival enlargement and bleeding on probing was seen in madibular anterior region. A diagnosis of mild gingivitis with normal periodontal status was made [Figure 1].

Routine laboratory investigations revealed normal hemoglobin (9.6%), platelet count (3,77,000/mm 3 ), PT (10.5 seconds), active PTT (29 seconds), and bleeding time (15 seconds). The platelet aggregation test presented no agglutination with epinephrine, ADP, and collagen.

Periodontal treatment (scaling and polishing) under platelet transfusion was given followed by and oral hygiene instructions. The patient was prescribed 0.12% chlorhexidine and tranexamic acid mouth rinses. The therapy was successful with decrease in gum bleeding and the patient returning to status quo . Thereafter, she had weekly follow-up for one month and monthly recalls for the next six months [Figure 2].


   Discussion Top


GT is a familial disorder occurring in both the sexes. Most patients are diagnosed before the age of five. The main problem is the occurrence of hemorrhage whose frequency and severity may decrease with age. However, it is important to anticipate the risk of bleeding and administer prophylactic platelet transfusion even if the patient does not have a history of prior bleeding, because bleeding in thrombasthenia is unpredictable. Previous reports and investigations on the clinical management of the disease present only palliative means of treatment. [3]

It is suggested that any periodontal procedures involving the risk of hemorrhage be done at the time of platelet infusion. If this is not possible the prophylactic methods and transfusion should be performed with utmost care and upon consultation with the patient's hematologist. The treatment modalities should be conservative as far as possible and procedures that would necessitate repeated visits should be avoided. Optimal oral hygiene should be encouraged and a soft-bristle toothbrush prescribed. Preventive therapeutic means are very important in GT patients. Antiplaque agents are beneficial for the maintenance of proper oral hygiene in the postoperative period. A 0.12% chlorhexidine mouth rinse was used in our case and was found to be beneficial in controlling plaque. Although the tooth staining necessitates additional scaling appointments, regular use of ultrasonic scalers and polishing with rubber cups benefits patients without any further risk of hemorrhage. [4]

It would be wise to initiate meticulous oral hygiene immediately in all patients with this disorder. If a thorough medical history is obtained, a hematological pretreatment is sought, precautions are taken, and a hematological pretreatment is conducted prior to the referral to dental office, periodontal treatment can be successfully carried out.

The differential diagnosis in patients with mucocutaneous bleeding, prolonged bleeding times, and normal platelets includes von Willebrands disease and Bernard-Soulier syndrome in addition to Glanzmann's thombasthenia, although it may not be easy to diagnose and differentiate among many bleeding disorders in which severe hemorrhage is seen. A dental and hematological close collaboration therefore is essential for the management of such complicated cases. [5]


   Conclusion Top


If a thorough medical history is obtained, precautions are taken, and a hematological pretreatment is conducted prior to the referral to dental office, periodontal treatment can be successfully carried out.

 
   References Top

1.Kantarci A, Cebeci I, Firatli E, Atamer T, Tuncer O. Periodontal management of Glanzmann's hrombasthenia: Report of 3 cases. J Periodontal 1996;67:816-20.  Back to cited text no. 1    
2.Badhe BA, Jayanthi S, Datta T. Clinical spectrum of Glanzmann's thrombasthenia. J Pathol Microbial 2000;43:297-302.  Back to cited text no. 2    
3.Bisch FC, Bowen KJ, Hanson BS, Kudryk VL, Billman MA.Dental consideration for a Glanzmann's thrombasthenia patient: A case report. J Periodontal 1996;67:536-40.  Back to cited text no. 3    
4.Nixon KC, Keys DW, Brown G. Oral management of Glanzmann's thrombasthenia: A case report. J Periodontal 1975;46:364-7.  Back to cited text no. 4    
5.Fernandes Gomes M, de Melo RM, Plens G, Pontes EM, Silva MM, da Rocha JC. Surgical and clinical management of a patient with Glanzmann's thrombasthenia. Quintessence Int 2004;35:617-20.   Back to cited text no. 5  [PUBMED]  


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 Oral Surgery in Patients With Glanzmann Thrombasthenia: A Case Series
Eleonora Segna,Andrea Artoni,Raffaele Sacco,Aldo Bruno Gianń
Journal of Oral and Maxillofacial Surgery. 2017; 75(2): 256
[Pubmed] | [DOI]



 

Top
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    Introduction
    Case Report
    Discussion
    Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed1768    
    Printed132    
    Emailed0    
    PDF Downloaded391    
    Comments [Add]    
    Cited by others 1    

Recommend this journal