Pediatric Thalassemia Case Report
Budget: $10 – $30 USD
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Case Summary:
A 12-year-old child with a history of thalassemia presented with inflamed and bleeding gums for the past 2–3 months. The child’s medical history includes multiple blood transfusions since age 1, followed by gingival hypertrophy and frequent bleeding gums. Clinical examination and various tests reveal characteristic signs of the disease, including facial changes and hematological abnormalities.
Chief Complaint (CC):
The patient complains of "bleeding gums and swollen gums" that have been persisting for the past 2-3 months.
History of Present Illness (HPI):
The patient, a 12-year-old child, has been experiencing inflamed and bleeding gums for the past 2-3 months. The bleeding occurs frequently, especially after blood transfusions (twice or thrice a month). The symptoms started after several years of blood transfusions, which were given due to thalassemia. There was no relief despite usual oral hygiene measures.
Medical History:
Thalassemia: Multiple blood transfusions since the age of 1.
No history of splenectomy: Not performed.
Family History: Non-contributory, with no genetic or hereditary conditions noted.
Social History:
Nothing is mentioned about lifestyle factors, smoking, alcohol use, or other habits that may impact oral health.
Review of Systems:
General: No significant extraoral swelling or lymphadenopathy.
Oral: Persistent gum bleeding and hypertrophy.
Hematological: Anemia (Hb 5.7 gm/dL), low leukocyte count (2300/μL), and elevated INR (1.4).
Skin, Eyes, Nails: Pale appearance observed.
Craniofacial: Depressed cranial vault, frontal bossing, and saddle nose (chipmunk facies).
Dental History:
Nothing is mentioned about previous dental treatments, oral hygiene practices, or any other dental issues.
Clinical Presentation & Examination Findings:
General: The child has a small stature, is moderately built, and appears well-nourished.
Oral Examination: There is significant gingival hypertrophy with hemorrhagic tissue. The gingiva is soft to firm, non-tender, and bleeds easily. There is hyperpigmentation seen in the palate and tongue region.
Craniofacial: Characteristic "chipmunk facies" with depressed cranial vault, frontal bossing, and saddle nose. No extraoral swelling or lymphadenopathy.
Hematology: Hb of 5.7 gm/dL, low TLC, and elevated INR and APTT values.
Radiographic Findings: Orthopantomogram (OPG) shows mixed dentition with thinned cortical boundaries, short spiky roots, and a changed trabecular pattern. Lateral skull view shows a "hair on end" appearance, widening of the diploic space, and salt-and-pepper appearance with enlarged marrow spaces.
Diagnosis Process:
The diagnosis is primarily based on clinical findings and radiographic images, coupled with the patient’s history of thalassemia. The presence of typical facial features and hematological abnormalities further supports this diagnosis. A differential diagnosis was ruled out using laboratory results such as low Hb and platelet count, and the radiographic "hair on end" appearance seen on skull X-rays.
Dental Considerations & Management:
Impact on Dental Care: The systemic condition (thalassemia) complicates dental care due to poor oral health from anemia, bleeding gums, and potential delayed healing. Dental procedures may be challenging due to low blood counts.
Management Approach: Preventive dental care should focus on reducing gum inflammation and managing bleeding. Topical fluoride treatments and careful scaling may be recommended. If needed, a consultation with a hematologist for blood transfusion management is essential. Bleeding precautions should be followed during any invasive dental procedures.
Case Summary:
A 12-year-old child with a history of thalassemia presented with inflamed and bleeding gums for the past 2–3 months. The child’s medical history includes multiple blood transfusions since age 1, followed by gingival hypertrophy and frequent bleeding gums. Clinical examination and various tests reveal characteristic signs of the disease, including facial changes and hematological abnormalities.
Chief Complaint (CC):
The patient complains of "bleeding gums and swollen gums" that have been persisting for the past 2-3 months.
History of Present Illness (HPI):
The patient, a 12-year-old child, has been experiencing inflamed and bleeding gums for the past 2-3 months. The bleeding occurs frequently, especially after blood transfusions (twice or thrice a month). The symptoms started after several years of blood transfusions, which were given due to thalassemia. There was no relief despite usual oral hygiene measures.
Medical History:
Thalassemia: Multiple blood transfusions since the age of 1.
No history of splenectomy: Not performed.
Family History: Non-contributory, with no genetic or hereditary conditions noted.
Social History:
Nothing is mentioned about lifestyle factors, smoking, alcohol use, or other habits that may impact oral health.
Review of Systems:
General: No significant extraoral swelling or lymphadenopathy.
Oral: Persistent gum bleeding and hypertrophy.
Hematological: Anemia (Hb 5.7 gm/dL), low leukocyte count (2300/μL), and elevated INR (1.4).
Skin, Eyes, Nails: Pale appearance observed.
Craniofacial: Depressed cranial vault, frontal bossing, and saddle nose (chipmunk facies).
Dental History:
Nothing is mentioned about previous dental treatments, oral hygiene practices, or any other dental issues.
Clinical Presentation & Examination Findings:
General: The child has a small stature, is moderately built, and appears well-nourished.
Oral Examination: There is significant gingival hypertrophy with hemorrhagic tissue. The gingiva is soft to firm, non-tender, and bleeds easily. There is hyperpigmentation seen in the palate and tongue region.
Craniofacial: Characteristic "chipmunk facies" with depressed cranial vault, frontal bossing, and saddle nose. No extraoral swelling or lymphadenopathy.
Hematology: Hb of 5.7 gm/dL, low TLC, and elevated INR and APTT values.
Radiographic Findings: Orthopantomogram (OPG) shows mixed dentition with thinned cortical boundaries, short spiky roots, and a changed trabecular pattern. Lateral skull view shows a "hair on end" appearance, widening of the diploic space, and salt-and-pepper appearance with enlarged marrow spaces.
Diagnosis Process:
The diagnosis is primarily based on clinical findings and radiographic images, coupled with the patient’s history of thalassemia. The presence of typical facial features and hematological abnormalities further supports this diagnosis. A differential diagnosis was ruled out using laboratory results such as low Hb and platelet count, and the radiographic "hair on end" appearance seen on skull X-rays.
Dental Considerations & Management:
Impact on Dental Care: The systemic condition (thalassemia) complicates dental care due to poor oral health from anemia, bleeding gums, and potential delayed healing. Dental procedures may be challenging due to low blood counts.
Management Approach: Preventive dental care should focus on reducing gum inflammation and managing bleeding. Topical fluoride treatments and careful scaling may be recommended. If needed, a consultation with a hematologist for blood transfusion management is essential. Bleeding precautions should be followed during any invasive dental procedures.