Gingival Bleeding in a Child with Fanconi Anemia: A Case Rep
Fanconi anemia (FA) is a rare autosomal recessive disorder characterized by multiple congenital abnormalities, bone marrow failure, and higher susceptibility to malignancies, especially to head and neck carcinomas. Only few reports about the oral manifestations of FA are available. The main reported oral conditions associated with FA are microdontia and advanced periodontitis.

A 10-year-old male patient was referred by his hematologist for spontaneous severe gingival bleeding during the last two days before consultation.The patient was diagnosed with FA at the age of five. The patient was operated for bifid thumbs at the age of 2 years and for cryptorchidism at the age of seven.He had a pale skin as well as skin pigmentations in the form of “café au lait” spots that were noticeable on his face and arms.

The intraoral examination revealed petechial hemorrhages with oozing blood from the gingiva which was more evident in the lower anterior region with a blood collection in the lower vestibule.Given the patient’s agitation, the pancytopenia, and the severe bleeding, no dental therapeutics were possible.

Therapeutic approach consisted in the application of a sterile compress soaked in tranexamic acid (Exacyl 1 mL/10 L) in local compression for 5 minutes in each bleeding area. A prescription of tranexamic acid, four times a day, as a passive mouthwash was recommended. The patient was asked to avoid hot foods and drinks.

The patient was hospitalized to keep him under supervision and to correct his blood count. Given the FA-related severe thrombocytopenia, a platelet concentrate was necessary to raise the platelet count above 50000/μL. The patient was therefore given a single unit of leuko-depleted and irradiated apheresis platelet.

The oral examination showed poor oral hygiene and discolored teeth. However, the gingival bleeding was scarce .Sixty minutes before the dental scaling, the patient received 1.5 g ampicillin per os to reduce the risk of postoperative infection. Dentists started by rinsing the patient’s mouth for 2 minutes with 0.2% chlorhexidine solution after that, manual supragingival scaling was performed under local anesthesia. The gingival bleeding was controlled by local compression using gauze saturated with tranexamic acid.

The patient’s parents were informed of the risks of developing malignancies, and they were asked to perform a regular mouth inspection to their child to detect any possible suspicious lesion. Follow-up sessions were scheduled.

To conclude, dealing with the severe gingival bleeding of our young patient required the correction of his blood count and the use of an antifibrinolytic agent in local compression and a mouthwash. All these measures were necessary before starting the local treatment which consisted in a supragingival scaling that was aimed at reducing the local inflammation. These measures were efficient for a successful control of the severe gingival bleeding.

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