Bisch F C, Bowen K J, Hanson B S, Kudryk V L, Billman M A
U.S. Army Dental Activity, Ft. Gordon, GA, USA.
J Periodontol. 1996 May;67(5):536-40. doi: 10.1902/jop.1996.67.5.536.
Glanzmann's thrombasthenia is a qualitative platelet disorder characterized by a deficiency in the platelet membrane glycoproteins (GP) IIb-IIIa. It belongs to a group of hereditary platelet disorders typified by normal platelet numbers and a prolonged bleeding time. The bleeding seen in Glanzmann's thrombasthenia usually includes bruising, epistaxis, gingival hemorrhage, and menorrhagia. Spontaneous, unprovoked bleeding is unusual. The severity of bleeding is unpredictable in thrombasthenia and does not correlate with the severity of the platelet GP IIb-IIIa abnormality. The present case report describes the dental treatment of a patient with Glanzmann's thrombasthenia. A 39-year-old female with a history of Glanzmann's thrombasthenia presented for periodontal therapy for spontaneous gingival hemorrhage. The patient had been sporadically seen in the past and had a record of only returning for appointments on an "emergency" basis. The periodontal findings revealed a diagnosis of moderate to advanced adult periodontitis in all quadrants. After all dental options had been discussed, the treatment of choice was determined to be extraction of the remaining dentition and fabrication of immediate dentures. The patient received a loading dose of 5 grams of aminocaproic acid (EACA) intravenously 3 hours prior to the surgery. At the beginning of the extractions 1 gram of EACA per hour continuous infusion and a 6 pack of platelets was administered. The patient tolerated the extractions well. All sites healed normally. The patient has had no difficulty in adjusting to the dentures. The case report discusses a possible treatment option in a noncompliant patient having Glanzmann's thrombasthenia and briefly discusses other hereditary bleeding disorders with similar presentations.
血小板无力症是一种血小板质性疾病，其特征为血小板膜糖蛋白（GP）IIb-IIIa缺乏。它属于一组遗传性血小板疾病，其典型特征是血小板数量正常但出血时间延长。血小板无力症患者出现的出血通常包括瘀伤、鼻出血、牙龈出血和月经过多。自发性、无故出血并不常见。血小板无力症患者出血的严重程度无法预测，且与血小板GP IIb-IIIa异常的严重程度无关。本病例报告描述了一名血小板无力症患者的牙科治疗情况。一名有血小板无力症病史的39岁女性因自发性牙龈出血前来接受牙周治疗。该患者过去曾偶尔就诊，且只有在“紧急”情况下才回来预约就诊的记录。牙周检查结果显示所有象限均诊断为中度至重度成人牙周炎。在讨论了所有牙科治疗方案后，确定的治疗选择是拔除剩余牙列并制作即刻义齿。患者在手术前3小时静脉注射了5克氨甲环酸（EACA）的负荷剂量。拔牙开始时，每小时持续输注1克EACA，并输注6单位血小板。患者对拔牙耐受良好。所有创口均正常愈合。患者佩戴义齿没有困难。该病例报告讨论了一名不配合治疗的血小板无力症患者可能的治疗方案，并简要讨论了其他具有类似表现的遗传性出血性疾病。
