TERAPI IMUNOSUPRESAN PADA PASIEN ANEMIA APLASTIK DENGAN PERDARAHAN GUSI: MENYEMBUHKAN ATAU MEMPERPARAH?
Abstract
Case Management: A 18-year-old female patient referred from internal medicine department due to swelling of palate since 2 days before that interrupted eating activity. She routinely consumes Sandimun®100 mg tablets. A 2 x 1 cm black blood clot in anterior hard palate and ulcerative lesion at dorsal tongue regio 45 surrounded by necrotic area were found on intra oral examination. Patient was diagnosed with necrotizing ulcer-related neutropenia accompanied by AA-associated hemorrhagic bullae in the hard palate. Patient treated with mouthwash containing 0.1% hyaluronic
acid and 1% feracrylum.
Discussion: Immunosuppressant is the AA gold standard therapy. Cyclosporine (CsA) as imunosupressant is common drug to prevent T cells from attacking stem cells in bone marrow. The side effects of CsA is gingival hiperplasia.
Conclusions: Gingival bleeding and gingival hiperplasia due to thrombocytopenia and the use of cyclosporine are vicious circles that need to be aware. With comprehensive management, good oral conditions will be obtained, therefore the quality of life can increase.
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Rai A, Vaishali V, Naikmasur VG. Aplastic anemia presenting as bleeding of gingiva : Case report and dental considerations. SAUDI J Dent Res [Internet]. 2015;4–7.
Jalaeikhoo H, Khajeh-mehrizi A. Immunosuppressive Therapy in Patients with Aplastic Anemia : A Single-Center Retrospective Study. PLoS One. 2015;1–10.
Passweg JR. Immunosuppressive treatment for aplastic anemia : are we hitting the ceiling ? Haematologica. 2009;94(3):2–4.
Franch AM, Esteve CG, Pérez MS. Oral manifestations and dental management of patient with leukocyte alterations. 2011;3(1).
Khammissa RAG, Fourie J, Masilana A, Lawrence S, Lemmer J, Feller L. Oral manifestations of thrombocytopaenia. Saudi Dent J. 2017.
De AAS. Oral manifestation of thrombocytopenia in immunosuppressed patient - Report of case. 2016;1(June 2012):87–90.
Damodar S. Immunosuppressive Therapy for Aplastic Anaemia History of IST for Aplastic. 2015;16–20.
Young NS, Bacigalupo A, Marsh JCW. Aplastic Anemia : Pathophysiology and Treatment. Biol Blood Marrow Transplant. 2010;16(1):S119–25.
Frickhofen N, Heimpel H, Kaltwasser JP, Schrezenmeier H. Antithymocyte globulin with or without cyclosporin A : 11-year follow-up of a randomized trial comparing treatments of aplastic
anemia. Blood. 2003;101(4):1236–42.
Anemia A, Young NS. Antithymocyte Globulin and Cyclosporine for Severe Aplastic Anemia. J Am Med Assoc. 2003;289(9):5–10.
Seema G. Immunosuppressant Drugs : Role in Periodontium. 2016;6(2).
Martin L. Cyclosporin A-induced gingival overgrowth is not associated with myofibroblast transdifferentiation. 2010;1(2):182–8.
Gogalniceanu D. Gingival overgrowth induced by immunosuppressive treatment with cyclosporine A and mycophenolate mofetil in a patient with kidney transplant. Int J Med Dent. 2013;3(3):183–7.
Isyanto, Abdulsalam M. Masalah Pada Tata Laksana Anemia Aplastik Didapat. Sari Pediatr. 2005;7(1):26–33.
Puhar I. Severe Generalized Periodontitis in a Patient with an Aplastic Anemia : a 5 Year Follow-up Case Report. acta Stomatol croat. 2015;49(2):151–7.
Adeyemo T, Adediran A, Akanmu A, Adeyemo W, Akinbami AJ. Orofacial manifestations of hematological disorders: Anemia and hemostatic disorders. Indian J Dent Res. 2011;22(3):454.
Isabel ANA, Ramos B. Aplastic anemia-from pathophysiology to diagnosis, maagement and treatment. 2015;
Montané E, Ibáñez L, Vidal X, BallarÃn E, Puig R, GarcÃa N, et al. Epidemiology of aplastic anemia: A prospective multicenter study. Haematologica. 2008;93(4):518–23.
Young NS, Calado RT, Scheinberg P. Current concepts in the pathophysiology and treatment of aplastic anemia. Blood J. 2006;108(8):2509–20.
Brennan MT, Sankar V, Baccaglini L, Pillemer SR, Kingman A, Nunez O, et al. Oral manifestations in patients with aplastic anemia. Oral Surg Oral Med Oral Pathol Oral Radiol. 2001;92(5):503–8.
Glick M, Murray W. Burket’s Oral Medicine. 2015.
Scheinberg P, Young NS. How I treat acquired aplastic anemia. Blood J. 2012;120(6):1185–97.
Ponnaiyan D, Jegadeesan V. Cyclosporine A : Novel concepts in its role in drug-induced gingival overgrowth. 2015;499–506.
Aral CA, Dilber E, Aral K, Sarıca Y, Sivrikoz ON. Management of Cyclosporine and Nifedipine-Induced Gingival Hyperplasia. 2015;12–5.
Nelmi Wahyuni. Peran Dokter Gigi Dalam Mendeteksi Dini Leukemia Melalui Manifestasinya Di Rongga Mulut (Laporan Kasus). USU e-Repository © 2008. 2008;
Cooper CL, Loewen R, Tsiporah Shore. Gingival Hyperplasia Complicating Acute Myelomonocytic Leukemia. Journal_Canadian_Dental_Association. 2000;66(2):78–9.
Gupta A, Epstein JB, Cabay RJ. Bleeding Disorders of Importance in Dental Care. 2007;73(1).
Sarmast ND, Quevedo MJG, Wang HH, Herrera ERG. Acute Local Spontaneous and Profuse Gingival Hemorrhage during Neoadjuvant Treatment with Paclitaxel and Trastuzumab. 2016;4–7.
Darby I. Drugs and gingival bleeding. Aust Prescr. 2006;29(6):154–5.
Laddha AK, Mulla M, Sharma SS, Lahoti BK. A prospective comparison of topical feracrylum citrate versus adrenaline as haemostatic agent in hypospadias surgery in children. 2014;
Nuvvula S, Gaddam K, Kamatham R. Efficacy of tranexamic acid mouthwash as an alternative for factor replacement in gingival bleeding during dental scaling in cases of hemophilia: A
randomized clinical trial. Contemp Clin Dent. 2014;5(1):49.
Marsh JCW, Ball SE, Cavenagh J, Darbyshire P, Dokal I, Gordon-smith EC, et al. Guidelines for the diagnosis and management of aplastic anaemia. 2012;(May):43–70.
DOI: http://dx.doi.org/10.30659/odj.6.1.23-29
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