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Immune thrombocytopenic purpura presenting with spontaneous gingival haemorrhage in pregnancy
  1. Louise Dunphy1 and
  2. Rhodri Williams2
  1. 1 Department of Surgery, Milton Keynes University Hospital, Milton Keynes, UK
  2. 2 Department of Oral and Maxillofacial Surgery, The Queen Elizabeth Hospital, Birmingham, UK
  1. Correspondence to Dr Louise Dunphy, dunphylmb{at}


Gingival bleeding is a common intraoral finding, typically associated with inflamed tissues and periodontal disease. It is easily provoked by periodontal probing or toothbrushing. Spontaneous gingival bleeding rarely occurs and may be the only sign of systemic bleeding problems such as thrombocytopenia, leukaemia or coagulopathy. In pregnancy, acute onset of thrombocytopenia may occur in systemic disorders such as severe pre-eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) or the acute fatty liver of pregnancy. The diagnosis and management of such conditions may challenge physicians. It requires a systematic approach with a comprehensive history to exclude causes of gingival haemorrhage such as periodontal disease, anticoagulant therapy, maxillofacial trauma, haematological disorders or a bacterial infection. The authors describe a case of immune thrombocytopenic purpura presenting with spontaneous gingival haemorrhage in pregnancy. This case highlights the fact that medical intervention to correct the underlying aberration of haemostasis is necessary for local measures to stop the gingival bleeding successfully.

  • dentistry and oral medicine
  • haematology (drugs and medicines)

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  • Contributors LD: wrote the case report. RW: edited the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.