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.