title: Idiopathic thrombocytopenic purpura presenting as post-extraction hemorrhage.
abstract: OBJECTIVE
  The aim of this article is to present a case of idiopathic thrombocytopenic purpura (ITP) in order to emphasize the importance of the clinical exam since the anamnesis leads to a diagnostic hypothesis of ITP.
  
  
  BACKGROUND
  Acute ITP is considered an autoimmune disease characterized by the production of antibodies against platelets, antigens produced by a viral infection, or a platelet sparing drug combination. These antibodies adhere to platelets and are recognized and destroyed by the reticulo-endothelial system. Consequently, the platelet count gradually diminishes and is insufficient for the maintenance of primary hemostasis.
  
  
  METHODS
  A 77-year-old woman presented with post-extraction intermittent bleeding. The physical examination revealed discoloration of the skin, multiple petechiae, hematomas, ecchymosis of the upper lip, bruises all over the body, gingiva that bled spontaneously, and a malformed blood clot at the extraction site of tooth #44. The hematological exams confirmed the hypothesis of ITP. The patient was immediately hospitalized in the Hematology Department of a local hospital and received platelet replacement, hydration, medication, and general care. After the spontaneous bleeding stopped, the malformed clot was removed using alveolar curettage along with a thorough cleaning of the extraction site with a 0.9% saline solution before suturing the wound and prescribing medication. After the sixth day of hospitalization, the patient presented with the following results: Hb: 12.3 mg/dL, Ht: 36.1%, and PC: 87,000 mm3. The patient was then discharged and was placed under outpatient follow-up care.
  
  
  CONCLUSIONS
  The importance of the clinical exam must be emphasized since the anamnesis leads to a diagnostic hypothesis of ITP and provides the dental surgeon with an opportunity to make important systemic alterations to improve the prognosis of a patient with ITP.
authors.affiliation: Department of Oral Diagnosis, School of Dentistry-São Paulo State University (FOUSP), São Paulo, Brazil. martinifopunicamp@yahoo.com
authors.forename: Marcelo Zillo
authors.initials: MZ
authors.lastname: Martini
authors.forename: Jesús Saavedra
authors.initials: JS
authors.lastname: Lopez
authors.forename: José Luiz Pinto Lima
authors.initials: JL
authors.lastname: Gendler
authors.forename: Eduardo Vasques
authors.initials: EV
authors.lastname: da Fonseca
authors.forename: Haroldo Arid
authors.initials: HA
authors.lastname: Soares
authors.forename: Sergio Altini
authors.initials: SA
authors.lastname: Franzi
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008487:Medical History Taking; D006472:Oral Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D010808:Physical Examination; D017713:Platelet Transfusion; D019106:Postoperative Hemorrhage / Q000175:diagnosis*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D014081:Tooth Extraction / Q000009:adverse effects