The case
A 56 year old male reported to the outpatient Department of Oral and
Maxillofacial Surgery, Sharad Pawar Dental College with a complaint of
bleeding from extraction socket of left first mandibular molar. Patient
self-extracted the aforementioned tooth 6 days back. Even after elapsing
of 2 hours after extraction the bleeding ceased to stop. This raised an
alarm in the patients mind. He went to the same Dentist where suturing
of the socket was done, evident by the residual suture tags. Even after
that oozing was present from extraction site. Patient did not pay much
attention to the ooze and continued his daily activities in the
anticipation of stoppage of bleeding over course of time. He gave no
history of any bleeding or clotting disorder, hemophilia, episode of
myocardial infarction or any other systemic condition. He gave history
of chronic alcohol consumption. He presented with no history of long
term medication known to impede blood clot formation or blood thinning
therapy
Intra-oral examination revealed continuous ooze from the socket. Buccal
cortical plate was found to be missing. Clots from around the surgical
site were retrieved. Local hemostatic control measures yielded no
encouraging results. On systemic inspection Petechiae were found on the
chest and back region. At the outset patient was reluctant to get
admitted in anticipation of a minor problem. On persistent persuasion
and counselling he and his relatives agreed upon. Preliminary
hematological investigations were performed .MCV (Mean corpuscular
volume) was found to be 132 FL, MCH (Mean corpuscular hemoglobin) 40Pg,
hematocrit value was found to be 35.1, MCHC (Mean corpuscular hemoglobin
concentration) of 30.1 which suggested of macrocytic anemia. This could
be attributed to his habit of chronic alcoholism .Prothrombin time was
found to be 16 seconds. He was found to be thrombocytopenic having a
platelet count of 20000/mm3.Peripheral smear was suggestive of acute
myeloid leukemia. Bone marrow biopsy was planned to confirm the
diagnosis At this point of time initial focus of treatment was on
controlling acute bleeding. Local hemostatic measure in form of gelatin
sponge packing followed by suturing was instituted. Systemic
administration of Vitamin K yielded no encouraging results. Infusion of
fresh frozen plasma was about to be initiated.
Following this patient went unconscious. He was immediately intubated.
Computed tomography revealed intra-parenchymal bleed in left
fronto-parieto-temporal and gangliocapsular region. Epidural, subdural
and subarachnoid hemorrhage too was observed. (Fig.1) Patient was
immediately shifted to Department of Neurosciences for management. In
the course of treatment he did not improve and eventually succumbed.